Theme: Models of Care Year: 2022
Background:
COVID-19 triggered unprecedented expansion of telemedicine, including for delivery of opioid agonist
treatment (OAT). However, people with opioid use disorder (PWOUD) often lack technologies
necessary for remote care, have complex needs, and/or are disengaged from mainstream services.
We therefore developed a unique program delivering high-quality telecare to PWOUD within a
community-based harm reduction setting in Montreal, Canada.
Description of model of care/intervention:
Procedures were co-constructed by the Centre hospitalier de l’Université de Montréal’s Addiction
medicine service (CHUM-A) and CACTUS Montréal, a community-based harm reduction organization
known and trusted by its clientele. CACTUS Montréal workers promoted the program, facilitated
eligibility screening, established private on-site telemedicine connections to CHUM-A, and offered
holistic ongoing follow-up. CHUM-A offered individualized OAT, often combined with short-acting
opioids to reduce withdrawal and illicit consumption, and other health services as needed.
Effectiveness was assessed via longitudinal chart review and semi-structured interviews with 20
participants.
Effectiveness:
75 people initiated OAT through the program between April 2020 and February 2022, at which time
88% remained in care. Roughly half were transferred to primary care or the CHUM-A outpatient clinic.
Five participants commenced HIV treatment, 16 were treated for HCV, and 10 left homelessness.
13/70 participants prescribed short-acting opioids ceased this treatment component. Participants
perceived the initiative to be convenient, flexible, and responsive to their needs. The implication of
CACTUS Montréal was highly valued for enabling care in a familiar and non-judgmental environment,
facilitating communication, and providing ongoing support. Expanded medication options and the
patient-centered approach of CHUM-A were other noted advantages.
Conclusion and next steps:
Our community-based telemedicine program provides an alternative treatment pathway for PWOUD
disengaged from traditional care, integrated within a local harm reduction organization. This model
presents a promising means to reduce gaps between patients and institutional services, and increase
access to care in remote locations.
Disclosure of Interest Statement:
Høj: Salary from Canadian Institutes of Health Research grant. Bruneau: Research grants from Gilead
Sciences and Abbvie (unrelated to the present work); Canada Research Chair in Addiction Medicine;
Advisor fees from Gilead Sciences and Abbvie (unrelated to the present work). All other authors
have nothing to declare.