JMIR Publications

ABSTRACT

Background:

The use of telemedicine to deliver medications for the treatment of opioid use disorder (TMOUD) has become more prevalent during the COVID-19 pandemic, particularly in North America. This is considered a positive development as TMOUD has the potential to increase access to evidence-based treatment for a population heavily impacted by the opioid crisis and consequent rising mortality and morbidity rates in relation to opioid use disorder. Despite the rise in the use of TMOUD, there is a lack of consensus on best practice regarding the design, delivery, and implementation of TMOUD interventions across different settings.

Objective:

This study was designed to produce consensus and evidence-based guidance for the implementation and delivery of TMOUD.

Methods:

The successful healthcare improvement from translating evidence framework for evidence translation in complex systems was applied. A three-level qualitatively modified Delphi process was implemented to obtain multi-stakeholder engagement and opinions.

Results:

Diverse representations at each of our Delphi rounds included policymakers, civil servants, treatment service directors, psychiatrists, general practitioners, nurses, pharmacists, innovation leads, people with lived experience, affected family members, advocacy groups, and non-governmental organizations. For the TMOUD service pre-design phase, there was consensus on the importance of strategic alignment with digital policies, leadership, regulatory frameworks, clinical risk management, reducing digital inequality, ensuring trustworthy technological systems, data-driven needs assessments and having a quality improvement focus. For the TMOUD service design phase, there was consensus on the importance of defining criteria for the appropriate use and mode of telemedicine in MOUD delivery, on who should provide the service and how the clinic should be managed and coordinated. Finally, we used a clinical risk management approach to reach a consensus on the processes and practice of MOUD which would need to be adapted to telemedicine delivery.

Conclusions:

We produced a detailed consensus and evidence-based guide for designing and implementing a TMOUD service. By including first-hand international experience and evidence-based implementation knowledge into our draft guidance document and diverse expert representation at each Delphi stage, we have produced an authoritative document which can be adapted for use in diverse settings and jurisdictions.