Introduction: The COVID - 19 pandemic has interfered with innumerable services in different sectors of the healthcare industry, including the opioid use disorder recovery community. This communitybased empirical study explored the impact of the COVID-19 pandemic and the mutually reinforcing variable of low social capital on the distribution of medication - assisted peer support.

Methods: Six interviews with leaders of a combined medication - assisted and peer support group were conducted to identify the impact of COVID - 19 and low social capital on the substance use disorder recovery community. Specifically, the recovery community is incarcerated individuals receiving buprenorphine treatments and individuals who have been released into the community. Using a comparative analysis of these interview transcriptswe identified key areas for procedural changes to reduce the impact of the COVID - 19 pandemic and low social capital on the delivery of medication - assisted peer support.

Results: Two major themes were elucidated through interviews with six peer support organization executives (PSOE) and recovery peer support specialists (PSS): the effect of the COVID-19 pandemic on the delivery of medication - assisted peer support services and the effect of low social capital factors on the delivery of substance use recovery resources. Secondary to these themes, services have dropped from daily group activities to difficult-to-schedule weekly one-on-ones, and constant barriers in communication with participants secondary to the COVID-19 pandemic.

Discussion: Losing interpersonal relationships of medication - assisted peer support has disproportionately affected those who otherwise have none, resulting in a loss of accountability in recovery efforts. By increasing the duration and frequency of meeting times and hiring additional service leaders to take on these responsibilities, there can be a restoration in the value of the program. Additional studies are needed to further clarify the impact of COVID - 19 on the SUD recovery community, the complications of low social capital on the SUD recovery community, and strategies to help mitigate the impact of COVID - 19 on these issues.

Conclusion: In the opioid recovery community, the distribution and efficacy of medication - assisted peer support programs have been severely reduced by COVID - 19 and social capital related factors - and often a combination of the two. Through this case study, we have identified targeted areas of improvement to optimize medication - assisted peer support and other recovery resources.