UNSTRUCTURED
The COVID-19 pandemic triggered unprecedented expansion of telemedicine, including in the delivery of opioid agonist treatment (OAT) for people with opioid use disorder (PWOUD). However, many PWOUD lack the technological resources necessary for remote care, have complex needs, or are disengaged from mainstream services. To address the needs of these individuals, a unique program delivering telemedicine with the support of community outreach workers was co-constructed in Montreal, Canada, by the addiction medicine service of the Centre hospitalier de l’Université de Montréal (CHUM-A) and CACTUS Montréal, a community-based harm reduction organisation known and trusted by its clientele. Procedures were developed jointly to enable flexible and rapid appointment scheduling. CACTUS Montréal workers promoted the program, facilitated private on-site telemedicine connections and warm handoff to the CHUM-A team, accompanied patients during online appointments if requested, and provided ongoing holistic support and follow-up. The CHUM-A team offered individualized OAT regimens and other health services as needed. Between April 2020 and March 2022, 75 people initiated OAT through the program. In March 2022, 88% remained engaged in care, exceeding reported 1-year OAT retention rates of 30-70%. Five participants commenced HIV treatment and 16 were treated for hepatitis C. Overall, participants perceived the initiative to be convenient, non-judgmental, and responsive to their needs; the implication of CACTUS Montréal was highly valued and integral to these outcomes. Beyond the pandemic context, our program presents a flexible and accessible means to deliver alternative treatment options for PWOUD disengaged from traditional care, bridge gaps between communities and health providers, and improve access to care in rural/remote settings.