ORIGINAL RESEARCH

Treatment Outcome Comparison Between Telepsychiatry

and Face-to-face Buprenorphine Medication-assisted
Treatment for Opioid Use Disorder: A 2-Year Retrospective
Data Analysis
Wanhong Zheng, MD, Michael Nickasch, BS, Laura Lander, MSW, Sijin Wen, PhD, Minchan Xiao, PhD,
Patrick Marshalek, MD, Ebony Dix, MD, and Carl Sullivan, MD

Key Words: buprenorphine, medication-assisted treatment, opioid

Objectives: To retrospectively review clinic records to assess the
use disorder, retention, telepsychiatry
difference between face-to-face and telepsychiatry buprenorphine
medication-assisted treatment (MAT) programs for the treatment of (J Addict Med 2017;11: 138–144)
opioid use disorder on 3 outcomes: additional substance use, average
time to achieve 30 and 90 consecutive days of abstinence, and
treatment retention rates at 90 and 365 days. O ver the past decades, opioid use disorder has become an
epidemic health problem both in the United States and
globally. Congruent with the peaking prevalence of this
Methods: Medical records of patients (N ¼ 100) who were partic-
ipating in telepsychiatry and in face-to-face group-based outpatient epidemic, the demand for medication-assisted treatment
buprenorphine MAT programs were reviewed and assessed using (MAT) for opioid use disorder has risen sharply. In a span
descriptive statistical analysis. of 15 years, from 1997 to 2011, opioid-dependent Americans
Results: In comparison with the telepsychiatry MAT group, the face-
seeking MAT had increased by 900% (SAMHSA, 2010,
2013). Despite national data projecting a prevalence of opioid
to-face MAT group showed no significant difference in terms of
use disorder in sums surpassing 5 million in the United States,
additional substance use, time to 30 days (P ¼ 0.09) and 90 days of
only a fraction of this population (22%) had received MAT
abstinence (P ¼ 0.22), or retention rates at 90 and 365 days
from the years 2009 to 2013 (Rinaldo and Rinaldo, 2013;
(P ¼ 0.99).
Alexander et al., 2015). Whereas attributable etiologies behind
Conclusions: We did not find any significant statistical difference poor treatment engagement are multifactorial, the reality of
between telepsychiatry buprenorphine MAT intervention through patient access limitations must be strongly considered, as 96%
videoconference and face-to-face MAT treatment in our Comprehen- of all states in the United States face a despairing gap between
sive Opioid Addiction Treatment model for individuals diagnosed with their opioid-dependent population and their MAT capacity
opioid use disorder in terms of additional substance use, average time (Jones et al., 2015). The current waitlist for MAT at West
to 30 and 90 days of abstinence, and treatment retention rates. Virginia University Chestnut Ridge Center (CRC) is more than
600 patients. Although healthcare, legislative, and collabora-
tive community efforts have produced progress in combating
the opioid epidemic, the current state requires novel solutions to
From the Department of Behavioral Medicine and Psychiatry (WZ, LL, PM,
MN, ED, CS), School of Medicine; Department of Biostatistics (SW, improve access for patients seeking treatment.
MX), School of Public Health, West Virginia University, Morgantown, Opioid use disorder is a complex chronic health con-
WV. dition that often requires long-term structured treatment and
Received for publication August 10, 2016; accepted November 28, 2016. care. The success of treatment often relies on combination of
Funding disclosure: Data analysis was conducted by Dr Sijin Wen whose
work was supported by the National Institute of General Medical Sciences
specific pharmacological and psychosocial interventions that
of the National Institutes of Health under Award Number U54GM104942. aim to reduce both illicit opioid use and its related harms, and
The content is solely the responsibility of the authors and does not to improve quality of life (WHO, 2009). Currently, methadone
necessarily represent the official views of the National Institutes of Health. and buprenorphine are the only 2 opioid agonist medications
This project was funded by West Virginia University Department of approved by the US Food and Drug Administration (FDA) for
Behavioral Medicine and Psychiatry internal research pilot grant.
The authors report no conflicts of interest. MAT of opioid use disorder.
Send correspondence and reprint requests to Wanhong Zheng, MD, 930 Methadone is a full opioid agonist and has been used for
Chestnut Ridge Road, Department of Behavioral Medicine and Psychia- opioid medication maintenance for many years (Dole and
try, School of Medicine, West Virginia University, Morgantown, WV Nyswander, 1965; Mattick et al., 2009). Buprenorphine is a
26505. E-mail: wzheng@hsc.wvu.edu.
Copyright ß 2017 American Society of Addiction Medicine
partial m-opioid agonist that was approved in 2002 by the US
ISSN: 1932-0620/17/1102-0138 FDA as a pharmacotherapy agent for the treatment of opioid
DOI: 10.1097/ADM.0000000000000287 use disorder in the United States (Fiellin et al., 2001; Food and

