{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:58:03Z","timestamp":1786737483189,"version":"build-2736575974"},"reference-count":60,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Buprenorphine is an effective treatment for opioid use disorder and is associated with reduced mortality when retention is high; however, national studies show low retention. Evidence from outpatient settings, including telehealth, remains limited, despite population-level analyses suggesting improved retention with virtual care. Further research is needed to better understand retention and optimize care for people with opioid use disorder.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to describe patient retention in a telehealth-delivered buprenorphine program over 24 months, both overall and by treatment transition pathway.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a retrospective cohort study of adults initiating opioid use disorder treatment in a multistate, telehealth-only addiction treatment program between May 1, 2019, and April 30, 2025. Before March 2020, participants completed an in-person visit before transitioning to telehealth. Participants completed an intake appointment and either continued on a stable dose of buprenorphine started prior to care entry or transitioned to buprenorphine treatment via 1 of 6 treatment pathways (high dose, standard low dose, standard, Quick Start, low dose, or other). Retention in care was defined by ongoing clinical engagement, specifically through a completed medical visit or a patient-initiated secure message, each of which was required to continue buprenorphine treatment. Retention was analyzed both overall and by patient characteristics and treatment pathway. Chi-square tests and absolute risk differences with 95% CIs were used for comparisons.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 22,064 patients, the mean age was 41.2 (SD 9.9) years, 48.6% (10,542\/21,676) were female, 33.8% (7464\/22,064) lived in rural areas, 78.5% (16,826\/21,446) were enrolled in Medicaid, and 37.1% (8181\/22,064) transitioned to buprenorphine. Retention declined from 86.8% (19,154\/22,064) at month 1 to 71.0% (11,488\/16,183) at month 6 and then declined gradually through 24 months. At month 6, retention was higher among patients with prior buprenorphine exposure (8613\/12,230, 70.4% vs 586\/1128, 52.0%; risk difference: 18.5 percentage points, 95% CI 15.5%\u201021.5%). Retention varied by pathway, with high dose showing the highest early retention (2330\/2870, 81.2% at month 1), while patients already receiving buprenorphine at intake had higher retention than all other transition pathways.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this large, multistate study of telehealth-only buprenorphine treatment, retention was comparable to or markedly higher than national benchmarks. These findings underscore the potential of low-threshold, harm-reduction telehealth models to support long-term retention in opioid use disorder care during a period in which illicitly manufactured fentanyl predominates in the drug supply.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/100527","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T18:10:10Z","timestamp":1783620610000},"page":"e100527-e100527","source":"Crossref","is-referenced-by-count":0,"title":["Retention in Telehealth-Delivered Buprenorphine Treatment for Opioid Use Disorder: Multistate Retrospective Cohort Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1504-4968","authenticated-orcid":false,"given":"Laura B","family":"Monico","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3958-3728","authenticated-orcid":false,"given":"Elizabeth A","family":"Bambury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6818-3399","authenticated-orcid":false,"given":"Jennifer K","family":"Foreman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8416-603X","authenticated-orcid":false,"given":"Melody","family":"Avila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0356-5440","authenticated-orcid":false,"given":"Stephen A","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"R1","unstructured":"Determination that a Public Health Emergency Exists. 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