BEST-OUD: Behavioral Economic Screening Tool of Opioid Use Disorder for use in clinical practice

PROJECT SUMMARY Fatal overdose from opioid misuse is one of the most pressing issues affecting the modern worldAs one of the nation s leading preventable causes of deatha critical line of defense against opioid use disorderOUDmust be standardized screening provided by the patient s primary care physicianpsychiatristand or counselorStandardized screening methods for opioidshoweverare simply inferior and no gold standards existReform proposals call for improved technology for electronic screening to save time and improve standards of careMoreoverthe National Institute of Mental Health s Research Domain CriteriaRDoCframework prescribes a focus on defining the underlying functional dynamics of OUD instead of using symptom based tools as biomarkers for diseaseThereforethe present proposal aims to develop a validatedtheoretically guided toolwhich provides clinicians with information beyond OUD symptomsReinforcer pathology is a measure of severity derived from the synergy between two distinct decision making processespreference for immediately available small rewardsi eexcessive delay discountingandover valuation of substances such as opioid prescription pillsi ehigh behavioral economic demandParamount to this proposaldecades of research have concluded that delay discounting and demand are highly correlated with substance use severity and important predictors of OUD treatment successIn order to develop a feasible and acceptable reinforcer pathology based mobile tablet applicationBEST OUDfor use in the clinicthe present proposal aims to recruit clinicians to provide feedback via semi structured interview sessionsAimand integrate the BEST OUD application into their practiceAimaDevelopmentiterationand maintenance of the appincluding the user interface and back endsecure databasescore calculationand associated web portal will be built and maintained by BEAM DiagnosticsIncAimA total of three tool prototype iterationsbased on clinician feedbackwill be administered to clinic patients throughout the testing period to collect reinforcer pathology scores and patient feedbackAimbThis reinforcement pathology assessment tool is innovative given its propensity to bypass self report of past substance use behavior and OUD symptomsand prospectively predict severity based on a theoretical frameworkmaking this Phase I STTR application both timely and necessary PROJECT NARRATIVE Currentlyovermillion Americans suffer from opioid use disorderOUDa disease characterized by significant impairment or distressand many of these individuals will ultimately transition to strongerillegaland dangerous opioids such as heroinyet the current standardized screening measures for opioid misuse in clinical practice are poor and test only symptoms of past behaviorInsteadand in response to National Institute of Health s call for increased translation of theoretically based screening tools that examine core functions of substance use disordersthe reinforcer pathology framework examines an individual s decisionmaking processes about opioid use providing the clinician with more information about patient OUD severity and prospective riskThe current proposal seeks to develop and test the feasibility of a reinforcer pathology mobile tablet application to rapidly assess OUD severity and risk in the clinicproviding improved screening of vulnerable patients