138 J Addict Med  Volume 11, Number 2, March/April 2017

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J Addict Med  Volume 11, Number 2, March/April 2017 Telepsychiatry vs. Face-to-face Buprenorphine MAT

Drug Administration, 2002). Buprenorphine is considered to substance use disorder-focused group therapy at the same
be safer than methadone and equally effective for mainten- clinic visit. The group therapy content is not standardized;
ance treatment (Pinto et al., 2008; Amass et al., 2012; however, all therapists use a cognitive behavioral therapy-
Salisbury et al., 2012; Hser et al., 2014). Treatment using based therapeutic model incorporating psychoeducation
buprenorphine was reported to have good retention rates, regarding the disease of addiction, relapse prevention, and
treatment adherence, and patient, and also provider satisfac- 12-step facilitation concepts. There were no efforts to ensure
tion (Becker and Fiellin, 2006; Pinto et al., 2008; Strobbe the equivalence of group therapy at the 2 sites. Initially,
et al., 2011). Unlike methadone clinics, which are typically patients attend these treatment services weekly. Once they
housed in stand-alone facilities, buprenorphine treatment have 90 days of abstinence and are actively involved in
programs are office-based. This allows patients to have easier 12-step meetings as evidenced by having a 12-step sponsor,
access to MAT. However, many individuals, especially those they begin to come every other week. After a year of absti-
who live in rural areas, seek this treatment, but have limited to nence from alcohol and any illicit drugs, they may attend
no access to buprenorphine providers. treatment monthly.
Telepsychiatry may present a promising way to deliver Each patient signs an agreement before being enrolled
MAT to this population and expand access to care. Using new in the COAT clinic. A list of medications including selected
audio-video technology to remove the barriers of time and controlled substances is disallowed for the purpose of bupre-
distance for individuals who are most in need of medical and norphine maintenance treatment. All patients are required to
healthcare services is not a new idea, yet it has become attend a minimum of four 12-step meetings a week and submit
increasingly popular in recent years (Wilson and Maeder, to random urine drug screens. All urine drug tests are first
2015). In the realm of psychiatry, diagnoses and treatment done on site using enzyme immunoassay (EIA) screening that
decisions are frequently based on record review, patient allows for rapid results reporting. The provider gets the
interview, and observation, enabling telepsychiatry to quickly screening report immediately during the group time, and
evolve as an alternative to office visits for patients who do not discusses the results with patients. Secondary analysis on
have easy access to mental health services (Deslich et al., the same specimen is performed with gas chromatography/
2013; Ulzen et al., 2013). This could be a particularly mass spectrometry (GC/MS) testing methodology. This serves
attractive option for rural patients for whom face-to-face as confirmatory, and provides identification and quantifi-
treatment access is limited. A recent published review of cation of the specific drugs present. The final results (if
