Global perspectives on telemedicine-enabled medications for opioid use disorder: Practices, priorities, and barriers
Year: 2026
Type: article
Study design: Observational Study
Abstract: IntroductionTelemedicine (TM) has potential to address the global opioid use disorder treatment gap, yet its uptake, priorities, and barriers have not been mapped internationally.MethodsWe conducted a cross-sectional, web-based survey (July to November 2024) of clinicians and clinical leaders via the International Society of Addiction Medicine, World Psychiatric Association, and allied contacts. The questionnaire captured telemedicine facilitated medication for opioid use disorder (TMOUD) practices, priorities, and barriers. Responses were summarised overall and stratified by World Bank country-income group and by current TMOUD availability.ResultsSixty-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%), more often in high-income than LMIC settings (58% vs 11%). Barriers to prescribing were identified, and few settings reimbursed video and telephone consultations equally. Improving treatment retention (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.DiscussionTMOUD remains uneven and concentrated in high-income countries. Updated clinical guidance, digital connectivity investment and interoperable e-health systems, and targeted workforce development, particularly in LMICs, are needed to realise TM's potential for equitable and effective treatment of opioid use disorder. This global survey fills a critical knowledge gap by documenting expert perspectives across income settings, offering cross-national evidence to inform equitable expansion of TMOUD worldwide.
Authors: Joe Schofield, Alexander Mario Baldacchino, Atul Ambekar, Honest Anaba, Jenna L Butner, Nathaniel Day, Hamed Ekhtiari, Fatima Elomari, Marica Ferri, Konstantinos Kokkolis, Christos Kouimtsidis, Jonna Levola, Jiang Long, David Martell, Dario Gigena Parker, Afarin Rahimi-Movaghar, Kristiana Siste, Scott Steiger, Arash Khojasteh Zonoozi, Joseph Tay Wee Teck
Institutions: University of St Andrews, All India Institute of Medical Sciences, Johns Hopkins University, Yale University, University of Alberta, University of Minnesota, Mohammed V University, Surrey and Borders Partnership NHS Foundation Trust, University of Helsinki, Helsinki University Hospital, Shanghai Jiao Tong University, Shanghai Mental Health Center, Dalhousie University, Universidad Nacional de Córdoba, Tehran University of Medical Sciences, University of Indonesia, Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, University of California System
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,400
OpenAlex ID: W7125416159