MySafeRx: a mobile technology platform integrating motivational coaching, adherence monitoring, and electronic pill dispensing for enhancing buprenorphine/naloxone adherence during opioid use disorder treatment: a pilot study

Zev Schuman-Olivier, Jacob T Borodovsky, Jackson Steinkamp, Qays Munir, Kyle Butler, Mary Ann Greene, Jonah Goldblatt, Hai Yi Xie, Lisa A Marsch, Zev Schuman-Olivier, Jacob T Borodovsky, Jackson Steinkamp, Qays Munir, Kyle Butler, Mary Ann Greene, Jonah Goldblatt, Hai Yi Xie, Lisa A Marsch

Abstract

Background: While buprenorphine/naloxone (B/N) is approved for opioid use disorder treatment, effective delivery of B/N comes with significant challenges. Most notably, many patients do not take medication daily as prescribed; this non-adherence worsens treatment outcomes, increases healthcare costs, and leads to persistent worries of diversion among providers and policymakers. The present study examines the feasibility, usability, and acceptability of MySafeRx-a mobile technology platform integrating motivational coaching, adherence monitoring, and electronic pill dispensing designed to address the challenges of office-based opioid treatment (OBOT) with B/N.

Methods: The MySafeRx platform integrates electronic pill dispensers, text-messaging, and videoconferencing to provide supervised self-administration of medication and daily motivational coaching through an Android app interface. High-risk early adults (18-39 years old) who were enrolled in OBOT with B/N and had documented illicit opioid use in the past month during opioid agonist therapy (n = 12) participated in a 28-day single-arm observational study of the MySafeRx platform in addition to standard care.

Results: Two-thirds of participants who completed the study achieved an average of > 5 days per week of supervised B/N self-administration. Visual confirmation of medication adherence was demonstrated for an average of 72% of study days among all participants. All participants achieved platform technical proficiency within 60 min, reporting good levels of usability and acceptability. Illicit opioid abstinence rates confirmed by urine toxicology increased by 53% during MySafeRx but fell 43% within 3 weeks post-intervention.

Conclusion: The MySafeRx medication adherence and remote coaching mobile platform is acceptable and can be feasibly implemented in real-world opioid use disorder treatment settings during high-risk periods (i.e., initial stabilization, after illicit opioid lapse), resulting in reduced illicit opioid use; however, the effect did not last after intervention completion, suggesting longer duration or extended taper of program may be needed. ClinicalTrials.Gov NCT02942199 10/24/16 https://ichgcp.net/clinical-trials-registry/NCT02942199.

Figures

Fig. 1
Fig. 1
MedicaSafe pill dispenser
Fig. 2
Fig. 2
MysafeRx mobile recovery program
Fig. 3
Fig. 3
Consort diagram
Fig. 4
Fig. 4
Frequency of illicit opioid abstinence during and after MySafeRx (based on weekly toxicology)