70 studies found a wide consensus of equivalence, and in positive) are used to compare with patients’ self-reports,
some cases, superiority, in terms of diagnosis, clinical out- and discussed in the following week’s medication and therapy
comes, access to care, and patient satisfaction of telepsychia- group session. To ensure treatment adherence, buprenorphine
try medicine when compared with in-person services (Hilty and its metabolite norbuprenorphine must be present in the
et al., 2013). However, data regarding the utility of tele- urine drug screen for a new prescription to be written. If a
psychiatry for MAT for opioid use disorder is very limited. patient has a positive urine drug screen, they may be required
To our knowledge, there have been no studies published to attend more 12-step meetings, to increase individual
regarding outcomes of telepsychiatry using buprenorphine therapy sessions, or to come back for more frequent pill
in MAT. counts or urine drug screens. Sometimes, a patient in a bi-
This article reports data from a 2-year retrospective weekly group may be sent back to the weekly group if
analysis comparing treatment outcomes between telepsychia- frequent relapses occur. Patients can only be moved to a
try and face-to-face MAT for opioid use disorder with bupre- bi-weekly group after attaining 90 consecutive days of absti-
norphine. We introduce our outpatient Comprehensive Opioid nence, completing the required number of 12-step meetings
Addiction Treatment (COAT) model for opioid maintenance and obtaining a 12-step sponsor. Criteria for patient discharge
treatment and assess the difference between telepsychiatry include evidence of dishonesty, diversion, illegal activity on
MAT and face-to-face treatment in this setting. The purpose of the premises, or if a patient requires a higher level of care.
this pilot study is to establish a groundwork of evidence These circumstances are all clearly specified in the COAT
surrounding telepsychiatry and its role as an alternative means treatment agreement signed before patient enrolls in the
of delivering substance use disorder treatment to those program. Patients who discontinue the clinic for any reason
outpatients who live in rural areas with limited access to can re-enroll after 1 month. The telepsychiatry program for
addiction treatment and services. MAT follows the same model, except that the psychiatrist
delivers addiction assessment and care in a group setting
METHODS through videoconferencing to patients who live in 2 rural
southern West Virginia counties located 225 miles from CRC.
Study Setting Those patients receive their group therapy and random urine
This study was conducted at West Virginia University drug screenings through local community mental health
Department of Behavioral Medicine and Psychiatry CRC, one facilities.
of the largest mental health service centers in West Virginia.
The center provides opioid use disorder treatment through Design
both face-to-face and telepsychiatry clinics by using an The study design is a retrospective chart review. Treat-
interdisciplinary team approach named the COAT program. ment information regularly recorded for all COAT patients
It includes group-based medication management followed by includes current and previous buprenorphine formulation and

