Remote observed dosing to improve Suboxone compliance in clinical practice

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PROJECT SUMMARY Opioid Use Disorder (OUD) is a major public health problem. Although several effective treatments that mitigate withdrawal and promote abstinence have been developed and are widely used, physicians have expressed hesitation in prescribing them due to misuse and diversion. The most recent of these treatments, buprenorphine (Suboxone®), can be prescribed by physicians in private practice. While Suboxone® has a lower abuse liability and decreased risk of overdose than methadone, compliance is low and diversion is an ongoing problem. The goal of this project is to develop and test the preliminary efficacy of using remote compliance monitoring in buprenorphine (Suboxone®) treatment for OUD. To that end, 40 subjects with OUD will be recruited through the University of Pennsylvania's Treatment Research Center, an outpatient substance abuse treatment facility. All subjects will receive a smartphone (and data plan); buprenorphine (Suboxone®) (16 mg/day, adjusted as needed according to individual requirements); and counseling in the form of weekly Medication Management (MM) for 12 weeks. Participants will be randomized into one of two groups: remote compliance monitoring or an attention match group that mirrors current clinical care. Using an iterative process we propose to develop an innovative, low cost, and scalable platform physicians can easily integrate into their private practice. Findings from the study will be used to support an R01 application to test the use of remote compliance monitoring in a larger prescription opiate-dependent sample in clinical practices. This methodology has broad applications for increased compliance in office-based treatment for addiction and other chronic medical conditions.