We analyzed data from a cohort of individuals with OUD treated at Ophelia, a virtual-first telehealth OUD treatment platform. Individuals in New York and Pennsylvania were recruited directly online (e.g., Facebook and Google ads). Medical visits and clinically indicated urine drug screens, organizational structure, custom EHR, and care coordination services were all built explicitly for remote care without requiring any in-person visits. In-network patients, predominantly Medicaid beneficiaries, used insurance. Patients out of network or uninsured paid $195 monthly to receive unlimited real-time, video-based clinical visits. Eligible patients (i.e., those with OUD not requiring a higher level of care) were prescribed buprenorphine at intake, and seen weekly during the stabilization phase, and then stepped down to monthly visits under a nurse care manager model.

To investigate 180-day treatment retention, a minimum duration of pharmacotherapy for OUD endorsed by the National Quality Forum6, we analyzed a sample of consecutive new intakes from July 1, 2020, to April 15, 2021. Kaplan-Meier survival analyses determined retention, with discontinuation being defined as a 60+ day gap between clinical visits. Consistent with prior studies, care episodes of ≤ 7 days (9% of total episodes) were excluded3 as they often reflected patients ineligible or unwilling to initiate treatment. Geographic heat maps compared distribution of patients to the SAMHSA locator for buprenorphine x-waivered prescribers at the zip code level with eSpatial mapping technology. Patients’ home addresses were categorized under USDA Rural-Urban Commuting Area Codes, RUCA codes, with 1–3 denoting urban and 4–10 denoting rural locations.7 Secondary outcomes measuring adherence included the proportion of days covered (PDC) and medication possession ratio (MPR) of buprenorphine. The Western (WCG) IRB approved a waiver of consent for the study conducted under STROBE guidelines.