Abstract
Background: Telemedicine (TM) has been promoted as a means to address the global Opioid Use Disorder treatment gap, yet its current uptake, development priorities, and barriers have not been mapped internationally.
Methods: We conducted a cross-sectional, web-based survey (01 July to 30 November 2024) of clinicians and clinical leaders recruited through the International Society of Addiction Medicine Global Expert Network, the World Psychiatric Association, and allied contacts. The questionnaire captured telemedicine and Telemedicine facilitated Medication for Opioid Use Disorder (TMOUD) practice, perceived priorities, and barriers. Responses were summarised overall and stratified by World Bank country-income group and by current TMOUD availability.
Findings: Sixty-eight experts from 37 countries, 32% from low/middle-income countries (LMICs), participated. General TM use rose from 57% before COVID-19 to 94% in 2024. TMOUD was available in 26 jurisdictions (38%), markedly more often in high-income than LMIC settings (58% vs 11%). Where offered, there were barriers to prescribing, and a minority of settings reimbursed video and telephone consultations at parity. Participants judged improving retention in treatment (69%), reducing missed appointments (62%), and expanding medications to underserved (60%) or remote (57%) populations as top priorities, yet fewer than 40% reported that TMOUD was currently used to meet those goals. Key barriers were inadequate policy support (60%), lack of professional guidance (63%), restrictive regulation (48%), poor digital infrastructure (broadband 29%; e-prescribing 56%), and limited clinician training (54%); almost every barrier was more common in LMICs.
Interpretation: TMOUD implementation remains uneven and concentrated in high-income countries. Updated clinical guidance, investment in digital connectivity and interoperable e-health systems, and targeted workforce development, particularly in LMIC, are needed to realise telemedicine’s potential for equitable and effective treatment of opioid use disorder.
Keywords: Opioid-Related Disorders, Telemedicine, Substance Abuse Treatment Centers, Health Services Accessibility, Global Health, Medical Informatics, Health Policy, Developing Countries, Health Disparities, Remote Consultation
Methods: We conducted a cross-sectional, web-based survey (01 July to 30 November 2024) of clinicians and clinical leaders recruited through the International Society of Addiction Medicine Global Expert Network, the World Psychiatric Association, and allied contacts. The questionnaire captured telemedicine and Telemedicine facilitated Medication for Opioid Use Disorder (TMOUD) practice, perceived priorities, and barriers. Responses were summarised overall and stratified by World Bank country-income group and by current TMOUD availability.
Findings: Sixty-eight experts from 37 countries, 32% from low/middle-income countries (LMICs), participated. General TM use rose from 57% before COVID-19 to 94% in 2024. TMOUD was available in 26 jurisdictions (38%), markedly more often in high-income than LMIC settings (58% vs 11%). Where offered, there were barriers to prescribing, and a minority of settings reimbursed video and telephone consultations at parity. Participants judged improving retention in treatment (69%), reducing missed appointments (62%), and expanding medications to underserved (60%) or remote (57%) populations as top priorities, yet fewer than 40% reported that TMOUD was currently used to meet those goals. Key barriers were inadequate policy support (60%), lack of professional guidance (63%), restrictive regulation (48%), poor digital infrastructure (broadband 29%; e-prescribing 56%), and limited clinician training (54%); almost every barrier was more common in LMICs.
Interpretation: TMOUD implementation remains uneven and concentrated in high-income countries. Updated clinical guidance, investment in digital connectivity and interoperable e-health systems, and targeted workforce development, particularly in LMIC, are needed to realise telemedicine’s potential for equitable and effective treatment of opioid use disorder.
Keywords: Opioid-Related Disorders, Telemedicine, Substance Abuse Treatment Centers, Health Services Accessibility, Global Health, Medical Informatics, Health Policy, Developing Countries, Health Disparities, Remote Consultation
| Original language | English |
|---|---|
| Journal | The Lancet Digital Health |
| Publication status | Submitted - 15 May 2025 |
