EXTRA-MEDICAL MOUD use was reported at one in 10 treatment visits among urban adults receiving opioid agonist therapy.
Extra-Medical MOUD Use During Treatment
Adults receiving prescribed methadone or buprenorphine may still be using medications for opioid use disorder outside formal treatment settings, according to cohort data from 641 adults in Baltimore, Maryland, who had injected drugs and were engaged in treatment.
The analysis included 1,325 visits between January 2023 and December 2024 from participants in the ALIVE cohort who self-reported prescribed or dispensed buprenorphine or methadone use within the past 6 months. Extra-medical MOUD use, defined as use of buprenorphine or methadone in a way not directed by a healthcare provider, was reported at 129 visits, or 10% of all included visits.
At the person level, 117 of 641 participants reported extra-medical MOUD use at least once during the study period, representing 18% of the cohort. Prevalence was 17% among participants receiving only methadone and 21% among those receiving only buprenorphine.
Treatment Access and Clinical Vulnerability
The study identified a clear pattern: extra-medical MOUD use was most common among participants with markers of elevated drug-related harm. Use of multiple substances was associated with higher odds of extra-medical MOUD use, as were injection drug use, withdrawal sickness, depressive symptoms, homelessness, incarceration, syringe service program utilization, and carrying naloxone.
The strongest associations included injection drug use, which was linked with nearly sevenfold higher odds, and use of multiple substances, which was linked with more than sixfold higher odds. Withdrawal sickness was also strongly associated with extra-medical MOUD use, supporting the possibility that some adults may be attempting to manage symptoms or treatment gaps despite being formally engaged in care.
Methadone and Buprenorphine Patterns Differed
Among participants dispensed methadone, treatment duration appeared important. Those engaged in methadone treatment for at least 6 months had significantly lower odds of extra-medical MOUD use compared with those newly engaged in treatment, even after adjustment for sociodemographic factors, substance use, service utilization, and required opioid treatment program attendance.
By contrast, among participants prescribed buprenorphine, dose rather than treatment duration was associated with extra-medical use. Adults receiving at least 16 mg of sublingual buprenorphine had higher adjusted odds of extra-medical MOUD use than those receiving lower doses.
The authors noted that the findings may reflect unmet treatment needs among adults already receiving medication for opioid use disorder. They emphasized that extra-medical MOUD use may represent concurrent supplementation, use before formal enrollment, replacement during care disruption, or sporadic use across changing treatment circumstances. Further research is needed to clarify motivations and guide policies that shape methadone and buprenorphine access.
Reference
Moon KJ et al. Concurrent Use of Extra-Medical Medication for Opioid Use Disorder Among Adults Prescribed Methadone or Buprenorphine: A Cohort Study of Urban Adults Who Have Injected Drugs. Drug Alcohol Rev. 2026;45(5).
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