Opioid treatment programs faced significant technical and logistical challenges implementing telehealth during the COVID-19 pandemic, but the vast majority report that virtual care ultimately improved treatment access despite the obstacles. That’s the key finding from a new Department of Health and Human Services Office of Inspector General report examining how addiction treatment providers adapted to pandemic conditions.
The report, based on responses from 142 randomly selected OTPs audited by the OIG, reveals both the friction points and surprising benefits of rapid telehealth adoption in a treatment setting that historically relied heavily on in-person visits and observed medication dosing. The findings offer important lessons about what worked, what didn’t, and what support providers need to sustain telehealth gains as pandemic-era flexibilities face uncertain futures.
For an industry segment that serves some of the most vulnerable patients and operates under strict regulatory requirements, the telehealth pivot represented both necessity and experiment. Understanding how OTPs navigated this transition—and what outcomes resulted—provides insights relevant to broader discussions about addiction treatment delivery and telehealth policy.
The Scale of Telehealth Adoption
Of the 142 OTPs surveyed, 128 implemented or expanded telehealth services to continue providing treatment during the coronavirus emergency. This 90% adoption rate demonstrates how urgently programs needed alternative delivery methods when in-person visits became difficult or impossible due to lockdowns, patient fears, and infection control requirements.
The fact that 128 programs either launched telehealth from scratch or significantly expanded limited pre-pandemic virtual services indicates just how transformative COVID-19 was for OTP service delivery. Before the pandemic, federal regulations severely restricted telehealth use in opioid treatment, requiring most patients to visit clinics in person for medication dosing and counseling.
Emergency regulatory waivers issued by the Substance Abuse and Mental Health Services Administration and Drug Enforcement Administration relaxed these restrictions, allowing take-home doses of methadone and buprenorphine for stable patients and permitting counseling and assessments via telehealth. These policy changes created the regulatory space for OTPs to pivot to virtual care models that would have been illegal months earlier.
The high adoption rate also reflects the severity of patient needs. Unlike some medical services that could be deferred during the pandemic, opioid use disorder treatment is urgent and ongoing. Interrupting medication-assisted treatment creates immediate risks of relapse, overdose, and death. OTPs had to find ways to continue serving patients regardless of logistical challenges.
The Reality of Implementation Challenges
While adoption was widespread, implementation was far from smooth. Approximately 70% of the 128 OTPs that implemented or expanded telehealth—87 providers—reported problems related to staff, patients, or both.
The most common challenges detailed in the OIG report included knowledge gaps in learning telehealth software, lack of internet access for patients or clinics, insufficient technology and equipment necessary for virtual service delivery, and inadequate funding to purchase telehealth infrastructure.
These barriers reflect the reality that many OTPs serve low-income patient populations and operate in communities with limited broadband infrastructure. Patients struggling with opioid use disorder often face housing instability, unemployment, and poverty—circumstances that make reliable internet access and personal devices far from guaranteed.
For patients without smartphones or internet-connected computers at home, participating in video telehealth appointments becomes impossible. Some OTPs reported patients relying on public Wi-Fi at libraries or fast-food restaurants—options that became unavailable during lockdowns and that compromise privacy for sensitive behavioral health discussions.
Staff knowledge gaps created different friction. Many OTP clinicians and administrators had limited experience with telehealth technologies before the pandemic. Suddenly needing to master video platforms, troubleshoot technical problems, and adapt clinical workflows to virtual formats while continuing to serve patients created steep learning curves.
Equipment and funding challenges compounded these problems. OTPs needed to purchase computers, webcams, headsets, and software licenses for staff conducting telehealth visits. They needed upgraded internet bandwidth to support multiple simultaneous video sessions. These technology investments required capital that many resource-constrained programs struggled to access, particularly as the pandemic disrupted revenues.
The report doesn’t specify what proportion of OTPs received emergency funding through CARES Act or other COVID-19 relief programs that could be used for telehealth infrastructure. However, the persistence of funding challenges suggests that available support didn’t fully meet needs or that navigating funding applications created additional administrative burdens for already-stressed programs.
Despite Challenges, Positive Outcomes Emerged
The striking finding is that despite these substantial implementation problems, OTPs overwhelmingly reported positive experiences with telehealth and improvements in treatment access. The disconnect between high rates of technical challenges and high rates of satisfaction suggests that overcoming initial hurdles produced meaningful value.
One OTP quoted in the report captured this well: “Our no-show rate is nonexistent because of telehealth. We have bus and transportation issues when weather is bad, but with telehealth it is not an issue. The verbal feedback from patients is 100% satisfaction.”
