Syringe Service Program-Based Telemedicine Linkage to Opioid Use Disorder Treatment: Results From a Pragmatic Randomized Trial of the STAMINA Intervention.

Background: Although medication for opioid use disorder (MOUD) is the most effective form of treatment for reducing opioid misuse and related fatalities, programs continue to struggle to reach and engage those with relatively severe disorders and most in need of treatment. Objectives: This study assessed whether providing a rapid medical appointment conducted via telehealth could improve MOUD linkage versus the standard model of an in-person referral. Methods and Design: We recruited participants from a syringe service prevention program (SSP) and the surrounding communities, randomly assigning them to have an initial medical examination via telemedicine (n = 136) or an in-person (n = 135) referral. We administered structured interviews and collected urine samples for drug testing at baseline and 90 days. The primary outcome was treatment linkage within 14 days of study enrollment, measured by attendance at their first in-person appointment. Secondary outcomes included MOUD engagement (34 days), 3-month retention, and self-reported and urine-detected non-MOUD opioid use at 3-month follow-up. Findings: Contrary to expectations, telemedicine participants had lower odds of a successful linkage (aOR=0.42, CI=0.36, 0.49) than control condition participants. A significant interaction between the treatment condition and the timing of the initial treatment appointment indicated that having a treatment appointment scheduled within 48 hours of the medical evaluation had a more pronounced and positive impact than having a telehealth evaluation (aOR=2.9, CI=2.04, 4.12). There were no other significant differences for any secondary outcomes. Conclusions: Telemedicine participants were less successfully linked to MOUD than standard referrals, likely owing to experiencing longer delays between their medical evaluation and first in-person treatment appointment compared with those having an in-person medical evaluation. More effective alternatives for coordinating MOUD and SSP services include co-locating MOUD within an SSP or full delivery of MOUD via telemedicine at an SSP, both of which would further obviate delays in treatment initiation. Trial Registration: ClinicalTrials.gov (NCT04575324).