(39) High Retention Over 24 Months in Telehealth-Only Buprenorphine Program

Background & Introduction: Buprenorphine effectively treats opioid use disorder and reduces mortality by more than 50% when retention is sustained. However, national studies show persistently low retention of just 22-30% at 180 days. These low rates limit treatment benefit, especially in the era of illicitly manufactured fentanyl which continues to drive rising overdose deaths and disparities. Although telehealth expansions during the COVID-19 pandemic have improved treatment access, evidence from outpatient settings is limited. This study contributes the most comprehensive outpatient telehealth data on buprenorphine retention to date, describing 24-month retention in a telehealth-only buprenorphine program, both overall and by buprenorphine transition pathway.

Methods: We conducted a retrospective cohort study of 22,066 adults initiating opioid use disorder care in a multistate, telehealth-only treatment program from May 2019 to April 2025. Eligible participants completed an intake appointment and initiated buprenorphine through one of six transition pathways (High-Dose, Standard-Low-Dose, Standard, Quick Start, Low-Dose, or Other). The primary outcome was retention, defined monthly as attendance at a medical appointment or patient-initiated secure messaging. Retention was described overall and by pathway. Chi-square tests and absolute risk differences compared retention across patient characteristics and pathways.

Results: Of 22,066 patients enrolled, 13,885 (62.9%) were already taking buprenorphine and continued. The remaining 8,181 (37.1%) transitioned to buprenorphine at intake. Overall retention moved from 86.8% at month 1 to 71.0% at month 6, followed by a more gradual decline through 24 months. At month 6, retention was higher among patients with any prior buprenorphine exposure, including at intake, compared to those without (70.4% vs 52.0%; RD, –18.5 [95% CI, –21.5 to –15.5]). Retention also varied by transition pathway, with High-Dose showing the highest retention at month 1 (81.2%), and differences across pathways persisting over time.

Conclusion & Discussion: In this large, outpatient, multi-state study of telehealth-only buprenorphine treatment, retention was comparable to or markedly higher than historical benchmarks. These findings underscore the potential of patient-centered, trauma-informed telehealth models to support long-term engagement in opioid use disorder care, while highlighting the need for continued research on outcomes associated with sustained retention in virtual settings.

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