Telehealth-Delivered Medication-Assisted Treatment for Opioid Use Disorder: A Systematic Review and Meta-Analysis of Efficacy and Outcomes

Background: The opioid epidemic remains a prominent public health issue across the United States, with growing incidence rates of Opioid Use Disorder (OUD) and overdose fatalities. Medication-Assisted Treatment (MAT), which involves FDA-authorized medications, along with counseling and behavioral therapies, is a high standard for OUD treatment. Stigma, shortage of available providers, and regulatory complications, however, hold back its availability. Telehealth, which enables remote treatment delivery, offers a scalable solution to address these limitations, particularly in underserved rural areas. Objective: This systematic review and meta-analysis analyzed the effectiveness, practice, and patient outcomes of telehealth-delivered MAT for OUD compared with traditional in-person treatment modes. Methods: Following the PRISMA guidance and Cochrane Handbook recommendations, electronic literature searches were conducted in PubMed, Scopus, Web of Science, and Cochrane Library for publications up to April 2024. Qualified studies assessed telehealth-delivered MAT and provided data on patient retention, overdose, or other relevant endpoints. Design-specific risk of bias tools were used for the risk of bias assessment, while a random-effects DerSimonian–Laird model was used to pool the data. Results: Thirty-three studies were included. Telehealth MAT improved patient retention compared with in-person MAT (log OR=0.32, 95% CI: [-1.09, 1.73]), was associated with a moderate reduction in overdose risk (pooled effect size 0.66, 95% CI: [0.19, 1.13]), and showed beneficial effects for co-occurring substance use disorders (log OR=0.28, 95% CI: [0.04, 0.52]) and mental health conditions such as major Depression (log OR=0.44, 95% CI: [0.03, 0.84]) and bipolar disorder (log OR=0.44, 95% CI: [0.05, 0.84]). Conclusion: Telehealth-enabled MAT is more effective for treatment retention, less likely to lead to overdose, and combines mental health care with OUD management. These results justify the perseverance in policy efforts to maintain telehealth prescription flexibility and enhance broadband infrastructure, both of which serve to reduce treatment disparities. Research needs assessments alone are insufficient to evaluate long-term effectiveness, cost-effectiveness, and patient experience.