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Zheng et al. J Addict Med  Volume 11, Number 2, March/April 2017

dosage, abstinence time, random urine drug screen results, Statistical Analysis
peer support group meeting attendance, 12-step sponsorship The primary endpoints are the treatment outcomes
status, and so on. The two telepsychiatry sites in remote measured in 3 parameters: rates of additional substance
counties included in this study keep records of initial psy- use, average time to get to first 30 and 90 consecutive days
chosocial intakes and therapy notes that include substance use of abstinence, and retention rates at 90 and 365 days. For the
and treatment history, psychosocial history, and therapy prog- continuous outcome of time to 90 consecutive days of absti-
ress-related information. We reviewed the notes from January nence with standard deviation of 35 days, our sample size in
1, 2013 to December 31, 2014 and selected COAT clinic this study had 80% power to detect a difference of 20 days
patients who were under the care of the same psychiatrist who between 2 treatment groups using 2-sided 2-sample t test. For
provided medication management through both telepsychia- the binary outcome of retention (yes or no), the same sample
try and face-to-face method during the same study period. size had 80% power to detect a difference of 50% versus 78%
Those who enrolled after October 1, 2014 were excluded retention rates between 2 treatment groups. Descriptive stat-
because they had not been in the treatment program for 90 istics were used to analyze the parameters being investigated,
days by the end of the study window time (December 31, including mean with standard deviation and range for con-
2014) and therefore could not be used for 90 days abstinence tinuous variables such as time in days to 30 and 90 days of
or retention calculation. Patients included in the study abstinence, and proportions or percentage for categorical
received MAT services in weekly and biweekly groups at variables. Wilcoxon rank-sum test was used to assess tele-
CRC or telepsychiatry sites. Group therapy at all locations had psychiatry and face-to-face groups without normal distri-
the same structure and goals. The treatment requirements bution assumption. Chi-square test was applied to assess
including meeting and therapy attendance followed the same the observed difference in additional substance use and
agreement and policy. The group therapists were different for retention rates between the two groups. Generalized estimat-
telepsychiatry and face-to-face treatment. Group therapy was ing equations (GEEs) with a logit link were used to adjust
face-to-face for both treatment groups. As this was a retro- for covariates for determining the association between treat-
spective chart review of existing clinical data, the West ment modality and retention measured as a binary outcome
Virginia University Institutional Review Board approved this (yes/no). A P value <0.05 implies the statistical significance
study and granted a waiver regarding the need to obtain in this study. Statistical calculations were performed using
informed consent and Health Insurance Portability and SAS 9.2 and R software, version R 3.1.3.
Accountability Act authorization.
At the beginning of this study period, the diagnostic and Participants
statistical manual of mental disorders, 4th edition was still in A total of 100 patients were included in this study. Basic
use and some patients in the study were diagnosed with opioid demographic and opioid use characteristics are presented in
dependence. Since that time, the DSM 5 has been approved. Table 1. There were several instances of missing data due to
All patients were assessed to meet criteria for opioid use incomplete records.
disorder and that diagnosis is the one referenced in this paper.
RESULTS
Measures The demographics of 2 study populations are illustrated
Abstinence time was defined as days since last use of in Table 1. No statistical difference was detected between
nonprescribed or illicit opioids or any prohibited drugs or the telepsychiatry and face-to-face groups, exemplified by
alcohol. Drug use was based on both patient self-report and/or P values >0.05 in each demographic metric examined.
random urine drug screen test results. Though not specifically Additional substance use is summarized in Figure 1.
examined, it appears to the clinicians that patients reported The telepsychiatry group percentage of those attaining 90
more relapses than detected by urine drug screen tests. consecutive days of abstinence before December 31, 2014 is
Times to 30 and 90 days abstinence were defined as 49%, and 37% in the face-to-face group; chi-square test
from the time each patient started the treatment program to (P ¼ 0.31) indicated no significant difference between the
the time each patient reached 30 and 90 consecutive days of 2 groups. More than half of each group (51% of the tele-
abstinence time, respectively. psychiatry and 63% of the face-to-face group) was unable to
Treatment retention was calculated at 90 and 365 days attain 90 days of abstinence before December 31, 2014.
after the enrollment. The admission to treatment programs Among those reaching 90 days of abstinence time, 10
was on a rolling basis, which means that patients could be (43%) telepsychiatry patients and 6 (27%) face-to-face
admitted anytime during the year. For this study, we reviewed patients did not use any additional substances while attending
the notes over 2 years. The retention rate was calculated as the the weekly groups. Six (13%) patients from the telepsychiatry
percentage of patients who stayed in treatment over 90 or 365 group and 4 (7%) patients from the face-to-face group
days. With the study period ending on December 31, 2014, we dropped out of the program (mostly had no shows to groups)
excluded patients starting the program after October 1, 2014 at an early treatment phase (some less than 1 week), before a
for 90-day retention calculation and those starting after possible relapse could be recorded. Additionally, comparison
January 1, 2014 for the 365-day retention calculation. Some of the percentage of patients with 0, 1 to 2, or 3 relapses
patients were discharged, but then re-enrolled during the study between the 2 groups failed to show differences that were
period; these were counted as separate cases for this study statistically significant (P ¼ 0.12). There was also no statisti-
purpose. cal difference (P ¼ 0.38) when comparing only those patients

