Reward-based technology to improve opioid use disorder treatment initiation after an ED visit

Project Summary/Abstract Millions of people in the US misuse opioids each year, leading to thousands of deaths and billions of dollars in total economic burden. Medications for opioid use disorder (MOUD) are highly efficacious, but only a fraction of people with Opioid Use Disorder (OUD) access MOUD, and further treatment non-adherence is common and is associated with poor outcomes. This application will extend the scope of our parent R42 Opioid Addiction Recovery Support with Contingency Management (OARS+CM) study assessing the impact of OARS+CM technology on MOUD treatment initiation and adherence by expanding enrollment sites to include additional EDs and inpatient psychiatric and detox facilities to reach the sample size needed to adequately analyze the data. Expansion is necessary as volume at the current enrollment sites are lower than predicted. In the parent grant, the project enhanced the Opioid Addiction Recovery Support (OARS) application by adding an evidence-based reward, contingency management (CM) function. CM interventions systematically reward (reinforce) specific behaviors like treatment initiation and adherence with therapy attendance and drug-free urine tests and are highly efficacious. An OARS solution enhanced with a CM component (OARS+CM) that allows for the automatic calculation, delivery, and redemption of rewards contingent on objective evidence of treatment behaviors may be key to improving MOUD initiation and adherence. After Phase 1 of the parent grant, the existing OARS clinician portal and patient mobile application was modified to accommodate entry into the software system from an acute care setting and to automatically manage and deliver rewards to create OARS+CM using patient- centered design principles. Usability sessions with OUD patients and other key stakeholders informed design. Primary usability outcomes were examined, and the program iteratively updated. Upon meeting milestones, there was proof-of-concept pilot of usability, acceptability, and effects on initial behavior targets with 10 patients. Currently in Phase 2, an RCT is in progress, in which acute care OUD patients appropriate for outpatient MOUD (N = 102) are recruited and allocated to one of two study conditions: 1) treatment as usual (TAU), comprised of screening, brief intervention, and referral to treatment by a trained clinician with MyMAT, an attentional control mobile application, and 2) OARS+CM. The active intervention window for the two intervention groups is 12 weeks. Participants are onboarded prior to discharge from acute care settings (i.e., ED, inpatient medical care, acute psychiatric and detox facilities). In the outpatient MOUD setting, data on treatment adherence and opioid use will be captured from clinical records for six months. Telephone follow-up assessments and vital statics registry reviews will be at month 1, month 3 (end-of-study intervention period), and month 6. Primary MOUD treatment initiation outcomes will be scheduling and completing the MOUD intake. Primary MOUD treatment outcomes will be sustained abstinence at Month 6 and longest duration of abstinence. Analysis will examine data on cost avoidance and cost savings through reduced acute care visits between study conditions.