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Introduction: The COVID-19 pandemic incurred numerous impediments on day-to-day emergency medical services including Opioid Substitution Therapy (OST) for People Who Inject Drugs (PWID). To prevent treatment cessation and lost to follow-up, we tried to implement an alternate mitigating intervention like telemedicine.Methodology: This research was conducted on a cohort of OST clients during the COVID-19 pandemic (from 1st April 2020 to 31st March 2021, trial registration number 00928, dated 06.08.2018) in Narayanganj, a port city adjacent to the capital Dhaka and one of the most COVID-affected districts, with a high PWID and HIV burden. The participants were male, female and transgender women who were all ex-PWID and were under OST services. A telehealth intervention model was designed and implemented in the OST clinic at Narayangonj. Quantitative and qualitative data were collected during pre and post-intervention of telehealth services.Results A total of 297 OST clients of Narayangonj were provided with telehealth services from April 2020 to March 2021. The participants were predominantly male (98.7%), 37.7% were between 30–39 years of age. 39.4% of the telephone calls were related to COVID-19-related symptoms followed by 21.7% for opioid withdrawal, 12.5% for COVID-19 & vaccine-related information, 11.3% for chronic diseases like diabetes, hypertension and asthma, 9.3% for SSTI, and 5.8% for methadone-related effects. There was an improvement in treatment retention (29–87%), loss to follow-up (20–8%), and overdose-related death (1.3–0%) from pre to post intervention of telehealth services.Conclusion From our experience, we found that the telehealth intervention is beneficial for the OST clients and thus ensures treatment continuity and retention, both of which serve as crucial success indicators of the OST programme. Using simply the mobile phone, this intervention can reduce structural and logistical needs like clinic spaces and fewer human resources, ensuring cost-effectiveness and value for money.