Medication for Opioid Use Disorder in recovery housing: A statewide secret shopper audit of Florida Certified Recovery Residences.

BACKGROUND: Florida is facing a public health crisis involving opioid use disorder (OUD). One critical recovery support service is recovery housing, which has historically demonstrated inconsistent acceptance of patients taking Medication for Opioid Use Disorder (MOUD). Effective January 1, 2025, Florida Statute §397.487(13) restricts Certified Recovery Residences (CRRs) from denying housing to individuals solely based on receiving MOUD. This secret shopper audit evaluated CRR compliance with the new statute. METHODS: Simulated patient callers presented as individuals who had been prescribed methadone or buprenorphine and called 257 CRRs in Florida between May and July 2025. The responses were categorized into nominal categories (0= non-acceptance, 1 = acceptance, 2 = conditional acceptance, 3 = refusal to answer, and 4 = no response). Descriptive statistics summarized compliance rates, and multinomial logistic regression identified differences in compliance by medication type and level of support. Level I-III reflects a less intensive peer-run, monitored, or supervised recovery housing model, whereas Level IV/Multi-Tiered Level IV providers are credentialed to offer up to the highest level of supervision for a CRR. RESULTS: Only 30.7% (n = 79) of CRRs reported unconditional acceptance of individuals prescribed MOUD, while 16.7% (n = 43) reported conditional acceptance. A total of 23.7% denied admission, 7.0% refused to answer questions related to MOUD, and 21.4% did not answer after three contact attempts. Callers who reported being on buprenorphine had a higher proportion of unconditional acceptance rate (38.8%) compared to those on methadone (22.7%). Multinomial logistic regression indicated that buprenorphine was associated with lower odds of refusal relative to unconditional acceptance compared with methadone users (OR = 0.21; 95% CI [0.10-0.43], p < .001). Acceptance patterns also differed by level of support: 38.8% of Level I-III providers reported unconditional acceptance, compared with 17.5% of Level IV/Multi-Tiered Level IV providers. CONCLUSION: This secret shopper audit found that less than one-third of Florida's CRRs reported unconditional acceptance of individuals prescribed MOUD, despite legislative protections. Methadone-related stigma, structural barriers, and inconsistent implementation practices appear to persist. The findings offer evidence of compliance gaps following the enactment of Florida Statute §397.487(13), highlighting the need for improved provider education, clear implementation guidance, and focused oversight to support access to recovery housing for individuals prescribed MOUD in Florida.