Smartphone-based rewards as a bridge to treatment for naloxone reversal patients

ABSTRACT Opioid overdose is a major public health crisisand a clear sign of problem drug useMany people who experience an overdose receive a naloxone reversal and are treated in a hospital emergency departmentHoweverfew overdose survivors enroll in treatmenteven if they receive care and referral to treatment while in an emergency departmentMedication assisted treatmentsMATsuch as methadone or buprenorphineare among the most effective treatments for opioid use disorderand effectively prevent overdosePromoting entry into MAT in people who received a naloxone reversal and overdose related care in an emergency department could reduce the risk of additional overdoseContingency managementCMinterventions have successfully improved a broad range of health behaviors including medication adherence and treatment attendanceIn CMincentives are made available contingent upon objective verification that the patient has engaged in a specified target behaviorFor examplea participant could receive cash or prizes in exchange for a drug toxicology test that indicated recent drug abstinenceWe believe a similar approach could promote entry into MATIf it doesthen we believe the intervention will be of substantial interest to health care payersThusthe purpose of this study is to develop a smartphone based intervention to promote MAT entry and engagement for people with opioid use disorderWe will specifically target people who received naloxone reversal and care in an emergency departmentThe applicant organizationDynamiCare Incis at the leading edge of the development and commercialization of low costhighly scalable CM technology and associated implementation for substance use disordersWe have a fully functionalfield tested intervention that facilitates CM adoption by lifting the burden of effort from the provider and placing control in the hands of the patientTo dateour focus has been on developing and evaluating this system to promote longitudinal retention and abstinenceUnder this application we intend to address the challenge of acute care motivation for initiation and engagement with MATThusin addition to our appandapos s current robust array of featureswe will need to add several othersa system for prompting users with incentives to input self generated reasons for seeking treatment and potential benefits of treatmentand a reframing of our existing selfie video system for salivary drug toxicology testing as a system for medication adherenceWe will manualize the intervention for deployment in emergency departmentsAfter the intervention has been tailored to the target population and the manual has been developed we will conduct a pilot studyNin naloxone reversal patients who seek treatment in emergency departments in KalamazooMIThe intervention will be available for up to two monthsIncentives will be supplied for key treatment seeking behaviorsengagement behaviorsand MAT adherenceThe intervention and technology will be revised as needed to prepare for Phase II and ultimate commercialization PROJECT NARRATIVE Medication assisted treatments for opioid use disorder are effective in reducing opiod use and preventing overdosebut the vast majority of out of treatment opioid users who experience an overdose and receive care in an emergency department fail to transition to treatmentWe propose to develop and evaluate a smartphonebased system for delivering a motivational intervention that will serve as a bridge between emergency department overdose services and enrollment in medication assisted treatmentIf successfulthis intervention will have robust commercialization potentialbecause payers see enrollment into treatment for opioid use disorder as a means of preventing more costly procedures and services such as those received in emergency departments