People in rural communities face multiple barriers to accessing medications for opioid use disorder. Telehealth services may address some of these barriers and improve treatment access and utilization. This study examined how telehealth implementation impacted access to, and utilization of, medications for opioid use disorder in rural counties.
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Rural communities have been especially hard hit by the opioid overdose epidemic – research suggests that the rural communities have had higher increases in overdose death rates. Medications for opioid use disorders are first-line treatments for opioid addiction, which work by mitigating withdrawal symptoms, reducing drug cravings, and for agonists like buprenorphine, maintaining opioid tolerance to reduce overdose risk. For rural communities, however, the availability of medications for opioid use disorder can be limited due to a lack of local clinicians and transportation challenges. One proposed solution to address such opioid care disparities is through the usage of telehealth technologies.
Telehealth services are any of a suite of communication options whereby patients can consult with a healthcare provider remotely (for example, via video conferencing software). Telehealth has become increasingly common since the COVID-19 pandemic – telehealth visits for a wide range of health issues increased by 75% from 2020 to 2021. This increase in telehealth usage included telehealth services for opioid use disorder treatment among those living in rural areas. However, it is unclear how telehealth services have impacted access and usage of medications for opioid use disorder in these rural areas and what barriers may be impacting telehealth utilization.
To this end, the current study sought to determine how telehealth services have been utilized (especially for medication for opioid use disorder) among rural US communities. Specifically, this work examined rates of telehealth use within rural communities, how telehealth changed access to opioid use disorder treatment, and explored challenges rural communities faced in using telehealth.
This study was a mixed methods secondary analysis of data submitted to the Rural Communities Opioid Response Program by representatives of funded consortia (i.e., a collection of funded agencies working together) from September 2019 to September 2022. This initiative was created by the Health Resources and Services Administration to fund organizations providing substance use treatment programs in rural communities. The goal of this work was to create a wide network of programs to provide prevention, treatment, and recovery services to rural communities, with an emphasis on increasing access to medications for opioid use disorder. For the current analysis, data were derived from several sources including Performance Improvement and Measurement System data and progress reports. These data were submitted regularly by program directors of each consortium to the Rural Communities Opioid Response Program.
The outcomes of this work included access to opioid use disorder treatment, the degree to which telehealth services were used, and barriers to utilizing telehealth services in rural areas. These outcomes were measured in several ways. First, individual performance data, including the number of individuals who received medications for opioid use disorders were derived from Performance Improvement and Measurement System reports. Quantitative and qualitative data were also derived from quarterly/biannual progress reports. Such reports contained data on the availability of in-person/telehealth-delivered opioid use disorder treatment services across service areas (at both the county- and consortium-level) and barriers specific to using telehealth for opioid use disorder treatment. The authors also estimated the minimum number of individuals in a service area who should have received medications for opioid use disorder (based on national treatment rates) and then compared this benchmark with the number of individuals in every consortium who received said treatment to determine whether each met or exceeded the national rate.
Data for the present study was derived from consortia project directors (N=92) distributed across 37 states in the continental US. Most agencies serviced multiple counties in the same state (64%). Nearly a third (31%) worked within service areas with low population density (e.g., 50,000–99,999 people). Most (62%) were led by a medical provider (e.g., a Critical Access Hospital), with 15% being led by a social service provider (e.g., a community-based organization or tribal organization), 12% were led by a university/research affiliated organization, 9% were led by behavioral health provider, and 2% were led by a government entity (e.g., state or local health department). Consortia included 1,120 member agencies, with an average of 12 member agencies per consortium.
Access to opioid use disorder treatment increased across counties
From March 2020 to March 2021 (the first year of the COVID-19 pandemic), the number of consortia providing telehealth for any opioid use disorder service (counseling, medications, etc.) increased from 47 out of 92 (51%) to 81 out of 92 (88%). However, there was a decline to 70 out of 90 (2 did not report; 78%) in September 2022.
Telehealth services expansion increased opioid disorder treatment access and usage
Programs that implemented telehealth practices reported more individuals receiving medications for opioid use disorder and retained more individuals in treatment (≥3 months) compared to programs that did not use telehealth. These effects were small to medium in magnitude. In addition, 11.5% is the overall rate at which individuals with opioid use disorder receive medications, nationally – communities near programs that provided telehealth were 5 times more likely to beat that national average.
