Syringe service program-based telemedicine linkage to opioid use disorder treatment: the randomized mixed method STAMINA trial

Background The opioid overdose crisis necessitates expanded access to medications for opioid use disorder (MOUD). Treatment programs often struggle to engage individuals at the highest overdose risk. This study, STAMINA, aimed to engage participants at a syringe service program (SSP) and connect them to treatment through a telemedicine platform. Methods In a pragmatic mixed methods trial, participants were randomized to either telemedicine (n = 138) or standard referral (n = 136). Baseline and 90-day structured interviews, urine testing, and administrative data from MOUD providers were collected. Additionally, a subset of participants (n = 36) completed semi-structured qualitative interviews. The study took place at two SSP sites in Chicago, IL, involving 274 individuals (78% male, 61% African American, 78% non-Latino, mean age = 48) interested in starting MOUD treatment. Interventions included an immediate telemedicine appointment with transportation to the first in-person MOUD appointment versus standard referral. Participants could choose from methadone, buprenorphine, or extended-release naltrexone. Results The primary outcome was measured by attendance at the first in-person appointment, indicating successful treatment linkage. Secondary outcomes included MOUD engagement, retention, and non-MOUD opioid use, assessed through self-report and urinalysis. The key determinant of linkage success was scheduling an in-person appointment within 48 hours of study enrollment (aOR = 3.20, p < .01). Methadone treatment posed significant requirements but showed greater success compared to buprenorphine. Participants reported various reasons for continued illicit opioid use. Conclusions Telemedicine alone is insufficient to overcome MOUD access barriers. Differences in MOUD requirements should inform the design of linkage interventions. Additional supports may be necessary to enhance the success of flexible treatments like buprenorphine. Trial registration ClinicalTrials.gov (NCT04575324).