This comment reveals how telehealth solved persistent access barriers that predated COVID-19. Transportation represents a major obstacle for OTP patients, many of whom lack personal vehicles and depend on public transit or rides from friends and family. Weather, bus schedules, vehicle breakdowns, or simple distance can prevent attendance at in-person appointments.
By eliminating transportation requirements, telehealth removed a friction point that historically caused missed appointments and treatment disruption. The reported elimination of no-shows is striking—zero missed appointments represents a dramatic improvement from typical OTP attendance rates.
Another provider noted that patients became more willing to participate in longer counseling sessions via phone than they would attend in person. An hour-long phone conversation felt more manageable than an hour on-site, possibly because patients could participate from comfortable, familiar environments without travel time or the social anxiety some experience in clinical settings.
This observation suggests telehealth may be particularly suited for certain patient populations or therapeutic modalities. For patients with social anxiety, past trauma, or discomfort in institutional settings, virtual appointments may lower psychological barriers to engagement. The flexibility to participate from home while managing childcare, work schedules, or other responsibilities also supports participation.
The Technology Platforms OTPs Used
Providers reported using diverse platforms to deliver telehealth services, including Google Voice, Zoom, BlueJeans, Doximity, and Doxy.me. This variety reflects both the rapid adoption timeline—programs used whatever tools they could quickly access—and different needs around security, functionality, and cost.
Some platforms like Zoom and BlueJeans are general-purpose video conferencing tools that became ubiquitous during the pandemic. They’re relatively easy to use and widely familiar, but weren’t necessarily designed with healthcare-specific features or HIPAA compliance as primary considerations, though HIPAA-compliant versions exist.
Doximity and Doxy.me represent healthcare-specific telehealth platforms built with clinical workflows and privacy requirements in mind. These tools typically include features like waiting rooms, session documentation, and security architectures designed for protected health information.
Google Voice, a phone service rather than video platform, suggests some OTPs relied heavily on telephone-based telehealth rather than video. For patients without smartphones or reliable internet, phone-based counseling may have been the only accessible option. Phone also works for check-ins, care coordination, and brief counseling that doesn’t necessarily require visual connection.
The report mentions that OTPs “often called patients to check in, in addition to conducting diversion checks via video.” This indicates a hybrid approach where different modalities served different purposes. Regular phone check-ins provided continuous support and monitoring between scheduled appointments. Video sessions allowed visual assessment for diversion checks—verifying patients are taking their medications as prescribed rather than diverting them to others.
The platform diversity also reveals an important reality: there’s no single “right” telehealth solution for OTPs. Different programs serve different patient populations in varying contexts with distinct technological capacities and clinical needs. The flexibility to choose appropriate tools rather than being mandated to use specific platforms likely facilitated higher adoption rates.
Keys to Successful Implementation
Despite widespread challenges, OTPs that successfully implemented telehealth identified three critical success factors: training, flexibility, and more frequent communication.
Training matters because telehealth requires new skills for both clinical staff and patients. Staff need to understand how to use platforms, troubleshoot technical problems, adapt clinical techniques to virtual formats, and maintain therapeutic relationships through screens rather than in-person presence. Patients need guidance on accessing appointments, using video software, and understanding what to expect from virtual visits.
Programs that invested in training—whether through formal sessions, quick reference guides, or peer support—appear to have overcome initial knowledge gaps more successfully than those expecting staff and patients to figure out technology independently.
Flexibility proved essential given the diversity of patient circumstances and capabilities. Programs that offered multiple modalities—video, phone, and modified in-person visits for patients unable to engage virtually—could serve broader populations than those implementing rigid telehealth-only approaches. Flexibility around appointment scheduling, allowing patients to connect from various locations, and adapting clinical protocols to virtual contexts all supported successful implementation.
More frequent communication helped address both technical problems and therapeutic needs. When patients struggled with technology, more frequent outreach helped troubleshoot issues and maintain connection during the learning curve. From a clinical perspective, shifting from weekly in-person visits to more frequent virtual check-ins maintained treatment intensity while using lighter-touch modalities.
The emphasis on communication also reflects the relational nature of addiction treatment. Successful recovery depends heavily on therapeutic relationships and social support. When in-person contact decreased, increased communication frequency through available channels helped maintain these critical connections.
Implications for Post-Pandemic Policy
The OIG report’s findings have significant implications for policy decisions about whether to maintain pandemic-era telehealth flexibilities for OTPs after the public health emergency ends.
The evidence suggests telehealth substantially improved access for many patients by eliminating transportation barriers, increasing appointment availability, and allowing participation from comfortable settings. These access improvements would disappear if regulations revert to pre-pandemic restrictions.
