Opioid use disorder (OUD) is one of the most serious health challenges facing veterans in the United States. Drug overdose is a leading cause of death among veterans with homeless experience. Yet a striking number of those who need treatment are not receiving it. A cohort study published in JAMA Network Open (May 2026) examined over 10,000 veterans with OUD in federal supportive housing. It found that only 1 in 6 received medications for opioid use disorder (MOUD) within a year of being housed. These are not abstract statistics. They represent real people whose lives remain at risk, not because treatment does not exist, but because access remains deeply unequal.

Understanding who is being left behind matters enormously. It matters for policymakers, for clinicians, and for anyone who cares about the wellbeing of some of the nation’s most vulnerable citizens.

What Are Medications for Opioid Use Disorder?

Medications for opioid use disorder include buprenorphine, methadone, and extended-release naltrexone. Clinicians commonly refer to these as MOUD. They reduce the risk of overdose and opioid-related death, improve treatment retention, and support long-term recovery. Their effectiveness is well established.

Despite this, these treatments remain widely underused. Of the 1,685 veterans (17%) who received MOUD in the study, buprenorphine was most common at 93%. Methadone accounted for 5% and extended-release naltrexone for 3%. The remaining 83% of veterans with opioid use disorder received no medication treatment at all during the follow-up period. That figure alone demands attention.

Who Is Most Likely to Miss Out on Opioid Use Disorder Treatment?

The research identified several groups who face notably lower odds of receiving treatment for opioid use disorder.

Older veterans face some of the steepest barriers. Veterans aged 55 to 64 had roughly half the odds of receiving MOUD compared with those aged 18 to 34 (adjusted odds ratio of 0.52). Similar patterns appear in civilian populations. Clinician hesitancy around prescribing in older adults may play a role. So might concerns about polypharmacy or the tendency to misread signs of OUD as normal ageing.

Race shapes access in significant ways. Non-Hispanic Black veterans were more than twice as unlikely to receive MOUD compared with non-Hispanic White veterans (adjusted odds ratio of 0.47). Veterans from other minoritised racial groups also faced lower odds. Overdose mortality among Black and Asian veterans with OUD has continued to rise in recent years. This makes the disparity in opioid use disorder treatment not just unjust, but urgent.

Co-occurring conditions add further complexity. Veterans with alcohol use disorder, cannabis use disorder, or stimulant use disorder were all less likely to receive MOUD. Managing multiple diagnoses at once can make engagement with any single treatment pathway more difficult.

The Role of Behavioural Health Engagement

Greater engagement with behavioural health services strongly predicts MOUD receipt. Veterans with at least one substance use disorder specialty clinic visit were over six times more likely to receive medications for opioid use disorder. Veterans in the highest mental health service use group were four times more likely to receive treatment than those with minimal engagement.

Behavioural health contacts are not just important for mental health in isolation. They create real opportunities to identify opioid use disorder, make a diagnosis, and connect people to care. More frequent and better-quality contacts could meaningfully improve treatment rates.

Primary care visits told a different story. The study found no significant link between primary care attendance and receiving MOUD. This is notable given national efforts to expand prescribing in primary care settings. Something is not translating from policy into practice, particularly for veterans navigating housing instability at the same time.

Hospitalisation as a Missed Opportunity

Veterans who had at least one hospitalisation in the year following move-in were actually less likely to receive opioid use disorder treatment. That finding goes against what many would expect.

Hospitalisation should offer a clear opportunity to begin MOUD. A person admitted for a medical or substance-related complication is already in the system. Starting medications for opioid use disorder at that point could save lives. Opioid withdrawal during a hospital stay reduces tolerance. Lower tolerance after discharge raises the risk of fatal overdose.

Stigma towards people experiencing homelessness, limited staff training, and weak follow-up pathways after discharge all likely contribute to this missed window.

What Needs to Change

Several practical steps could improve access to opioid use disorder treatment for veterans in supportive housing.

Embedding addiction-trained clinicians within housing and community care teams would bring MOUD to veterans where they live. Expecting a highly vulnerable population to navigate multiple care systems independently is not realistic. Equipping case managers and peer support workers to identify OUD and facilitate referrals is equally important.

Closing racial gaps in access to medications for opioid use disorder requires deliberate effort. Clinicians and case managers need cultural competence training. Outreach programmes should be tailored to veterans from minoritised communities. Equity in MOUD prescribing should become a measurable quality standard, not a vague goal.

For older veterans, clinician education about opioid use disorder in later life is essential. Integrating MOUD into primary and geriatric care settings could reach a group that current specialist pathways are clearly failing.

Hospitals must also act. Teams should initiate medications for opioid use disorder during inpatient stays. They should put a clear plan for continued care in place before discharge. Leaving this to chance costs lives.

Opioid use disorder is treatable. Effective medications exist. The harder work is making sure those medications reach every person who needs them, whatever their age, race, or background.

Source: jamanetwork