Delivering telemedicine to vulnerable people with opioid use disorder: Outcomes of a program co-constructed and implemented with a community-based harm reduction service in Montreal, Canada

Background: COVID-19 triggered unprecedented expansion of telemedicine, including for delivery of opioid agonist treatment (OAT). However, people with opioid disorder (PWOUD) often lack technologies necessary for remote care, have complex needs, and/or are disengaged from mainstream services. To address the needs of these individuals, a unique program delivering telemedicine with the support of community outreach workers was co-constructed by the Centre hospitalier de l’Université de Montréal Addiction medicine service (CHUM-A) and CACTUS Montreal, a community-based harm reduction organisation known and trusted by its clientele.

Methods: Procedures were developed jointly to enable flexible and rapid appointment scheduling. CACTUS Montreal workers informed clients of the program, facilitated private on-site telemedicine connections and warm handoffs to the CHUM-A team, accompanied patients during appointments (if requested), and provided continuing follow-up and support using a holistic approach. CHUM-A offered individualized treatment with long-acting opioids, often combined with a short-acting opioid to increase comfort and reduce risks related to illicit use, and other health services as needed. Mixed-method evaluation combined longitudinal chart reviews and qualitative interviews (n=20) to assess program outcomes and patient experiences.

Results: Between April 2020 and October 2021, 66 people initiated OAT through the program. In January 2022, 83% remained engaged in care, exceeding reported 1-year OAT retention rates of 30-70%. Five participants commenced HIV treatment and 16 were treated for hepatitis C. Interviews suggest an enthusiastic response; the initiative was perceived to be convenient and protective in the pandemic context, and the implication of CACTUS Montreal was highly valued. Several participants reported reduced drug consumption and greater stability in their lives.

Conclusion: Our telemedicine program provides a flexible approach with alternative treatment options for PWOUD disengaged from traditional care, integrated within a local community-based harm reduction organisation. It represents an affordable solution to bridge patient-provider gaps and a promising means to improve access in rural/remote settings.