MySafeRx: An integrated mobile platform for buprenorphine adherence

Dartmouth College, Hanover NH

Investigators

Linked publications & trials

Abstract

? DESCRIPTION (provided by applicant): Opioid Dependence is a serious public health issue. Opioid-related overdose deaths are the leading cause of drug-related overdose and more than 100 people die each day in the US due to drug overdose. Rates of Hepatitis C infections have increased dramatically among young adults. Buprenorphine/naloxone (B/N) is a medication that can prevent opioid overdose and block the ability to get high from illicit opioids. B/N also averts opioid withdrawal and decreases craving. Therefore, taking B/N daily reduces relapse and prevents overdose each day it is taken. Extended treatment with B/N increases rates of recovery and keeps people engaged in treatment. When an opioid abuser is in B/N treatment, the risk of transmitting Hepatitis C and HIV are reduced. Staying in treatment is important because dropout is associated with relapse and a high risk of overdose death. While many people with opioid dependence achieve stability in B/N treatment, 50% relapse or drop out within the first year; B/N treatment failure is strongly associated with younger age. Taking B/N every day can be critical for helping young people stay in treatment and avoid relapse. In a study of opioid dependent youth, 93% of those who took B/N at least 5 days each week were still in treatment after 12 weeks compared with only 57% of less adherent participants. Also, when patients prescribed B/N do not take their full dose, then they may sell it or share it with others; this diversion is worrisome and intensifies physician reluctance to treat people with opioid dependence. The MySafeRx integrative therapy platform provides a higher level of care for vulnerable adults with opioid dependence during periods of instability by providing daily motivational recovery support delivered remotely via videoconference in combination with supervised self-administration of B/N from a secure electronic pill dispenser. By offering this higher level of care during risky periods and ensuring daily medication-taking, MySafeRx could improve treatment and save lives. The goal of the MySafeRx project is to integrate text messaging reminders, secure electronic pill organizers, and daily remote brief motivational recovery support visits with a standardized protocol for supervised self- administration of B/N via videoconferencing. This systems integration approach could become the foundation for a nationwide adjunctive treatment program supporting office-based opioid treatment providers and caring for vulnerable patients. This program could expand access to B/N for marginalized, high-risk groups and those living in areas with minimal treatment resources. Providing targeted motivational recovery support each day at the moment of medication-taking when patients are most receptive to participating in treatment is central to the concept of MySafeRx. We will recruit 70-96 vulnerable, unstable opioid dependent patients (<35 years old) from rural physician practices in Southwest Vermont by enrolling patients during buprenorphine induction and after illicit opioid lapse during treatment. We will conduct a pilot trial comparing MySafeRx versus standard care on rates of B/N adherence, opioid use, and treatment retention.