140 ß 2017 American Society of Addiction Medicine

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J Addict Med  Volume 11, Number 2, March/April 2017 Telepsychiatry vs. Face-to-face Buprenorphine MAT

TABLE 1. Participant Characteristics who attained 90 consecutive days of abstinence. In both the
telepsychiatry and face-to-face groups, the most common
Telepsychiatry Face-to-face number of relapses was 1 to 2. Among telepsychiatry patients
(n ¼ 46) (n ¼ 54) P
who eventually attained 90 consecutive days abstinence
Age 37.2  7.6 34.4  9.9 0.11 within the study window, it was almost equally as common
Sex 0.89
Male (%) 22 (47%) 24 (44%)
for patients to relapse 1 to 2 and 3 times. Comparatively,
Female (%) 24 (53%) 30 (56%) overall, there were less face-to-face patients who had 3
Race 0.57 relapses, but had more than 2 times the amount of patients
African-American (%) 1 (2%) 2 (3.7%) relapsing 1 to 2 times in contrast to the telepsychiatry 90-day
Caucasian (%) 45 (98%) 49 (90.7%) abstinence subgroup. Of note, there were several instances of
Other (%) 0 (0%) 1 (1.9%)
Unknown (%) 0 (0%) 2 (3.7%) repeat enrollment. In the telepsychiatry group, 1 patient had 2
Education 0.99 separate enrollments in the weekly group and was counted
Less than high school (%) 15 (33%) 17 (32%) twice (total 47 instead of 46); this patient did not advance past
High school or above (%) 31 (48%) 32 (13%) weekly group in 2 enrollments. In the face-to-face group,
Unknown (%) 0 (0%) 5 (9%)
Employment 0.99
5 patients had 2 separate enrollments in the weekly group,
Not employed 43 (93%) 39 (72%) therefore counted twice (total 59 instead of 54). Among these
Employed 3 (7%) 10 (19%) 5, only 2 advanced to the biweekly group on second attempt.
Unknown (%) 0 (0%) 5 (9%) Table 2 illustrates the comparison of time to reach
Other comorbid 0.9 30 and 90 days of abstinence between the 2 groups. In the
psychiatric diagnosis
No 13 (28%) 17 (31%) telepsychiatry group, it took patients a range of 30 to 70 days
Yes 33 (72%) 37 (69%) to reach 30 consecutive days of abstinence, whereas it took the
Length of opioid use, mo 0.85 patients in the face-to-face group 30 to 112 days. In terms of
>36 43 (94%) 50 (93%) time to reach 90 days of abstinence, telepsychiatry patients
36 2 (4%) 4 (7%)
Unknown (%) 1 (2%) 0 (0%)
required 90 to 194 days, whereas face-to-face patients
required 90 to 236 days. Neither of these differences was
statistically significant, although at the 0.09 P value, the
telepsychiatry group trended towards achieving clean time

Telepsychiatry group

47 paent enrollments
before 10/01/2014

24 (51%) did not reach 23 (49%) aained 90

90 consecuve consecuve
absenence days absenence days
before 12/31/2014 before 12/31/2014

6 had no recorded 10 had no recorded

14 relapsed 1-2 mes 4 relapsed ≥ 3 mes 7 relapsed 1-2 mes 6 relapsed ≥ 3 mes
relapse relapse

Face-to-face group

59 paent enrollments
before 10/01/2014

37 (63%) did not reach 22 (37%) aained 90

90 consecuve consecuve
absenence days absenence days
before 12/31/2014 before 12/31/2014

4 had no recorded 6 had no recorded

21 relapsed 1-2 mes 12 relapsed ≥ 3 mes 11 relapsed 1-2 mes 5 relapsed ≥ 3 mes
relapse relapse

FIGURE 1. Summary of additional substance use.

