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Drug Alcohol Depend. 2017 Jul 1;176:133-138. doi: 10.1016/j.drugalcdep.2017.01.048. Epub 2017 May 17.

The effectiveness of telemedicine-delivered opioid agonist therapy in a supervised clinical setting.

Author information

1
Northern Ontario School of Medicine, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada.
2
Canadian Addiction Treatment Centers, 13291 Yonge St., Ste. 403, Richmond Hill, ON L4E 4L6, Canada.
3
Center for Rural and Northern Health Research, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada.
4
Northern Ontario School of Medicine, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada; Canadian Addiction Treatment Centers, 13291 Yonge St., Ste. 403, Richmond Hill, ON L4E 4L6, Canada. Electronic address: dmarsh@nosm.ca.

Abstract

OBJECTIVE:

Opioid use disorder has been declared a public health crisis across North America and opioid agonist therapy (OAT) is the standard of care for these patients. Despite the increasing adoption of telemedicine as a delivery method for OAT, its effectiveness has not yet been evaluated against traditional in-person treatment. This study compared treatment outcomes for in-person versus telemedicine-delivered OAT.

METHODS:

We conducted a non-randomized cohort comparison study using an administrative database for patients who commenced OAT between 2011 and 2012 across 58 clinic sites in the province of Ontario, Canada. Patients were stratified by primary treatment modality as being: in-person (<25% appointments by telemedicine), mixed (25-75% by telemedicine), or via telemedicine (>75% appointments by telemedicine). The primary outcome was continuous retention in treatment as defined by one year of uninterrupted therapy, based on pharmacy dosing records.

RESULTS:

A total of 3733 OAT initiating patients were identified. Patients treated via telemedicine were more likely to be retained in therapy than patients treated in-person (n=1590; aOR=1.27; 95% CI 1.14-1.41; p<0.001). Telemedicine patients demonstrated a retention rate of 50% at one year whereas in-person patients were retained at a rate of 39%. The mixed group also had higher likelihood of retention than the in-person group (n=418; aOR=1.26; 95% CI 1.08-1.47; p=0.001) and had a retention rate of 47% at one year.

CONCLUSION:

Telemedicine may be an effective alternative to delivering in person OAT, and it has the potential to expand access to care in rural, remote, and urban regions.

KEYWORDS:

Harm reduction; Medication assisted treatment; Methadone maintenance treatment; Telehealth

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