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 yearleading to thousands of deaths and costing billions of dollars in total economic burdenMedication assisted treatmentMATfor opioid use disorderOUDis highly efficaciousbut only a fraction of OUD persons access MATand treatment non adherence is common and associated with poor outcomesThis STTR Fast Track proposal is designed to increase rates of Suboxonebuprenorphine naloxonetreatment initiation and adherence among OUD patients recruited from emergency and inpatient acute careTo accomplish these aimsthe project will enhance the Opioid Addiction Recovery SupportOARSan existing Q i company technologywith a new evidence based rewardcontingency managementCMfunctionCM interventions systematically rewardreinforcespecific behaviors like treatment initiation and adherence with therapy attendance and drug free urine testsand are highly efficaciousAn OARS solution enhanced with a CM componentOARS CMthat allows for the automatic calculationdeliveryand redemption of rewards contingent on objective evidence of treatment behaviors may be key to improving Suboxone initiation and adherenceIn Phaseof this proposalthe existing OARS clinician portal and patient mobile application will be 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 principlesUsability sessions with OUD patients and other key stakeholders will inform designPrimary usability outcomes will be examined and the program iteratively updatedOn meeting milestonesthere will be proof of concept pilot of usabilityacceptabilityand effects on initial behavior targets with approximatelypatients and at leastprovidersOn meeting milestonesa RCT will followin which acute care OUD patients appropriate for outpatient SuboxoneNare recruited and allocated to one of three study conditionstreatment as usualTAUcomprised of screeningbrief interventionand referral to treatment by a trained clinicianOARSandOARS CMThe active intervention window for the two intervention groups will beweeksPatients will be onboarded prior to discharge from acute careIn the outpatient Suboxone settingdata on treatment adherence and opioid use will be captured from clinical records for six monthsTelephone follow up assessments and vital statics registry reviews will be at monthmonthend of study intervention periodand monthPrimary Suboxone treatment initiation outcomes will be scheduling and completing the Suboxone intakePrimary Suboxone treatment outcomes will be sustained abstinence at Monthand longest duration of abstinenceAnalysis will examine data on cost avoidance and cost savings through reduced acute care visits between study conditions PROJECT NARRATIVE Public Health Relevance Increasing the demand and reach of effective Medication Assistance TreatmentMATfor opioid use disorderOUDis critical to decreasing OUD associated morbiditymortalityand economic consequencesThe technology breakthrough to be studied in this project will give individuals with OUD access to a smartphone application designed to help support initiation and adherence with MAT treatment regimens through patientoriented educational and monitoring featuresas well as a new evidence based reward function shown in other research to promote treatment adherenceimprove abstinenceand improve other health outcomesThe intervention will aim to facilitate the entire treatment trajectorystarting with initial transition from an acute care setting to outpatient MAT initiation and continuing through successful transition to maintenance