If you are thinking about getting care by video, it is fair to ask whether it works as well as sitting in a clinic. Over the past few years, researchers have been able to study that question on a large scale. During the COVID-19 public health emergency, temporary rule changes let far more people get care by telehealth, and studies followed.
Here is what some of the strongest recent studies and federal sources found, and where the evidence still has limits.
Why researchers focus on staying in treatment
For opioid use disorder, one of the most closely watched measures is retention. That means whether people keep taking their medication and stay connected to care over time. Studies also look at overdoses, since preventing them is one of the main goals of treatment.
Telehealth may help with retention for practical reasons. A video visit can mean less travel, less time off work and fewer problems with childcare or transportation. The question is whether the research backs that up.
Opioid use disorder: what large studies found
Medicare: higher retention and lower overdose odds
A 2022 study in JAMA Psychiatry compared Medicare beneficiaries who began opioid use disorder care before the pandemic with those who began during it. During the pandemic, 19.6% received telehealth related to opioid use disorder, compared with 0.6% before.
Among people taking medication for opioid use disorder, those who had this kind of telehealth had higher odds of staying on their medication. People who received it also had about one-third lower odds of a medically treated overdose.
A 2023 follow-up in the same journal, led by researchers from CDC, CMS and NIDA, looked at fatal overdoses. Receiving opioid use disorder telehealth was associated with 33% lower odds of a fatal drug overdose. Getting medication through opioid treatment programs or buprenorphine in office-based settings was also linked to lower odds.
The authors were careful about what this means:
"Given the observational nature of the study, we cannot draw causal inferences."
Jones et al., JAMA Psychiatry, 2023
Medicaid in Kentucky and Ohio
A 2023 study in JAMA Network Open, part of the NIDA-supported HEALing Communities Study, looked at Medicaid enrollees who started buprenorphine in 2019 and 2020.
- In Kentucky, 48% of people who started buprenorphine by telehealth stayed in treatment for 90 straight days, compared with 44% who started in other settings.
- In Ohio, the figures were 32% and 28%.
Starting treatment by telehealth was not associated with a higher chance of a nonfatal overdose. The study also found that some groups were less likely to receive treatment by telehealth and less likely to stay in treatment for the full 90 days. These included non-Hispanic Black individuals, men and people who had a prior opioid overdose.
Veterans Health Administration
A 2022 study of 17,182 veterans receiving buprenorphine found that retention was higher for patients who had telehealth visits than for those with only in-person visits. This held both for people who started treatment before the pandemic rule changes and for those who started after.
Among people who started after the changes, video visits were linked to higher retention than phone-only visits. But older veterans, Black veterans and people experiencing homelessness or housing instability were less likely to get video care. The authors suggested that cutting back on phone access could disrupt treatment for groups who already face barriers.
Substance use beyond opioids
A 2021 evidence review from the Substance Abuse and Mental Health Services Administration (SAMHSA) looked at telehealth for substance use disorders and serious mental illness. It reported that substance use treatments delivered by telehealth have led to less alcohol use, more people quitting tobacco, and better engagement and retention in opioid use disorder treatment.
For medication treatment that combined telehealth and in-person care, the studies SAMHSA reviewed found no significant difference from in-person care in retention, counseling attendance or patient satisfaction. SAMHSA also noted that, at the time, evidence for medication treatment delivered only by telehealth was limited.
Mental health: similar results in randomized trials
Mental health research includes more randomized trials, which are better at comparing two approaches fairly.
A 2023 review in JMIR Mental Health reviewed 20 randomized trials of treatment for PTSD, depression and anxiety. Telehealth was comparable with in-person care for symptom improvement, patient satisfaction and dropout rates. The reviewers rated their confidence in the evidence as moderate.
A 2026 review in the Journal of Medical Internet Research looked at 12 randomized trials with 900 people. It found no significant difference in symptom improvement between video-based and face-to-face therapy. The authors noted that most trials focused on PTSD and cognitive behavioral therapy, many involved US veterans, and their confidence in the evidence was low. Still, they described video therapy as a practical way to extend access to care.
SAMHSA's review reached a similar conclusion. It found that evidence-based treatments for serious mental illness and substance use disorders are also effective by telehealth, with outcomes comparable to in-person care.
So is telehealth "better"?
Not across the board. A fair summary is this. For opioid use disorder, several large studies found that people who received telehealth were more likely to stay in treatment, and Medicare studies linked it with lower odds of overdose. For mental health, randomized trials generally show results similar to in-person care.
There are real limits to keep in mind:
- Association is not proof. Most opioid use disorder studies used insurance and health records. People who received telehealth may have differed in ways the data could not fully capture.
- Much of the data is from the pandemic. Rules, habits and services were changing quickly during that time.
- Access is not equal. Some groups were less likely to get telehealth or video care. SAMHSA notes gaps in internet access and devices, so phone options matter.
- Some care needs a physical exam. SAMHSA points out that certain medication side effects are harder to assess by video. Many programs blend video and in-person care.
What this means if you are considering care
The evidence suggests that, for many people, telehealth can be a solid way to get and stay in treatment. Good telehealth care should offer the same evidence-based treatments you would get in person, a care team that knows you, and a clear plan if something urgent comes up.
Bright Heart Health was founded in 2015 and is accredited by The Joint Commission. We provide outpatient treatment for opioid use disorder and substance use disorder, as well as mental health and psychiatric services, by secure video in California, New Mexico and North Carolina. We accept Medicare, Medicaid, commercial insurance and self-pay. If you have questions about whether telehealth is right for you, our team is here to talk.
This article is for general information and isn't a substitute for advice from your own clinician.
Sources
- Jones CM, et al. Receipt of Telehealth Services, Receipt and Retention of Medications for Opioid Use Disorder, and Medically Treated Overdose Among Medicare Beneficiaries Before and During the COVID-19 Pandemic. JAMA Psychiatry, 2022.
- Jones CM, et al. Association of Receipt of Opioid Use Disorder-Related Telehealth Services and Medications for Opioid Use Disorder With Fatal Drug Overdoses Among Medicare Beneficiaries Before and During the COVID-19 Pandemic. JAMA Psychiatry, 2023.
- Increased Telehealth Services, OUD Medications During COVID-19 Associated with Reduced Fatal Overdose Risk. National Institute on Drug Abuse, 2023.
- Hammerslag LR, et al. Telemedicine Buprenorphine Initiation and Retention in Opioid Use Disorder Treatment for Medicaid Enrollees. JAMA Network Open, 2023.
- Telehealth supports retention in treatment for opioid use disorder. National Institute on Drug Abuse, 2023.
- Frost MC, et al. Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic. JAMA Network Open, 2022.
- Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders. Substance Abuse and Mental Health Services Administration, 2021.
- Shaker AA, et al. Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis. JMIR Mental Health, 2023.
- Meyer-Keirath C, et al. Comparing Video-Based and Face-to-Face Psychotherapy: Systematic Review and Multilevel Meta-Analysis Across Mental Disorders. Journal of Medical Internet Research, 2026.
