Reflections on the preparation, implementation, and sustainability of a virtual SUD clinic: A public health response to the opioid epidemic.

Vroom EB, Bolton CD, Finley EP, Potter JS. Reflections on the preparation, implementation, and sustainability of a virtual SUD clinic: A public health response to the opioid epidemic. Journal of substance use and addiction treatment. 2026 Jul 28; 210082, DOI: 10.1016/j.josat.2026.210082.

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Abstract:

INTRODUCTION: There has been a "threefold" increase in opioid overdoses in the United States since the start of the COVID-19 pandemic. The pandemic led to the evolution of virtual services for individuals with opioid use disorder (OUD) through telehealth service options. However, less is known about contextual factors that may hinder or facilitate the rapid scale of telehealth substance use services during a public health emergency. The purpose of this exploratory study is to present a case example that qualitatively examines factors affecting and needs for preparing, implementing, and sustaining a virtual SUD clinic offering medications for OUD via telehealth across Texas. METHODS: The study conducted periodic reflections quarterly between January 2022 and September 2023 with clinic leadership, operations staff, and prescribing providers to examine implementation activities, processes, and/or events during clinic scale. Using the Consolidated Framework for Implementation Research 2.0, the study identified barriers and facilitators that were mapped and organized by the phases of implementation outlined in the Exploration, Preparation, Implementation, and Sustainment framework. RESULTS: Findings showed that rapid scale requires careful consideration of the following factors across EPIS phases: preparation - innovation design; implementation - individuals (mid- and high-level leaders) and corresponding characteristics (motivated, capable), external partnerships, internal structural characteristics, and team cohesion; and sustainment - planning, financing, high-level leaders, and ability to adapt. CONCLUSIONS: Given the ever-evolving landscape of telehealth services, examining the perspectives of leadership, operations staff, and prescribing providers on establishing a statewide virtual SUD clinic provides unique insights into critical factors that can support future planning for virtual SUD treatment models.