Engagement and Retention in OUD Treatment: Why the Real Work Happens Between Appointments
- jameliahand
- 3 days ago
- 3 min read
By Jamelia Hand MHS CADC CODP I
Marcus walked into treatment determined to get his life back. After an overdose and a terrifying wake-up call, he started buprenorphine and felt stable for the first time in years. His first few months were strong. But then the real world showed up: unpredictable work hours, childcare challenges, missed rides, and eventually a missed appointment that snowballed into two. No one followed up. No one closed the loop. Marcus drifted out of care quietly. Six months later, he didn’t survive his next overdose.
Clinics see versions of Marcus every day. And this is exactly why engagement and retention matter far more than any short-term outcome we like to celebrate.
MOUD Saves Lives, But Our Retention Strategies Aren’t Built for Real Life
I believe the science is solid on the lifesaving value of MOUD. Buprenorphine and Methadone reduce mortality, improve stability, and give people a fighting chance in one of the most dangerous drug landscapes we’ve ever seen.
But our field is still playing catch-up on understanding what actually sustains long-term engagement. We keep treating retention like an individual failing instead of a system design issue, and that mindset is costing lives.
We also can’t ignore that many of the “success stories” shaping public conversations come from short-term data. A few early months of stability get celebrated as a win — while real-world retention drops fast. Anyone running a clinic sees it. And the why is rarely simple.
Relapse
Stigma
Transportation barriers
Fractured care coordination
Inconsistent follow-up
Prior authorization battles
Life disruption
These are not “patient problems.” These are system design problems.
Where Retention Actually Breaks Down
What we don’t talk about enough is that we often treat MOUD as a prescription issue when the real risk lives in the moments between appointments.
Retention is won (or lost) in the gaps.
It’s won when a clinic calls someone after a missed appointment instead of waiting for them to reschedule.
It’s won when transportation is addressed proactively instead of reactively.
It’s won when care coordination is visible, not invisible.
It’s won when patients feel connected to a team, not processed through a calendar.
When those gaps go unmanaged, the system loses people who otherwise could have stayed engaged.
A System Problem Requires a System Solution
If we want to keep people in care, we need to redesign care around the realities of their lives.
What actually supports retention:
Integrated behavioral health and medical care
Clear follow-up pathways
Predictable communication
Transportation and scheduling supports
Reduced administrative friction
Wrap-around services
Fast, warm handoffs
Active outreach, not passive reminders
Retention is not a matter of willpower. It is a matter of design.
And if MOUD truly saves lives, then engagement is the metric that matters most.
How Vantage Helps
At Vantage, we work with clinics, health systems, and community programs to close the retention gaps. We strengthen follow-up systems, simplify care coordination, and build engagement-centered workflows that match the needs of real people living real lives.
If you’re ready to elevate your retention outcomes, improve patient stability, and redesign your MOUD model for longevity, we can help your organization get there.
For a full picture of the MOUD journey, you can also read:
“Navigating the Chain of Care: Starting Buprenorphine Treatment for Opioid Use Disorder”
Together, these two articles outline what it truly takes to support someone from the moment they start treatment to the sustained engagement that ultimately saves lives.
#MOUD #OUDTreatment #OBOT #EngagementAndRetention #HarmReduction #HealthcareConsulting #VantageClinicalConsulting
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