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

Abstract

BackgroundWhile 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.MethodsThe 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.ResultsTwo-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.ConclusionThe 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://clinicaltrials.gov/ct2/show/NCT02942199Electronic supplementary materialThe online version of this article (10.1186/s13722-018-0122-4) contains supplementary material, which is available to authorized users.

Video directly observed therapy intervention using a mobile health application among opioid use disorder patients receiving office-based buprenorphine treatment: protocol for a pilot randomized controlled trial

“…This study will provide valuable contributions to the rapidly growing field of smartphone-delivered addiction treatment tools. Mobile health technologies are being widely developed and implemented to improve treatment for a variety of other chronic medical conditions [ 35 , 36 ]. A number of innovative mobile phone applications have been tested for substance use disorders [ 54 – 57 ] and OUD, specifically [ 54 – 56 , 58 , 59 ].…”

“…Mobile health (mHealth) technologies hold potential to promote accountability and structure for patients on buprenorphine, and address providers’ concerns by potentially acting as a safeguard against non-adherence and diversion [ 32 – 36 ]. According to the World Health Organization, mHealth consists of “medical and public health practices supported by mobile devices, such as mobile phones, patient monitoring devices… (and) involves the use and capitalization on a mobile phone’s core utility of voice and short messaging services as well as more complex functionalities and applications…“ [ 37 ].…”

Remote Methods for Conducting Tobacco-Focused Clinical Trials

“…Synchronous or asynchronous video observation of medication-taking is a recent advance in clinical trials and well suited for inclusion in remote trials. Medication-taking can be observed via video connection with a staff member in real time (ie, synchronously 58 , 59 ), recorded via video on a mobile device and uploaded for subsequent staff review (ie, asynchronously 32 , 60 , 61 ), or automatically detected using a mobile app with facial recognition software, such as AICure. 62 Limitations of these methods include high participant burden, required access to technology with video capabilities, and the need for staff to observe dosing in real time or review videos at a later date (for synchronous and asynchronous methods, respectively).…”

Misalignment of Stakeholder Incentives in the Opioid Crisis

“…In addition, counselors may exhibit resistance towards contingency management and financial incentives, which could necessitate educational outreach and training [ 114 ]. As other initiatives have been demonstrated to yield positive outcomes, one can refer to syringe access/exchange programs [ 74 , 115 , 116 ] and the use of technology such as therapy observation via a mobile application [ 117 , 118 , 119 ].…”