Technological, financial, and comfort challenges impeded implementing telehealth services
A lack of internet connectivity was cited by most consortia (86%) as a challenge to implementing telehealth services. Additionally, telehealth-related costs were also cited as a barrier to effective use (e.g., expenses related to home equipment for staff [28%] and patients reporting high internet and cell phone minute costs [70%]). Finally, general discomfort using telehealth services (both from staff [47%] and patients [75%]) was cited as a barrier to telehealth implementation.
Results of the present study suggest that for those living in the rural US, telehealth can help increase opioid use disorder treatment access and utilization. However, several challenges need to be overcome to facilitate widespread telehealth implementation.
Across consortia, reports indicated that lack of reliable internet access was a significant challenge to implementing telehealth services. This is in line with previous evidence showing that lack of internet infrastructure has stymied telehealth uptake. There is a need for improved broadband internet infrastructure in the rural US. In addition, cost was also cited as a challenge to telehealth implementation. Multiple consortia reported that the high costs of cell phone minutes, data plans, and equipment were especially burdensome for rural practitioners and patients. This is not surprising given the poverty rates are high in rural communities. It is critical to identify potential reimbursement/cost saving mechanisms to create sustainable telehealth access in the rural US. Indeed, without robust implementation efforts like the one featured here, rural individuals, many of whom receive Medicaid, may not reap the benefits of increased treatment access through telehealth. Also, this study suggests that service provider and client discomfort with technology was a barrier to telehealth usage. However, the study did not present more detailed data that could help explain why (e.g., what specifically made providers uncomfortable using telehealth services). More work is needed to better understand the specific comfort needs of patients and how these can be addressed via telehealth. Finally, in this study, the patients’ perceived barriers to telehealth use were reported by the consortia leaders and not actual patients. Thus, these data may not be directly reflective of patient experiences.
Ultimately, the results of this study suggest that telehealth can be a viable modality for substance use disorder treatment in rural settings. Despite the cited barriers, areas in which consortia utilized telehealth services use had significantly higher rates of medication for opioid use disorder utilization compared to areas where telehealth was not used. Although the present study did not examine how effective the telehealth services used were at treating substance use disorders, other research suggests that telehealth is an effective treatment option. Therefore, reducing barriers to telehealth in the rural US could be a way to reduce the impact of substance use in such locations. Efforts to ensure access to telehealth services (e.g., access to affordable high-speed internet) should be expanded.
This study highlights the potential of telehealth to expand access to opioid use disorder treatment in rural US communities. Telehealth use was associated with higher medication for opioid use disorder treatment usage and retention. However, barriers including limited broadband internet access, financial costs, and provider and patient discomfort hindered implementation. Although the study was conducted under a federally funded program, suggesting limited scalability without continued support, its findings underscore the need for investment in infrastructure, cost-reduction strategies, and patient-centered design. Future efforts should prioritize sustainable telehealth integration and better understanding of patient experiences to close treatment gaps in rural areas.
Meyers, K., Herman, S., Schuler, H., Mun, C., Bresani, E., & Payne, R. K. (2025). The opioid epidemic in rural communities: Can telehealth increase access to medications for opioid use disorder and offset barriers to care? Drug and Alcohol Dependence, 271. doi: 10.1016/j.drugalcdep.2025.112628.
l
Rural communities have been especially hard hit by the opioid overdose epidemic – research suggests that the rural communities have had higher increases in overdose death rates. Medications for opioid use disorders are first-line treatments for opioid addiction, which work by mitigating withdrawal symptoms, reducing drug cravings, and for agonists like buprenorphine, maintaining opioid tolerance to reduce overdose risk. For rural communities, however, the availability of medications for opioid use disorder can be limited due to a lack of local clinicians and transportation challenges. One proposed solution to address such opioid care disparities is through the usage of telehealth technologies.
Telehealth services are any of a suite of communication options whereby patients can consult with a healthcare provider remotely (for example, via video conferencing software). Telehealth has become increasingly common since the COVID-19 pandemic – telehealth visits for a wide range of health issues increased by 75% from 2020 to 2021. This increase in telehealth usage included telehealth services for opioid use disorder treatment among those living in rural areas. However, it is unclear how telehealth services have impacted access and usage of medications for opioid use disorder in these rural areas and what barriers may be impacting telehealth utilization.
To this end, the current study sought to determine how telehealth services have been utilized (especially for medication for opioid use disorder) among rural US communities. Specifically, this work examined rates of telehealth use within rural communities, how telehealth changed access to opioid use disorder treatment, and explored challenges rural communities faced in using telehealth.
