National Institute on Drug Abuse – Center for Technology and Behavioral Health Pilot Core
September 2013 – August 2014
Zev Schuman-Olivier, MD
Other Project Staff
Jacob Borodovsky, BA
Robert E. Drake, MD, PhD; Mary F. Brunette, MD; Lisa A. Marsch, PhD
Opioid Dependence is a serious public health issue. Opiate replacement therapy with buprenorphine improves clinical outcomes for most people with dependence, but emerging adults (18-25 year olds) with opioid dependence seem to draw less benefit from treatment. Medication adherence may be a critical mediator in the relationship between emerging adulthood and poor clinical outcomes. An intervention that can simultaneously increase adherence and reduce diversion of buprenorphine is needed, especially among emerging adults.
Our study aims to demonstrate successful integration of several existing technologies into a mobile platform for daily remote supervised self-administration of buprenorphine. The platform will consist of the following components: (1) secure electronic pill organizers; 2) phone text messaging; 3) smartphone videoconferencing telemental health evaluations with daily brief motivational interventions; 4) a standardized protocol for monitoring daily self-administration of medication; and 5) sober social network support triggered by missed medication. Secure electronic mobile pill dispensers can help people organize medication administration and deter diversion. Mobile text messaging and videoconferencing can be used to arrange and conduct remote monitoring of medication adherence. During daily video encounters, motivational interventions can help resolve ambivalence about medication. On non-adherent days, clinical outreach can be conducted and/or participants’ sober social support network can be alerted. Participants will be recruited from WestBridge, a non-profit dual diagnosis assertive community treatment program, which already has been integrating many of the key components during daily in-person home visits by clinicians. This project will shift these interventions to a mobile platform combining them with secure electronic pill dispensers.
The primary goals of this pilot are to assess the feasibility, usability, and acceptability of this integrated mobile platform. In addition, this study aims to evaluate preliminary efficacy in the maintenance of medication adherence, diversion prevention, and conservation of staff resources during buprenorphine treatment.