Low Barrier Tele-Buprenorphine in the Time of COVID-19: A Case Report

J Addict Med. 2020 Jul/Aug;14(4):e136-e138. doi: 10.1097/ADM.0000000000000682.


Background: To reduce the spread of coronavirus disease 2019 (COVID-19), many substance use disorder treatment programs have transitioned to telemedicine. Emergency regulatory changes allow buprenorphine initiation without an in-person visit. We describe the use of videoconferencing for buprenorphine initiation combined with street outreach to engage 2 patients experiencing homelessness with severe opioid use disorder (OUD).

Case presentation: Patient 1 was a 30-year-old man with severe OUD who had relapsed to injection heroin/fentanyl after incarceration. A community drop-in center outreach harm reduction specialist facilitated a videoconference with an addiction specialist at an OUD bridge clinic. The patient completed a community buprenorphine/naloxone initiation and self-titrated to his prior dose, 8/2 mg twice daily. One week later, he reconnected with the outreach team for a follow-up videoconference visit. Patient 2, a 36-year-old man with severe OUD, connected to the addiction specialist via a syringe service program harm reduction specialist. He had been trying to connect to a community buprenorphine/naloxone provider, but access was limited due to COVID-19, so he was using diverted buprenorphine/naloxone to reduce opioid use. He was restarted on his previous dose of 12/3 mg daily which was continued via phone follow-up 16 days later.

Conclusions: COVID-19-related regulatory changes allow buprenorphine initiation via telemedicine. We describe 2 cases where telemedicine was combined with street outreach to connect patients experiencing homelessness with OUD to treatment. These cases highlight an important opportunity to provide access to life-saving OUD treatment for vulnerable patients in the setting of a pandemic that mandates reduced face-to-face clinical interactions.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Betacoronavirus
  • Buprenorphine / administration & dosage*
  • Buprenorphine, Naloxone Drug Combination / therapeutic use
  • COVID-19
  • Coronavirus Infections / epidemiology*
  • Humans
  • Ill-Housed Persons
  • Male
  • Narcotic Antagonists / administration & dosage
  • Opiate Substitution Treatment / methods*
  • Opioid-Related Disorders / therapy*
  • Organizational Innovation
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • SARS-CoV-2
  • Substance Abuse Treatment Centers* / methods
  • Substance Abuse Treatment Centers* / organization & administration
  • Telecommunications / organization & administration*
  • Telemedicine / methods
  • Telemedicine / organization & administration


  • Buprenorphine, Naloxone Drug Combination
  • Narcotic Antagonists
  • Buprenorphine