Approximately 10% of treatment visits among urban adults receiving opioid agonist therapy involve the extra-medical use of medications for opioid use disorder (MOUD), according to cohort data published in Drug and Alcohol Review. Research tracking 641 adults in Baltimore, Maryland, shows that individuals often supplement prescribed methadone or buprenorphine with non-prescribed versions of these same medications, a practice linked to higher rates of substance use and housing instability.
Why are patients using MOUD outside of formal prescriptions?
Extra-medical use of MOUD—defined as taking methadone or buprenorphine in ways not directed by a healthcare provider—often serves as a response to unmet needs within the formal care system. According to the study by Moon et al. (2026), 18% of the 641 participants reported at least one instance of extra-medical use during the study period. For many, this behavior represents a form of self-regulation, particularly when patients face gaps in treatment or withdrawal symptoms.
The data suggests that patients experiencing “withdrawal sickness” were significantly more likely to engage in extra-medical use. This indicates that current dosage or access protocols may not be fully stabilizing all patients. For those on buprenorphine, the study found that higher prescribed doses (16 mg or more) were associated with increased odds of extra-medical use, a finding that contrasts with methadone patients, where longer treatment duration served as a protective factor against such use.
The study, which analyzed 1,325 visits between January 2023 and December 2024, found that the prevalence of extra-medical MOUD use was 17% among methadone patients and 21% among those receiving only buprenorphine.
How do markers of vulnerability influence MOUD use?
Clinical vulnerability is a primary driver of extra-medical medication use. According to the research, individuals who reported injection drug use faced nearly sevenfold higher odds of using MOUD outside of a clinical setting. Similarly, the use of multiple substances was linked to more than sixfold higher odds of extra-medical use.
Other significant indicators of risk include:
- Homelessness and recent incarceration.
- Reported depressive symptoms.
- Frequent use of syringe service programs.
- Carrying naloxone as a harm-reduction measure.
These findings suggest that patients with the most complex social and medical needs are the most likely to seek out extra-medical medications, potentially as a way to “fill the gaps” in their prescribed treatment plans.
What are the future policy implications for MOUD access?
The findings from the ALIVE cohort highlight a need for more flexible treatment models. The authors note that extra-medical use may be a signal of “unmet treatment needs,” including sporadic use during times of care disruption or before formal enrollment. Addressing these patterns will likely require policymakers to re-evaluate how methadone and buprenorphine are dispensed.
While long-term engagement in methadone treatment appears to provide stability, the correlation between high-dose buprenorphine and extra-medical use suggests that clinicians may need to conduct more frequent assessments for patients at these dosage levels. Moving forward, the focus may shift toward identifying the specific motivations behind “supplemental” use to better tailor treatment to the individual’s environment and health status.
Frequently Asked Questions
What is extra-medical MOUD use?
It is the use of buprenorphine or methadone—medications typically prescribed to treat opioid use disorder—in a manner not directed or supervised by a healthcare provider.
Is extra-medical use common among patients in treatment?
According to the study, it was reported at 10% of all treatment visits among the Baltimore-based cohort, with 18% of individual participants reporting such use at least once during the study period.
Why do patients use extra-medical MOUD?
Researchers suggest it may be a reaction to unmet treatment needs, such as managing withdrawal symptoms, compensating for gaps in formal care, or attempting to stabilize symptoms before or during formal treatment.
What is the most significant risk factor identified?
Injection drug use and the use of multiple substances were the strongest predictors, linked to six- to sevenfold higher odds of extra-medical MOUD use.
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