Opioid Treatment Programs Struggle with Low Retention Rates

New study finds median 30-day retention rate of just 61% for US opioid treatment programs

Published on Feb. 11, 2026

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A new cohort study of over 261,000 Medicaid beneficiaries with opioid use disorder found that US opioid treatment programs had low retention rates, with a median 30-day retention rate of just 61% in 2023, dropping to 27.5% at 180 days. Even at the programs' peak performance in 2021, the 30-day retention rate was only 65%, highlighting significant challenges in patient engagement.

Why it matters

Improving retention rates at opioid treatment programs is critical for ensuring patients receive the full continuum of care needed to effectively manage opioid use disorder and reduce the risk of relapse and overdose. The low retention rates identified in this study point to systemic issues that need to be addressed by program operators, payers, and public health leaders.

The details

The study, led by researchers at RTI International, evaluated opioid treatment program retention rates at 30, 90, and 180 days across 5 measurement years from 2019 to 2023. In 2023, over 1,100 opioid treatment programs and nearly 433,000 total episodes of treatment were identified. Factors positively associated with 30-day retention included older age and recent hospitalization, while receipt of medications like buprenorphine and a mental health diagnosis were negatively associated.

  • The study period covered June 2018 to December 2023.
  • In measurement year 2023, the median 30-day retention rate was 61%, dropping to 41.5% at 90 days and 27.5% at 180 days.
  • The highest retention rate across all measures was observed in 2021, with a 30-day rate of 65%.

The players

Dylan E. DeLisle

MPH, research public health analyst at RTI International in Durham, North Carolina, and lead author of the study.

Ka Ming Gordon Ngai

MD, from Wayne State University in Detroit, and author of the accompanying editorial.

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What they’re saying

“The findings provide a timely and important call to action for OTP [opioid treatment program] operators, payers, and public health leaders. Implementing and measuring retention must become a core strategy in improving opioid use disorder treatment outcomes.”

— Ka Ming Gordon Ngai, MD (JAMA Network Open)

The takeaway

This study highlights the critical need for opioid treatment programs to focus on improving patient retention and engagement in order to deliver the full continuum of care required to effectively manage opioid use disorder and reduce the risk of relapse and overdose. Addressing the systemic issues driving low retention rates will require coordinated efforts from program operators, payers, and public health leaders.