There was a positive association observed between MMT discontinuation and recent homelessness in this study. Previous research has demonstrated socioeconomic factors impact adherence to addiction treatment (Haskew, Wolff, Dunn, & Bearn, 2008 ; Roux et al., 2014 ; Shen et al., 2016). For example, Kerr, Marsh, Li, Montaner, and Wood (2005) found that individuals who have access to stable housing remained on MMT for at least one year longer than those without access to housing (Kerr et al., 2005). Unstably-housed individuals with substance use disorder(s) often describe the need to prioritize access to food and shelter over MMT adherence (Paudyal et al., 2017). Furthermore, stable housing may allow individuals to have a more predictable structured time to visit pharmacies for daily witnessed dispensing. “Housing first” initiatives, in which rental apartments are provided to people experiencing homelessness and mental illness have been shown to improve housing stability and may facilitate retention on MMT (Appel, Tsemberis, Joseph, Stefancic, & Lambert-Wacey, 2012). For those who face ongoing barriers to housing, outreach strategies such as intensive case management have also been shown to be an effective retention approach (Coviello, Zanis, Wesnoski, & Alterman, 2006).