References

    1. Katz, J. Short answers to hard questions about the opioid crisis. The Upshot; 2017.
    1. Center for Behavioral Health Statistics and Quality Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. HHS Publication No. SMA 16-4984, 2016. NSDUH Series H-51.
    1. Fudala PJ, et al. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. N Engl J Med. 2003;349(10):949–958. doi: 10.1056/NEJMoa022164.
    1. National Institute on Drug Abuse Effective Treatments for Opioid Addiction; 2016.
    1. Fiellin DA, Rosenheck RA, Kosten TR. Office-based treatment for opioid dependence: reaching new patient populations. Am J Psychiatry. 2001;158(8):1200–1204. doi: 10.1176/appi.ajp.158.8.1200.
    1. Comer SD, et al. Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine-maintained intravenous heroin abusers. Addiction. 2010;105(4):709–718. doi: 10.1111/j.1360-0443.2009.02843.x.
    1. Sporer KA. Buprenorphine: a primer for emergency physicians. Ann Emerg Med. 2004;43(5):580–584. doi: 10.1016/j.annemergmed.2003.11.006.
    1. Weiss RD, et al. Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: a 2-phase randomized controlled trial. Arch Gen Psychiatry. 2011;68(12):1238–1246. doi: 10.1001/archgenpsychiatry.2011.121.
    1. Alford DP, et al. Collaborative care of opioid-addicted patients in primary care using buprenorphine: five-year experience. Arch Intern Med. 2011;171(5):425–431. doi: 10.1001/archinternmed.2010.541.
    1. Fiellin DA, O’Connor PG. Office-based treatment of opioid-dependent patients. N Engl J Med. 2002;347(11):817–823. doi: 10.1056/NEJMcp013579.
    1. LaBelle CT, et al. Office-based opioid treatment with buprenorphine (OBOT-B): statewide implementation of the massachusetts collaborative care model in community health centers. J Subst Abuse Treat. 2016;60:6–13. doi: 10.1016/j.jsat.2015.06.010.
    1. Masand PS, et al. Partial adherence to antipsychotic medication impacts the course of illness in patients with schizophrenia: a review. Prim Care Companion J Clin Psychiatry. 2009;11(4):147–154. doi: 10.4088/PCC.08r00612.
    1. Warden D, et al. Predictors of attrition with buprenorphine/naloxone treatment in opioid dependent youth. Addict Behav. 2012;37(9):1046–1053. doi: 10.1016/j.addbeh.2012.04.011.
    1. Zhang Z, Friedmann PD, Gerstein DR. Does retention matter? treatment duration and improvement in drug use. Addiction. 2003;98(5):673–684. doi: 10.1046/j.1360-0443.2003.00354.x.
    1. Tkacz J, et al. Compliance with buprenorphine medication-assisted treatment and relapse to opioid use. Am J Addict. 2012;21(1):55–62. doi: 10.1111/j.1521-0391.2011.00186.x.
    1. Clausen T, Anchersen K, Waal H. Mortality prior to, during and after opioid maintenance treatment (OMT): a national prospective cross-registry study. Drug Alcohol Depend. 2008;94(1–3):151–157. doi: 10.1016/j.drugalcdep.2007.11.003.
    1. Roncero C, et al. Professionals’ perception on the management of patients with dual disorders. Patient Prefer Adher. 2016;10:1855–1868. doi: 10.2147/PPA.S108678.
    1. Bickel WK, et al. Buprenorphine: dose-related blockade of opioid challenge effects in opioid dependent humans. J Pharmacol Exp Ther. 1988;247(1):47–53.
    1. Greenwald MK, Comer SD, Fiellin DA. Buprenorphine maintenance and mu-opioid receptor availability in the treatment of opioid use disorder: implications for clinical use and policy. Drug Alcohol Depend. 2014;144:1–11. doi: 10.1016/j.drugalcdep.2014.07.035.
    1. Tkacz J, et al. Relationship between buprenorphine adherence and health service utilization and costs among opioid dependent patients. J Subst Abuse Treat. 2014;46(4):456–462. doi: 10.1016/j.jsat.2013.10.014.
    1. Hadland SE, Park TW, Bagley SM. Stigma associated with medication treatment for young adults with opioid use disorder: a case series. Addict Sci Clin Pract. 2018;13(1):15. doi: 10.1186/s13722-018-0116-2.
    1. Fareed A, et al. Factors affecting noncompliance with buprenorphine maintenance treatment. J Addict Med. 2014;8(5):345–350. doi: 10.1097/ADM.0000000000000057.
    1. Dayal P, Balhara YPS. A naturalistic study of predictors of retention in treatment among emerging adults entering first buprenorphine maintenance treatment for opioid use disorders. J Subst Abuse Treat. 2017;80:1–5. doi: 10.1016/j.jsat.2017.06.004.
    1. Schuman-Olivier Z, et al. Emerging adult age status predicts poor buprenorphine treatment retention. J Subst Abuse Treat. 2014;47(3):202–212. doi: 10.1016/j.jsat.2014.04.006.
    1. DiMatteo MR, Haskard KB, Williams SL. Health beliefs, disease severity, and patient adherence: a meta-analysis. Med Care. 2007;45(6):521–528. doi: 10.1097/MLR.0b013e318032937e.
