Feasibility of mHealth technology-enabled service for remote observed therapy of methadone and COVID-19 screening for patients in an opioid treatment program

PROJECT SUMMARY Methadone remains a cornerstone of treatment for opioid use disorders (OUD). Daily or frequent supervised treatment with visual confirmation of ingestion (directly-observed therapy or “DOT”), is the standard of care for methadone treatment in federally licensed opioid treatment programs (OTPs) in the United States. DOT ensures adherence and mitigates the risk of medication poisonings and diversion; however, these same policies present major challenges to infection control. The COVID-19 pandemic has spurred initiatives to increase the number of non-observed take-home doses. Remote systems for monitoring DOT of methadone and screening of patients for COVID-19 are desperately needed by OTPs: the emocha mobile health provides a solution. Specific Aim #1 is to evaluate the acceptability, feasibility, and outcomes of an innovative mHealth platform to deliver asynchronous video-based DOT services plus COVID-19 symptom screening via smartphone for patients receiving methadone at an opioid treatment program that was implemented rapidly in response to COVID-19. In order to provide remote supervision and recovery support for patients with extended take-home doses due to the COVID-19 pandemic, Evergreen Treatment Services (ETS) rapidly implemented emocha’s video DOT pilot program for patients on methadone for OUD on April 16, 2020 and enrolled 38 patients within 2 weeks. We will conduct a retrospective, observational study of patients who utilized the video-DOT/symptom screening app during this pilot. Specific Aim #2 is to evaluate usability and user experiences of the innovative mHealth platform to deliver asynchronous video-based DOT services plus COVID-19 symptom screening via smartphone for patients receiving methadone at an opioid treatment program that was rapidly implemented in response to COVID-19. A usability study will be conducted with subsets of “high-use”, “medium-use” and “low-use” patients who participated in the pilot and the five counselors who offered the app and used the app’s web-based clinician-facing portal. The researchers will conduct usability testing sessions to objectively measure the duration of time and number of errors associated with completing video-DOT tasks and will obtain subjective ratings of the difficulty and helpfulness of video-DOT tasks and features. This Phase I research will well-position the team to submit a grant for Phase II in order to measure efficacy and further develop the model for business sustainability, which will allow for rapid translation to other OTPs.PROJECT NARRATIVE In early 2020, the opioid epidemic in the United States collided with the global COVID-19 pandemic. COVID-19 poses a particularly grave risk to persons with opioid use disorder (OUD) who are treated with methadone in opioid treatment programs where the standard of care is directly-observed therapy (DOT). The overarching goal of the propose research is to assess the feasibility, safety and acceptability of an innovative mobile health platform to provide asynchronous, video DOT and to screen for symptoms of COVID-19 for patients treated for OUD with methadone.