“The alternative is they’re not getting care at all”: a qualitative interview study of opioid use disorder treatment providers’ perspectives on quality and appropriateness of telehealth for buprenorphine access

BACKGROUND: Opioid use disorder (OUD) is a major source of morbidity and mortality in the United States. While substantial evidence supports the effectiveness of medications for opioid disorder (MOUD), 80% of people with OUD receive no treatment, and of those who do, less than half receive MOUD. Since the Covid-19 pandemic, there has been a substantial increase in the use of telehealth to deliver MOUD care. While telehealth has shown promise for increasing access and improving retention in treatment, its ongoing uptake and provision will depend on its acceptance and implementation by providers. This qualitative, interview-based study aims to explore how providers understand, experience, and assess telehealth for MOUD in the wake of its rapid expansion. METHODS: We conducted 25 in-depth, semi-structured interviews with MOUD providers in Southeastern Pennsylvania, including prescribing clinicians, clinic staff, mental health counselors, program administrators/leadership and pharmacists. We recruited from diverse substance use disorder treatment settings, using purposive and snowball sampling. Interviews were conducted over Zoom, transcribed, and coded and analyzed using iterative thematic coding. RESULTS: While most providers hold largely positive views of telehealth for MOUD due to its ability to improve access, they differed in their assessments of how such care compares to in-person MOUD treatment and for whom it is most appropriate and effective. Our findings show that debates over telehealth center on perceived quality of care and the "stability" of patients. Despite these disagreements, providers largely agree that telehealth is "better than nothing." CONCLUSIONS: While most providers hold largely positive views of telehealth for MOUD, hesitation towards telehealth is linked to assumptions about the broader empirical state of in-person MOUD treatment and about patient needs, preferences, and capacities to engage in care. Understanding when and why providers may oppose the use of telehealth for MOUD is critical to improving care for patients and reducing barriers to a form of treatment that can increase access to much-needed care for the most vulnerable patients.