    1. Sussman S, Arnett JJ. Emerging adulthood: developmental period facilitative of the addictions. Eval Health Prof. 2014;37(2):147–155. doi: 10.1177/0163278714521812.
    1. Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol. 2000;55(5):469–480. doi: 10.1037/0003-066X.55.5.469.
    1. Rosenblum A, et al. Distance traveled and cross-state commuting to opioid treatment programs in the United States. J Environ Public Health. 2011;2011:948789. doi: 10.1155/2011/948789.
    1. Lofwall MR, Walsh SL. A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world. J Addict Med. 2014;8(5):315–326. doi: 10.1097/ADM.0000000000000045.
    1. Accurso AJ, Rastegar DA. The effect of a payer-mandated decrease in buprenorphine dose on aberrant drug tests and treatment retention among patients with opioid dependence. J Subst Abuse Treat. 2016;61:74–79. doi: 10.1016/j.jsat.2015.09.004.
    1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–497. doi: 10.1056/NEJMra050100.
    1. National Forensic Laboratory Information System Special Report: Methadone and Buprenorphine, 2003–2008; 2009.
    1. Allen B, Harocopos A. Non-prescribed buprenorphine in New York City: motivations for use, practices of diversion, and experiences of stigma. J Subst Abuse Treat. 2016;70:81–86. doi: 10.1016/j.jsat.2016.08.002.
    1. Lofwall MR, Havens JR. Inability to access buprenorphine treatment as a risk factor for using diverted buprenorphine. Drug Alcohol Depend. 2012;126(3):379–383. doi: 10.1016/j.drugalcdep.2012.05.025.
    1. Schuman-Olivier Z, et al. Self-treatment: illicit buprenorphine use by opioid-dependent treatment seekers. J Subst Abuse Treat. 2010;39(1):41–50. doi: 10.1016/j.jsat.2010.03.014.
    1. Cicero TJ, Surratt HL, Inciardi J. Use and misuse of buprenorphine in the management of opioid addiction. J Opioid Manag. 2007;3(6):302–308. doi: 10.5055/jom.2007.0018.
    1. Jones HE. Practical considerations for the clinical use of buprenorphine. Sci Pract Perspect. 2004;2(2):4–20. doi: 10.1151/spp04224.
    1. Thomas CP, et al. Use of buprenorphine for addiction treatment: perspectives of addiction specialists and general psychiatrists. Psychiatr Serv. 2008;59(8):909–916. doi: 10.1176/ps.2008.59.8.909.
    1. Center for Substance Abuse Treatment, Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40, 2004, Substance Abuse and Mental Health Services Administration: Rockville, MD.
    1. Sigmon SC. Access to treatment for opioid dependence in rural America: challenges and future directions. JAMA Psychiatry. 2014;71(4):359–360. doi: 10.1001/jamapsychiatry.2013.4450.
    1. Free C, et al. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med. 2013;10(1):e1001362. doi: 10.1371/journal.pmed.1001362.
    1. Miller L, et al. Mobile technology interventions for asthma self-management: systematic review and meta-analysis. JMIR mHealth uHealth. 2017;5(5):e57. doi: 10.2196/mhealth.7168.
    1. Cooper V, et al. mHealth interventions to support self-management in HIV: a systematic review. Open AIDS J. 2017;11:119–132. doi: 10.2174/1874613601711010119.
    1. de Jongh T, et al. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev. 2012;12:CD007459.
    1. Amass L, Kamien JB, Mikulich SK. Thrice-weekly supervised dosing with the combination buprenorphine-naloxone tablet is preferred to daily supervised dosing by opioid-dependent humans. Drug Alcohol Depend. 2001;61(2):173–181. doi: 10.1016/S0376-8716(00)00141-1.
    1. Saulle R, Vecchi S, Gowing L. Supervised dosing with a long-acting opioid medication in the management of opioid dependence. Cochrane Database Syst Rev. 2017;4:CD011983.
    1. Bangor A, Kortum PT, Miller JT. An empirical evaluation of the system usability scale. Int J Hum Comput Interact. 2008;24(6):574–594. doi: 10.1080/10447310802205776.
    1. Bangor A, Kortum PT, Miller JT. Determining what individual SUS scores mean: adding an adjective rating scale. J Usability Stud. 2009;4(3):114–123.
    1. Harris PA, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. doi: 10.1016/j.jbi.2008.08.010.
    1. Schuman-Olivier Z et al. MySafeRx: an integrated mobile platform for buprenorphine adherence. In: American academy of addiction psychiatry (AAAP) 27th annual meeting and symposium 2016. Bonita Springs: Wiley/Blackwell (10.1111).
    1. Rollnick S, Miller WR. Motivational interviewing: helping people change. New York: The Guilford Press; 2013.
    1. Moyers TB, et al. The motivational interviewing treatment integrity code (MITI 4): rationale, preliminary reliability and validity. J Subst Abuse Treat. 2016;65:36–42. doi: 10.1016/j.jsat.2016.01.001.