This study was a mixed methods secondary analysis of data submitted to the Rural Communities Opioid Response Program by representatives of funded consortia (i.e., a collection of funded agencies working together) from September 2019 to September 2022. This initiative was created by the Health Resources and Services Administration to fund organizations providing substance use treatment programs in rural communities. The goal of this work was to create a wide network of programs to provide prevention, treatment, and recovery services to rural communities, with an emphasis on increasing access to medications for opioid use disorder. For the current analysis, data were derived from several sources including Performance Improvement and Measurement System data and progress reports. These data were submitted regularly by program directors of each consortium to the Rural Communities Opioid Response Program.
The outcomes of this work included access to opioid use disorder treatment, the degree to which telehealth services were used, and barriers to utilizing telehealth services in rural areas. These outcomes were measured in several ways. First, individual performance data, including the number of individuals who received medications for opioid use disorders were derived from Performance Improvement and Measurement System reports. Quantitative and qualitative data were also derived from quarterly/biannual progress reports. Such reports contained data on the availability of in-person/telehealth-delivered opioid use disorder treatment services across service areas (at both the county- and consortium-level) and barriers specific to using telehealth for opioid use disorder treatment. The authors also estimated the minimum number of individuals in a service area who should have received medications for opioid use disorder (based on national treatment rates) and then compared this benchmark with the number of individuals in every consortium who received said treatment to determine whether each met or exceeded the national rate.
Data for the present study was derived from consortia project directors (N=92) distributed across 37 states in the continental US. Most agencies serviced multiple counties in the same state (64%). Nearly a third (31%) worked within service areas with low population density (e.g., 50,000–99,999 people). Most (62%) were led by a medical provider (e.g., a Critical Access Hospital), with 15% being led by a social service provider (e.g., a community-based organization or tribal organization), 12% were led by a university/research affiliated organization, 9% were led by behavioral health provider, and 2% were led by a government entity (e.g., state or local health department). Consortia included 1,120 member agencies, with an average of 12 member agencies per consortium.
Access to opioid use disorder treatment increased across counties
From March 2020 to March 2021 (the first year of the COVID-19 pandemic), the number of consortia providing telehealth for any opioid use disorder service (counseling, medications, etc.) increased from 47 out of 92 (51%) to 81 out of 92 (88%). However, there was a decline to 70 out of 90 (2 did not report; 78%) in September 2022.
Telehealth services expansion increased opioid disorder treatment access and usage
Programs that implemented telehealth practices reported more individuals receiving medications for opioid use disorder and retained more individuals in treatment (≥3 months) compared to programs that did not use telehealth. These effects were small to medium in magnitude. In addition, 11.5% is the overall rate at which individuals with opioid use disorder receive medications, nationally – communities near programs that provided telehealth were 5 times more likely to beat that national average.
Technological, financial, and comfort challenges impeded implementing telehealth services
A lack of internet connectivity was cited by most consortia (86%) as a challenge to implementing telehealth services. Additionally, telehealth-related costs were also cited as a barrier to effective use (e.g., expenses related to home equipment for staff [28%] and patients reporting high internet and cell phone minute costs [70%]). Finally, general discomfort using telehealth services (both from staff [47%] and patients [75%]) was cited as a barrier to telehealth implementation.
Results of the present study suggest that for those living in the rural US, telehealth can help increase opioid use disorder treatment access and utilization. However, several challenges need to be overcome to facilitate widespread telehealth implementation.
Across consortia, reports indicated that lack of reliable internet access was a significant challenge to implementing telehealth services. This is in line with previous evidence showing that lack of internet infrastructure has stymied telehealth uptake. There is a need for improved broadband internet infrastructure in the rural US. In addition, cost was also cited as a challenge to telehealth implementation. Multiple consortia reported that the high costs of cell phone minutes, data plans, and equipment were especially burdensome for rural practitioners and patients. This is not surprising given the poverty rates are high in rural communities. It is critical to identify potential reimbursement/cost saving mechanisms to create sustainable telehealth access in the rural US. Indeed, without robust implementation efforts like the one featured here, rural individuals, many of whom receive Medicaid, may not reap the benefits of increased treatment access through telehealth. Also, this study suggests that service provider and client discomfort with technology was a barrier to telehealth usage. However, the study did not present more detailed data that could help explain why (e.g., what specifically made providers uncomfortable using telehealth services). More work is needed to better understand the specific comfort needs of patients and how these can be addressed via telehealth. Finally, in this study, the patients’ perceived barriers to telehealth use were reported by the consortia leaders and not actual patients. Thus, these data may not be directly reflective of patient experiences.
Ultimately, the results of this study suggest that telehealth can be a viable modality for substance use disorder treatment in rural settings. Despite the cited barriers, areas in which consortia utilized telehealth services use had significantly higher rates of medication for opioid use disorder utilization compared to areas where telehealth was not used. Although the present study did not examine how effective the telehealth services used were at treating substance use disorders, other research suggests that telehealth is an effective treatment option. Therefore, reducing barriers to telehealth in the rural US could be a way to reduce the impact of substance use in such locations. Efforts to ensure access to telehealth services (e.g., access to affordable high-speed internet) should be expanded.
This study highlights the potential of telehealth to expand access to opioid use disorder treatment in rural US communities. Telehealth use was associated with higher medication for opioid use disorder treatment usage and retention. However, barriers including limited broadband internet access, financial costs, and provider and patient discomfort hindered implementation. Although the study was conducted under a federally funded program, suggesting limited scalability without continued support, its findings underscore the need for investment in infrastructure, cost-reduction strategies, and patient-centered design. Future efforts should prioritize sustainable telehealth integration and better understanding of patient experiences to close treatment gaps in rural areas.
Meyers, K., Herman, S., Schuler, H., Mun, C., Bresani, E., & Payne, R. K. (2025). The opioid epidemic in rural communities: Can telehealth increase access to medications for opioid use disorder and offset barriers to care? Drug and Alcohol Dependence, 271. doi: 10.1016/j.drugalcdep.2025.112628.
l
Rural communities have been especially hard hit by the opioid overdose epidemic – research suggests that the rural communities have had higher increases in overdose death rates. Medications for opioid use disorders are first-line treatments for opioid addiction, which work by mitigating withdrawal symptoms, reducing drug cravings, and for agonists like buprenorphine, maintaining opioid tolerance to reduce overdose risk. For rural communities, however, the availability of medications for opioid use disorder can be limited due to a lack of local clinicians and transportation challenges. One proposed solution to address such opioid care disparities is through the usage of telehealth technologies.
Telehealth services are any of a suite of communication options whereby patients can consult with a healthcare provider remotely (for example, via video conferencing software). Telehealth has become increasingly common since the COVID-19 pandemic – telehealth visits for a wide range of health issues increased by 75% from 2020 to 2021. This increase in telehealth usage included telehealth services for opioid use disorder treatment among those living in rural areas. However, it is unclear how telehealth services have impacted access and usage of medications for opioid use disorder in these rural areas and what barriers may be impacting telehealth utilization.
To this end, the current study sought to determine how telehealth services have been utilized (especially for medication for opioid use disorder) among rural US communities. Specifically, this work examined rates of telehealth use within rural communities, how telehealth changed access to opioid use disorder treatment, and explored challenges rural communities faced in using telehealth.
This study was a mixed methods secondary analysis of data submitted to the Rural Communities Opioid Response Program by representatives of funded consortia (i.e., a collection of funded agencies working together) from September 2019 to September 2022. This initiative was created by the Health Resources and Services Administration to fund organizations providing substance use treatment programs in rural communities. The goal of this work was to create a wide network of programs to provide prevention, treatment, and recovery services to rural communities, with an emphasis on increasing access to medications for opioid use disorder. For the current analysis, data were derived from several sources including Performance Improvement and Measurement System data and progress reports. These data were submitted regularly by program directors of each consortium to the Rural Communities Opioid Response Program.
The outcomes of this work included access to opioid use disorder treatment, the degree to which telehealth services were used, and barriers to utilizing telehealth services in rural areas. These outcomes were measured in several ways. First, individual performance data, including the number of individuals who received medications for opioid use disorders were derived from Performance Improvement and Measurement System reports. Quantitative and qualitative data were also derived from quarterly/biannual progress reports. Such reports contained data on the availability of in-person/telehealth-delivered opioid use disorder treatment services across service areas (at both the county- and consortium-level) and barriers specific to using telehealth for opioid use disorder treatment. The authors also estimated the minimum number of individuals in a service area who should have received medications for opioid use disorder (based on national treatment rates) and then compared this benchmark with the number of individuals in every consortium who received said treatment to determine whether each met or exceeded the national rate.
Data for the present study was derived from consortia project directors (N=92) distributed across 37 states in the continental US. Most agencies serviced multiple counties in the same state (64%). Nearly a third (31%) worked within service areas with low population density (e.g., 50,000–99,999 people). Most (62%) were led by a medical provider (e.g., a Critical Access Hospital), with 15% being led by a social service provider (e.g., a community-based organization or tribal organization), 12% were led by a university/research affiliated organization, 9% were led by behavioral health provider, and 2% were led by a government entity (e.g., state or local health department). Consortia included 1,120 member agencies, with an average of 12 member agencies per consortium.
Access to opioid use disorder treatment increased across counties
From March 2020 to March 2021 (the first year of the COVID-19 pandemic), the number of consortia providing telehealth for any opioid use disorder service (counseling, medications, etc.) increased from 47 out of 92 (51%) to 81 out of 92 (88%). However, there was a decline to 70 out of 90 (2 did not report; 78%) in September 2022.
Telehealth services expansion increased opioid disorder treatment access and usage
Programs that implemented telehealth practices reported more individuals receiving medications for opioid use disorder and retained more individuals in treatment (≥3 months) compared to programs that did not use telehealth. These effects were small to medium in magnitude. In addition, 11.5% is the overall rate at which individuals with opioid use disorder receive medications, nationally – communities near programs that provided telehealth were 5 times more likely to beat that national average.
Technological, financial, and comfort challenges impeded implementing telehealth services
A lack of internet connectivity was cited by most consortia (86%) as a challenge to implementing telehealth services. Additionally, telehealth-related costs were also cited as a barrier to effective use (e.g., expenses related to home equipment for staff [28%] and patients reporting high internet and cell phone minute costs [70%]). Finally, general discomfort using telehealth services (both from staff [47%] and patients [75%]) was cited as a barrier to telehealth implementation.
Results of the present study suggest that for those living in the rural US, telehealth can help increase opioid use disorder treatment access and utilization. However, several challenges need to be overcome to facilitate widespread telehealth implementation.
Across consortia, reports indicated that lack of reliable internet access was a significant challenge to implementing telehealth services. This is in line with previous evidence showing that lack of internet infrastructure has stymied telehealth uptake. There is a need for improved broadband internet infrastructure in the rural US. In addition, cost was also cited as a challenge to telehealth implementation. Multiple consortia reported that the high costs of cell phone minutes, data plans, and equipment were especially burdensome for rural practitioners and patients. This is not surprising given the poverty rates are high in rural communities. It is critical to identify potential reimbursement/cost saving mechanisms to create sustainable telehealth access in the rural US. Indeed, without robust implementation efforts like the one featured here, rural individuals, many of whom receive Medicaid, may not reap the benefits of increased treatment access through telehealth. Also, this study suggests that service provider and client discomfort with technology was a barrier to telehealth usage. However, the study did not present more detailed data that could help explain why (e.g., what specifically made providers uncomfortable using telehealth services). More work is needed to better understand the specific comfort needs of patients and how these can be addressed via telehealth. Finally, in this study, the patients’ perceived barriers to telehealth use were reported by the consortia leaders and not actual patients. Thus, these data may not be directly reflective of patient experiences.
Ultimately, the results of this study suggest that telehealth can be a viable modality for substance use disorder treatment in rural settings. Despite the cited barriers, areas in which consortia utilized telehealth services use had significantly higher rates of medication for opioid use disorder utilization compared to areas where telehealth was not used. Although the present study did not examine how effective the telehealth services used were at treating substance use disorders, other research suggests that telehealth is an effective treatment option. Therefore, reducing barriers to telehealth in the rural US could be a way to reduce the impact of substance use in such locations. Efforts to ensure access to telehealth services (e.g., access to affordable high-speed internet) should be expanded.
This study highlights the potential of telehealth to expand access to opioid use disorder treatment in rural US communities. Telehealth use was associated with higher medication for opioid use disorder treatment usage and retention. However, barriers including limited broadband internet access, financial costs, and provider and patient discomfort hindered implementation. Although the study was conducted under a federally funded program, suggesting limited scalability without continued support, its findings underscore the need for investment in infrastructure, cost-reduction strategies, and patient-centered design. Future efforts should prioritize sustainable telehealth integration and better understanding of patient experiences to close treatment gaps in rural areas.
Meyers, K., Herman, S., Schuler, H., Mun, C., Bresani, E., & Payne, R. K. (2025). The opioid epidemic in rural communities: Can telehealth increase access to medications for opioid use disorder and offset barriers to care? Drug and Alcohol Dependence, 271. doi: 10.1016/j.drugalcdep.2025.112628.
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