Abstract The COVID-19 pandemic has caused rapid changes in health care delivery from in-person to telehealth services, including the treatment of persons with opioid use disorder (OUD). Telehealth services (e.g., telephone calls and video-to-home, or VTH) have been effectively used in psychiatry, but we have very little information about primary care clinicians’ or patients’ experiences using telehealth for visits associated with medication for opioid use disorder (MOUD) (e.g., buprenorphine). Understanding these issues among rural OUD patients during the COVID-19 pandemic is imperative because they are at high risk of drug use relapse, isolation and loneliness, and mental health declines. We propose to conduct a mixed-methods study of rural primary care clinicians and patients receiving MOUD. We will conduct qualitative interviews among a sample of 30 rural primary care clinicians to evaluate their practices’ abilities and experiences using telehealth (telephone and VTH) to diagnose and treat patients with OUD, perceived or experienced facilitators and barriers to implementing telehealth, and observations about OUD patients’ treatment adherence. Simultaneously, we will conduct quantitative surveys among a sample of 250 patients who are receiving MOUD. The quantitative surveys will evaluate OUD patients’ perspectives of the acceptability of telehealth services, experiences using telehealth services, treatment continuity, and drug use outcomes. Specific Aims are to: 1. Describe (using qualitative methods) rural primary care clinicians’ abilities and actual experiences transitioning to telehealth for patients receiving MOUD, their evaluations of how patients’ drug use and mental health changed when transitioning to telehealth, and characteristics of patients’ who did/did not adjust well to telehealth; 2. Identify (using quantitative methods) rural MOUD patients’ predictors of treatment continuity, satisfaction with telehealth services, and preferences for in-person vs. telehealth services; and 3. Identify (using quantitative methods) rural MOUD patients’ predictors of drug use relapse, actual overdose, and overdose risk. This study is very time-sensitive during a time of rapid changes in the essential delivery of telehealth services caused by the COVID-19 crisis that may have long-lasting implications for persons receiving treatment for OUD.