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Zheng et al. J Addict Med  Volume 11, Number 2, March/April 2017

TABLE 2. Comparison of Time to 30 and 90-Day Abstinence treatment. From our data, it appears that in both groups, once
Between Telepsychiatry Group and Face-to-face Group a patient makes it past the early phase of treatment that they
are much more likely to remain in treatment. Additionally,
Telepsychiatry Face-to-face
a possible trend was observed towards the telepsychiatry
Mean/Median (Range) Mean/Median (Range) P patients having slightly better outcomes in terms of time to
Time to 30 d 35/30 (30, 70) 42/30 (30, 112) 0.09 reach 30 and 90 consecutive days of abstinence. With a larger
Time to 90 d 106/90 (90, 194) 112/94 (90, 236) 0.22 sample size, we would be better able to assess if this translated
into a significant difference.
Addressing the opioid epidemic and optimizing treat-
more quickly. Whereas the face-to-face group had a longer ment for opioid use disorder remains a complex and multi-
average time to 30 and 90 days of abstinence, the P value faceted undertaking of great significance for patients, public
indicated that these differences were statistically insignificant. health policy, and health care as a whole. With its high
Group retention rates are presented in Tables 3 and 4. prevalence, chronic-relapsing nature, and broad implications
Table 3 illustrates the group comparison for 90-day retention. (infectious disease, overdose mortality, and crime rates), a
It includes all patients enrolled before October 1, 2014, as measurable strain is placed on local communities and health-
patients enrolled after this date could not feasibly meet care systems, making opioid use disorder an essential target
statistical inclusion for 90-day treatment retention by the for continued research, and for the development of new and
end of the study window December 31, 2014. For this same modification of existing evidence-based treatments. Conse-
reason, the 365-day retention comparison in Table 4 includes quentially, practitioner adaptation has resulted in substantial
only patients enrolled before January 1, 2014. We also variability between clinical practices of MAT for opioid use
calculated 90-day retention for this subgroup. disorder. This creates a challenge in terms of data congruency
For patients who could have potentially stayed in treat- and outcome measure (such as treatment retention rates and
ment for 90 days, both groups retained close to 50% of efficacy) compatibility across various clinical and research
patients at 90 days. Between patients who started treatment settings. Unfortunately, this study fails to address this challenge
before January 1, 2014, the retention rates at 90 days were and lacks ability to draw inferences regarding efficacy, as a
comparable with the previous groups, 12/24 (50% telepsy- consequence of the nature of our retrospective study design.
chiatry group) and 17/31 (54.9% face-to-face group), both In a recent meta-analysis of retention rates in MAT for
consistently close to 50%. The retention rates at 365 days opioid use disorder consisting of 55 published (RCT and non-
decreased to 10/24 (41.7% telepsychiatry group) and 11/31 RCT) trials from years 2010 to 2015, the authors report a
(35.5% face-to-face group). This difference was not statistically staggering overall variability in retention rates of 19% to 94%
significant between the 2 groups (P ¼ 0.99). In the multivariate at 3 months (Timko et al., 2016). The authors’ extensive
analysis of these retention rates, the fitted GEE logistic model stratification of this study data by research design, treatment
indicates no statistically significant difference between the 2 modality, and therapy modifiers clearly illustrates the broad
groups (P ¼ 0.29 for 90 days and P ¼ 0.55 for 365 days), spectrum of MAT in its current clinical form. Acknowledging
adjusting for all variables from Table 1, except for race, since a lack of study follow-up time for retention studies, the
there is only one African-American in the telepsychiatry group. authors report an aggregate 6-month retention of 55% from
Furthermore, when examining only the patients staying more non-RCT studies with buprenorphine/naloxone MAT with
than 90 days, the proportionate retention rates increased to a psychosocial program and group cognitive behavioral
83.3% (10/12) in the telepsychiatry group and 64.7% (11/17) in therapy. Interestingly, with comparable practices of MAT to
the face-to-face group. Chi-square test (P ¼ 0.49) showed no that of our study population, the retention statistics between
statistical difference. our study and that of the stratified meta-analysis cohort share
close resemblance.
DISCUSSION The primary strength behind our study is that it presents
The results of this study show that there is no significant pilot data on a patient population that has yet to be studied in
difference in terms of 3 different outcomes when comparing terms of interventional delivery and associated outcomes
telepsychiatry and face-to-face modalities in MAT of opioid through telepsychiatry when compared with its standard-of-
use disorder. In particular, retrospective analysis of patients care counterpart. In attempts to control for confounding,
enrolled in our COAT clinic failed to exemplify statistically the study uses a standard delivery of MAT treatment by the
significant differences in terms of demographics, additional same physician using the same MAT COAT model. While
substance usage, time to reach 30 and 90 consecutive days of contributing noteworthy strength and validity to our study, it
abstinence, and patient retention rates at 90 and 365 days of significantly restricts the sample size and statistical power,

