Overcoming barriers to traditional care delivery and pharmacy challenges: a qualitative study of buprenorphine, telehealth, and a digital therapeutic for opioid use disorder

Background
The opioid epidemic in the U.S. contributes to increased morbidity and mortality from drug overdoses, but barriers to traditional opioid use disorder (OUD) treatment limit access to care. During the COVID-19 pandemic, Public Health Emergency (PHE) provisions relaxed in-person requirements for buprenorphine inductions, expanding telehealth options for OUD treatment. This study explores patients' experiences with a digital therapeutic telehealth program offering buprenorphine for OUD.

Methods
Semi-structured qualitative interviews were conducted with 15 participants from a larger pilot study on feasibility and acceptability. The interviews covered opioid use, treatment history, barriers to previous treatments, medication adherence, counseling experiences, and comparisons between current and past treatments.

Results
Barriers to prior OUD treatments included logistical issues (attendance requirements, transportation, clinic wait times), financial strain, unreliable access to prescribers, and limited detox-only treatments. Participants compared these challenges with their experience in the virtual care setting, noting that telehealth overcame many barriers by eliminating transportation needs, offering flexible scheduling, and allowing home-based buprenorphine maintenance care. The main barrier to virtual care was the challenge of fulfilling buprenorphine prescriptions at local pharmacies.

Conclusion
The digital therapeutic telehealth program effectively addressed most barriers faced in previous OUD treatment episodes, supporting the continued use of telehealth for OUD care beyond the pandemic. The findings highlight the need for policy solutions to address pharmacy limitations that restrict access to buprenorphine for telehealth patients.