Telehealth-Based Delivery of Medication-Assisted Treatment for Opioid Use Disorder: a Critical Review of Recent Developments

Abstract

Purpose of Review Telehealth-delivered medication-assisted treatment for opioid use disorder (tele-MOUD) has received increased attention, with the intersection of the opioid epidemic and COVID-19 pandemic, but research on recent developments is scattered. We critically review recent literature on tele-MOUD and synthesize studies reporting primary data under four themes: clinical effectiveness, non-clinical effectiveness, perceptions, and regulatory considerations. Recent Findings Despite increasing publications, most failed to include long-term comprehensive assessments. Findings indicate favorable outcomes such as improvements in retention and abstinence rates, positive experiences, and improved feasibility with the relaxation of regulatory measures. With increased adoption, clinician and patient perceptions appeared largely positive. Negative findings, albeit minor, were primarily associated with workflow adaptation difficulties and limited access of underserved populations to technology and internet connection. Summary Additional financial, logistical, outreach, and training support for clinicians, patients, and support staff is recommended, in addition to permanent evidence-based regulatory reforms, to scale and optimize tele-MOUD services. Comprehensive recommendations to overcome limitations are expanded therein.

Changes in opioid treatment programs and harm reduction provider services during the COVID-19 pandemic: Findings from 10 states.

“…Changes in service delivery were also echoed by clients of the programs included in this study, particularly the flexibility in take-home MOUD doses and use of telehealth (Saloner et al, 2022), as well as in other studies conducted with people who use drugs during the same time period of the COVID-19 pandemic when this study was conducted (Krawczyk et al, 2021; Mahmoud et al, 2022). Despite this, nearly half the sites in this study reported reduction in funding during this period, while nationally there was an increase in opioid overdose (American Medical Association, 2022; National Center for Health Statistics, 2021).…”

Understanding healthcare engagement for people who inject drugs

“…Additionally, interviews were conducted before the COVID-19 pandemic. Although healthcare systems have changed and new methods of engagement, such as telehealth (Mahmoud et al, 2022), emerged during the pandemic, our participants were able to convey their experiences to obtain an understanding of how this population engages in their healthcare for their complex needs.…”

Virtual Primary Care for People with Opioid Use Disorder: A Scoping Review of Current Strategies, Benefits, and Challenges

“…This shift may have been helpful for individuals with OUD [25, 26], many of whom experience barriers to health care due to intersecting effects of criminalization, discrimination, and social marginalization [13]. Virtual care allows clinicians to deliver essential healthcare services to PWOUD [27, 28], offering improved accessibility [29] and the ability to deliver OAT [30], while reducing barriers related to transportation, mobility limitations, and stigma [31]. However, virtual visits may limit clinicians’ ability to fully assess patients’ physical and emotional wellbeing [27] and may introduce technological barriers for those with limited internet access and low digital literacy [32, 33].…”