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Heroin Addiction and Related Clinical Problems: 2026, 28: 37-48

Process evaluation of an Irish Remote Model of Opioid Agonist Treatment with a Focus on Rural Communities: An Embedded Mixed-Methods Study

Des Crowley, Claire Collins, Walter Cullen, Ide Delargy, Robyn Homeniuk, and Nandakumar Ravichandran

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2026-6

Summary: Background: Providing healthcare, including opioid agonist treatment (OAT), to people who use opioids (PWUO) remains challenging, particularly within marginalised communities. A remote model of OAT incorporating telemedicine was introduced during the COVID-19 pandemic, creating new opportunities to engage both existing and newly presenting patients in treatment. This process evaluation study explores the acceptability, feasibility, and effectiveness of this model, with particular focus on its potential for long-term integration into opioid dependence treatment services. Methods: An embedded mixed-methods study was conducted involving aggregated anonymised data of demographic and treatment characteristics and a qualitative study using semi-structured interviews with service users (n = 11) and service providers (n =9) involved with the new remote service. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis as described by Braun and Clarke. Results: A total of 101 individuals started their treatment in the remote clinic. Qualitative analysis on service users’ interviews identified three themes: a) Access, Flexibility, and Integration into Daily Life, b) Perceived effectiveness and satisfaction with care and c) Confidentiality, reduced stigma and therapeutic relationships. Qualitative analysis on service providers’ interviews identified four themes: a) Reduced waiting times and improved treatment retention, b) Need for structured training, guidance and clinical governance, c) Enhanced engagement and therapeutic relationships and d) Implementation challenges and suggestions. Conclusions: Remote models of OAT provision can be delivered effectively and safely to large numbers of people who use opioids, with high levels of patient satisfaction. Service providers’ views were more mixed with some concerns around confidentiality and clinical safety. A hybrid model of care may be the more appropriate model in the long-term but further research is required.

Keywords: People who use opioids; people who inject drugs; opioid agonist treatment; telemedicine; rural health; addiction services; continuity of care