Understanding the use of telemedicine across different opioid use disorder treatment models: A scoping review

Abstract

Introduction The COVID-19 pandemic has instigated the development of telemedicine-mediated provision of medications for opioid use disorder such as buprenorphine and methadone, referred to as TMOUD in this study. As services start to return to pre-pandemic norms, there is a debate around the role of TMOUD as addition to or replacement of the conventional cascade of care for people with opioid use disorder (PWOUD). This scoping review is designed to characterize existing TMOUD services and provide insights to enable a more nuanced discussion on the role of telemedicine in the care of PWOUD. Methods The literature search was conducted in OVID Medline, CINAHL, and PsycINFO, from inception up to and including April 2023, using the Joanna Briggs Institute methodology for scoping reviews. The review considered any study design that detailed sufficient descriptive information on a given TMOUD service. A data extraction form was developed to collect and categorize a range of descriptive characteristics of each discrete TMOUD model identified from the obtained articles. Results A total of 45 articles met the inclusion criteria, and from this, 40 discrete TMOUD services were identified. In total, 33 services were US-based, three from Canada, and one each from India, Ireland, the UK, and Norway. Through a detailed analysis of TMOUD service characteristics, four models of care were identified. These were TMOUD to facilitate inclusion health, to facilitate transitions in care, to meet complex healthcare needs, and to maintain opioid use disorder (OUD) service resilience. Conclusions Characterizing TMOUD according to its functional benefits to PWOUD and OUD services will help support evidence-based policy and practice. Additionally, particular attention is given to how digital exclusion of PWOUD can be mitigated against.

Developing a Theoretically Informed Implementation Model for Telemedicine-Delivered Medication for Opioid Use Disorder: Qualitative Study With Key Informants

“…Another example is the inclusion criterion for accepting patients into a TMOUD program. Clinical inclusion criteria may typically incorporate measures of stability such as housing status, criminal activity, polysubstance use, and the existence of concurrent mental health issues [ 57 ]. A TMOUD service that excludes people who are unstably housed or have comorbid health conditions may systematically exclude the most vulnerable among its catchment population [ 57 ].…”

“…Clinical inclusion criteria may typically incorporate measures of stability such as housing status, criminal activity, polysubstance use, and the existence of concurrent mental health issues [ 57 ]. A TMOUD service that excludes people who are unstably housed or have comorbid health conditions may systematically exclude the most vulnerable among its catchment population [ 57 ]. Furthermore, in the United States, people categorized as “unstable” based on these criteria tend to belong to people of color populations, leading to exclusion along racial lines [ 57 ].…”

“…A TMOUD service that excludes people who are unstably housed or have comorbid health conditions may systematically exclude the most vulnerable among its catchment population [ 57 ]. Furthermore, in the United States, people categorized as “unstable” based on these criteria tend to belong to people of color populations, leading to exclusion along racial lines [ 57 ].…”

“…As discussed previously, the evidence base for TMOUD has been rapidly evolving and growing, and implementation- or practice-specific knowledge has been lacking. We addressed this issue by carrying out a series of scoping reviews [ 48 , 57 ] that are flexible, inclusive, and iterative in nature [ 58 ] along with the sourcing of expert case studies through addiction professional networks such as the International Society of Addiction Medicine and the Canadian Society of Addiction Medicine.…”

“…The first iteration of the draft implementation model was based on a review of policy documents [ 4 , 60 , 61 ], information collected from our expert panel, synchronous discussion transcripts from the engagement seminar, and scoping reviews conducted to identify examples of program implementation and models and processes underpinning TMOUD delivery [ 48 , 57 ].…”