TABLE 3. Comparison of 90-day Retention Rates Between Telepsychiatry Group and Face-to-face Group For Patients Enrolled
Before October 1, 2014
Group Stayed Less Than 90 d Stayed More Than 90 d Total P
Telepsychiatry 23 (48.9%) 24 (51.1%) 47 0.99
Face-to-face 30 (50.8%) 29 (49.2%) 59

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J Addict Med  Volume 11, Number 2, March/April 2017 Telepsychiatry vs. Face-to-face Buprenorphine MAT

TABLE 4. Comparison of 90 and 365-Day Retention Rates Between Telepsychiatry Group and Face-to-face Group For Patients
Enrolled Before January 1, 2014
Group Stay Less Than 90 d Stay Between 90 and 364 d Stay More Than 365 d Total P
All patients
Telepsychiatry 12 (50%) 2 (8.3%) 10 (41.7%) 24 0.99
Face-to-face 14 (45.1%) 6 (19.4%) 11 (35.5%) 31
Patients who stayed
in program >90 d
Telepsychiatry 2 (16.7%) 10 (83.3%) 12 0.49
Face-to-face 6 (35.3%) 11 (64.7%) 17

which is its primary weakness. Our power analyses indicate medical practice, policy, and reform. Without question, the
that the sample size in this retrospective study may be too opioid epidemic demands priority and attention in terms of
small to detect small differences between these 2 treatment expanding research, practical solutions, increasing access,
groups, and that a larger prospective study should be used and improving treatment quality. Providing buprenorphine
to confirm the result. We attempted to increase the length of MAT for opioid use disorder patients can be done through
the study period, but were ultimately restricted to 2 years either videoconference or face-to-face groups. Retrospective
due to limitations in medical record access. However, when analysis of our COAT model yielded no statistically signifi-
compared with the majority of published literature on MAT cant differences in outcome measures between intervention
retention, our 2-year analysis period adds to our study’s modalities of telepsychiatry and face-to-face in terms of
strength. Alternatively, multiple time-to-recurrence analysis additional substance use, average time to reach 30 and 90
may be a better choice to study this population if the data had consecutive days of abstinence, and patient retention rates at
been available. Additionally, different therapists delivered 90 and 365 days into treatment.
the group services between study groups, so there was likely
some variation in the delivery of group therapy. Furthermore, ACKNOWLEDGMENTS
we must take into account the unique characteristics of the The authors thank Rhonda Hebb, Takeshi Yamamoto,
population studied. West Virginia faces the highest opioid- and other Southern Highlands CMHC staff, and Elizabeth
related mortality rates nationwide. This population represents Ashley Six-Workman, Tammy Feathers, Jordan Cunningham,
a rural population, which differs from that of the general and Ashman Dodd at the Chestnut Ridge Center for helping
treatment population, with telepsychiatry patients being from with data collection.
even less populated counties. Consequentially, it is important
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