Telehealth boosts retention of people on buprenorphine in addiction treatment

Patients who initiated treatment for opioid use disorder through a telehealth mobile app stayed with treatment at a greater rate over six months than those who started treatment in a physical clinic, a new study led by Oregon Health & Science University has found.

The study, published in the Journal of Substance Use and Addiction Treatment, is among the first to compare patient retention between telehealth and traditional office-based treatment.

The comparison was possible only because a federal exemption during the COVID-19 pandemic enabled clinicians to initiate treatment with buprenorphine through a phone or tablet rather than an in-person visit. The exemption is due to expire at the end of this year, raising the significance of this new finding amid an illicit drug use crisis that continues to kill more than 100,000 Americans annually.

“This finding reinforces the idea that telehealth is effective in starting and continuing treatment for people with opioid use disorders,” said lead author Brian Chan, M.D., M.P.H., associate professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine.

The study was conducted from September 2021 through March of 2023. Buprenorphine is a partial opioid receptor agonist that inhibits opioid withdrawal symptoms. It is one of three Food and Drug Administration-approved medications for the treatment of opioid use disorder.

Researchers studied a group of 159 patients from two groups: one that initiated treatment through a telehealth-only platform and one that initiated treatment in office-based settings, the traditional approach. Both groups experienced relatively low rates of discontinuation. However, the telehealth-only group stuck with treatment at a higher rate over six months. Adjusted over time, the study found that only 3.8% discontinued treatment in the telehealth-only group across six months, compared with 9.7% in the treatment-as-usual group.

“This finding provides additional evidence that an in-person evaluation to receive buprenorphine may not be necessary for some treatment-seeking patients,” the authors write.

The study does come with some important caveats, Chan said.

For one, the majority of both groups of patients—all in Oregon and Washington—stayed in treatment for six months, meaning retention was high no matter which mode of treatment they used. In addition, the overall rates of employment and stable housing among participants in the telehealth-only group were both slightly higher than the treatment-as-usual group.

“There’s still a role for in-person visits for certain types of patients,” Chan said. “At the same time, telehealth reduces the risk of having to disrupt treatment if patients can’t travel to in-person appointments.”

Boulder Care, a Portland-based company that provides telehealth treatment for substance-use disorders, provided telehealth access for participants in the study. In-person treatment was provided through a mix of primary care, addiction clinics and community-based clinical practices.

“We continue to learn that telehealth plays a vital role in high-quality addiction care,” said co-author Stephen Martin, M.D., Boulder Care’s medical director for research, education and quality. “This study contributes to a decisive body of evidence that virtual-only care is impressively effective in helping patients with life-saving treatment and their recovery.

“We hope policymakers quickly ensure it remains a permanent source of care for all Americans.”