However, the implementation challenges documented in the report indicate that simply maintaining regulatory flexibility isn’t sufficient. OTPs need ongoing support in several areas to sustain and improve telehealth services.
Technology funding remains critical. Programs need resources to purchase and maintain equipment, software licenses, and internet bandwidth adequate for telehealth delivery. Without dedicated funding streams, resource-constrained OTPs may struggle to sustain services they’ve built during emergency periods.
Training and technical assistance will continue being important as platforms evolve, staff turn over, and patient populations change. One-time emergency training isn’t sufficient—ongoing learning opportunities help programs optimize telehealth use and address emerging challenges.
Broadband access for patients represents a structural barrier that OTPs can’t solve independently. Policy interventions to expand internet access in underserved communities would benefit telehealth across healthcare, including addiction treatment. In the absence of universal access, OTPs need flexibility to use phone-based services for patients lacking video capability.
Reimbursement policies must support telehealth financially. If payers don’t cover virtual visits adequately or create administrative burdens that make telehealth impractical, programs won’t sustain services regardless of clinical effectiveness. Payment parity for telehealth relative to in-person visits, combined with streamlined billing processes, would support continued access.
The Equity Dimension
The challenges documented in the OIG report highlight important equity considerations in telehealth expansion. While virtual care improved access for many patients, it created new barriers for those lacking technology access, digital literacy, or private spaces for confidential health conversations.
Patients experiencing homelessness, those with severe poverty, individuals in unstable housing situations, or people in rural areas with limited broadband all face particular challenges accessing telehealth. These populations already experience worse health outcomes and face more barriers to treatment—telehealth shouldn’t widen those disparities.
The solution isn’t abandoning telehealth but ensuring OTPs can offer multiple access pathways. Some patients benefit enormously from virtual care. Others need in-person services or hybrid models. Patient-centered care requires matching modalities to individual circumstances rather than implementing one-size-fits-all approaches.
Programs serving diverse patient populations need resources and flexibility to maintain the range of service delivery options that meet varied needs. This likely means hybrid models where OTPs offer in-person, video, and phone-based services with patients and clinicians collaboratively determining appropriate modalities for different purposes.
What This Means for OTPs Going Forward
For opioid treatment programs navigating uncertain policy terrain as pandemic emergency declarations wind down, several strategic considerations emerge from the OIG findings.
First, documenting telehealth outcomes becomes critical for advocacy. Policymakers deciding whether to make flexibilities permanent need evidence that virtual care works clinically and improves access. OTPs should track metrics like no-show rates, treatment retention, patient satisfaction, and clinical outcomes comparing telehealth to in-person care.
Second, investing in technology infrastructure and staff capability makes sense even without guarantees about future regulations. Telehealth has proven valuable enough that programs should plan to incorporate virtual care into ongoing operations rather than viewing it as temporary pandemic response.
Third, developing hybrid models that offer multiple access pathways positions programs to serve diverse patients effectively while adapting to whatever regulatory framework emerges. Building operational flexibility into service delivery creates resilience.
Fourth, participating in policy advocacy around telehealth regulations and funding helps shape the environment OTPs will operate in. Industry associations, treatment providers, and patient advocates need to communicate clearly about what works, what doesn’t, and what support programs need to sustain access improvements.
The Broader Lesson
The OIG report tells a story familiar across healthcare during COVID-19: rapid adoption of new care delivery methods driven by urgent necessity, significant implementation challenges, and ultimately, meaningful improvements that many want to preserve.
What makes the OTP story particularly notable is the regulatory context. Opioid treatment has historically been one of the most heavily regulated areas of healthcare, with restrictions reflecting both appropriate concerns about diversion and outdated stigma-driven policies. The pandemic forced regulatory relaxation that providers had long advocated for, and the results suggest many restrictions weren’t necessary for safe, effective treatment.
The 70% of programs reporting implementation challenges while simultaneously praising telehealth’s benefits reveals an important truth: worthwhile innovations often face substantial adoption barriers. The presence of challenges doesn’t mean the innovation isn’t valuable—it means the innovation requires support, resources, and persistence to implement successfully.
For healthcare policy more broadly, the OTP telehealth experience offers lessons about regulatory flexibility, the importance of supporting implementation rather than just permitting innovation, and the value of listening to providers and patients about what works in practice rather than what sounds good in theory.
The millions of Americans who need opioid use disorder treatment deserve access to effective care delivered in ways that fit their lives and circumstances. The pandemic demonstrated that telehealth can expand that access significantly, but only if providers receive adequate support and policy maintains appropriate flexibility. The OIG report provides evidence that should inform those policy decisions as the healthcare system determines which pandemic-era changes to preserve.
