Importance: The coronavirus disease 2019 (COVID-19) pandemic prompted policy changes to allow increased telehealth delivery of buprenorphine, a potentially lifesaving medication for opioid use disorder (OUD). It is unclear how characteristics of patients who access different treatment modalities (in-person vs telehealth, video vs telephone) vary, and whether modality is associated with retention-a key indicator of care quality.

Question: Among Veterans Health Administration patients receiving buprenorphine for opioid use disorder in the year following implementation of COVID-19–related telehealth policies, did patient characteristics and retention differ across treatment modalities?

Findings: In this cross-sectional study of 17 182 patients, patients who were younger, male, Black, unknown race, Hispanic, non–service connected, or with certain comorbidities were significantly less likely to receive telehealth; those who were older, male, Black, non–service connected, or experiencing homelessness and/or housing instability were significantly less likely to receive video compared with telephone-only telehealth. Telehealth was positively associated with retention.

Meaning: These findings suggest that discontinuing or reducing telephone-only access may disrupt treatment for groups with access disparities and that telehealth-delivered buprenorphine may support retention.