    1. Zoom. Zoom Video Conferencing and Web Conferencing Service. 2017. Cited 2017 September 7, 2017. .
    1. Palmer RS, et al. Substance user treatment dropout from client and clinician perspectives: a pilot study. Subst Use Misuse. 2009;44(7):1021–1038. doi: 10.1080/10826080802495237.
    1. Rosen LD, et al. The media and technology usage and attitudes scale: an empirical investigation. Comput Human Behav. 2013;29(6):2501–2511. doi: 10.1016/j.chb.2013.06.006.
    1. First MB et al. Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition. Vol. SCID-I/P. 2002, New York: Biometrics Research, New York State Psychiatric Institute.
    1. Nasreddine ZS, et al. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699. doi: 10.1111/j.1532-5415.2005.53221.x.
    1. Brooke J. SUS—A quick and dirty usability scale. Usability Eval Ind. 1996;189(194):4–7.
    1. Sauro, J. SUStisfied? little-known system usability scale facts; 2011. .
    1. Schuman-Olivier Z et al. Feasibility for ActiWatch score (TM) for recording skills practice and conducting ecological momentary assessment in a RCT of mindfulness training vs. cognitive-behavioral therapy for tobacco smoking cessation. In: Poster presentation, international symposium on contemplative studies; 2012.
    1. Hwang W, Salvendy G. Number of people required for usability evaluation. Commun ACM. 2010;53(5):130. doi: 10.1145/1735223.1735255.
    1. Commitment of Alcoholics or Substance Abusers. Massachusetts general law; 2016.
    1. Dahan A, et al. Comparison of the respiratory effects of intravenous buprenorphine and fentanyl in humans and rats. Br J Anaesth. 2005;94(6):825–834. doi: 10.1093/bja/aei145.
    1. Boas RA, Villiger JW. Clinical actions of fentanyl and buprenorphine. The significance of receptor binding. Br J Anaesth. 1985;57(2):192–196. doi: 10.1093/bja/57.2.192.
    1. Bershad AK, et al. Opioid partial agonist buprenorphine dampens responses to psychosocial stress in humans. Psychoneuroendocrinology. 2015;52:281–288. doi: 10.1016/j.psyneuen.2014.12.004.
    1. Vuong C, et al. The effects of opioids and opioid analogs on animal and human endocrine systems. Endocr Rev. 2010;31(1):98–132. doi: 10.1210/er.2009-0009.
    1. Koob GF. A role for brain stress systems in addiction. Neuron. 2008;59(1):11–34. doi: 10.1016/j.neuron.2008.06.012.
    1. Sinha R. Chronic stress, drug use, and vulnerability to addiction. Ann N Y Acad Sci. 2008;1141:105–130. doi: 10.1196/annals.1441.030.
    1. Stein BD, et al. Physician capacity to treat opioid use disorder with buprenorphine-assisted treatment. JAMA. 2016;316(11):1211–1212. doi: 10.1001/jama.2016.10542.
    1. Substance Abuse and Mental Health Services Administration, National Survey of Stubstance Abuse Treatment Services (N-SSATS). 2017. BHSIS Series S-93 (HHS Publication No. (SMA) 17-5039), p. 1–213.
    1. Yang A, Arfken CL, Johanson CE. Steps physicians report taking to reduce diversion of buprenorphine. Am J Addict. 2013;22(3):184–187. doi: 10.1111/j.1521-0391.2012.00335.x.
    1. New Freedom Commission on Mental Health Subcommittee on Rural Issues: Background Paper. DHHS Pub. No. SMA-04-3890; 2004.
    1. Andrilla CHA, Coulthard C, Larson EH. Barriers rural physicians face prescribing buprenorphine for opioid use disorder. Ann Fam Med. 2017;15(4):359–362. doi: 10.1370/afm.2099.
    1. Sigmon SC, et al. Interim buprenorphine vs. waiting list for opioid dependence. N Engl J Med. 2016;375(25):2504–2505. doi: 10.1056/NEJMc1610047.
    1. Uosukainen H, Pentikainen H, Tacke U. The effect of an electronic medicine dispenser on diversion of buprenorphine-naloxone-experience from a medium-sized Finnish city. J Subst Abuse Treat. 2013;45(1):143–147. doi: 10.1016/j.jsat.2013.01.003.
    1. Fareed A, et al. Effect of buprenorphine dose on treatment outcome. J Addict Dis. 2012;31(1):8–18. doi: 10.1080/10550887.2011.642758.
    1. Greenwald M, et al. Buprenorphine duration of action: mu-opioid receptor availability and pharmacokinetic and behavioral indices. Biol Psychiatry. 2007;61(1):101–110. doi: 10.1016/j.biopsych.2006.04.043.
    1. Daniulaityte R, et al. Overdose deaths related to fentanyl and its analogs—Ohio, January–February 2017. MMWR Morb Mortal Wkly Rep. 2017;66(34):904–908. doi: 10.15585/mmwr.mm6634a3.
    1. Fluent L. Devices and demographics; 2016. 2 Nov 2017. .
    1. Statista. Subscriber share held by smartphone operating systems in the United States from January 2012 to June 2017; 2017. 1 Dec 2017. .

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever