Effects of remote motivational enhancement and MySafeRX on post-detox engagement and retention in buprenorphine treatment

项目摘要/摘要 阿片类药物使用障碍(OUD)是一个严重的公共卫生问题，在美国已经达到流行水平。 各州。自1999年以来，阿片类药物过量死亡人数增加了400%以上，现在已成为 过早死亡。当人们从监狱、住院戒毒(戒毒)或住宅区出来时 在治疗过程中，过量用药死亡的风险特别高。丁丙诺啡(BUP)可降低阿片类药物过量风险 50%，但其阻断效果取决于完全的用药依从性。门诊BUP中的滞留率较低 6个月后仍在接受治疗的患者不到50%。不完全遵守BUP是常见的，并与 故态复萌。最近的研究表明，关注患者对BUP的看法可能是一种 在过量用药的高危时期增加BUP使用量的重要组成部分。新颖创新 预防阿片类药物过量死亡的方法，以支持从住院或锁定的安全过渡 在提高服药依从性的同时，迅速需要门诊BUP治疗的环境 实现有意义的阿片类药物过量减少。我们已经进行了基于技术的 将远程激励增强(RME)会话与日常监督相集成的移动设备应用 通过视频会议从安全的电子药片分配器给药，以鼓励在BUP期间坚持服药 治疗称为MySafeRx。这项计划展示了高危人群中高水平的用药依从性 年轻人服用OUD并导致非法阿片类药物使用减少了50%。然而，人们对初始的 与BUP的参与期，以及在住院患者戒毒期间是否通过视频提供RME课程 可以帮助鼓励人们参与门诊BUP治疗，每天监督剂量。这个项目 将在160名患有尿毒症的患者中进行随机对照试验，以评估RME疗程的效果 在每日剂量的BUP治疗中关于戒毒后的参与。主要目的是检查以下因素的影响 RME会议与住院患者从戒毒到戒毒过渡期间的治疗参与信息 丁丙诺啡每日门诊监督剂量。我们预计在RME ARM注册的参与者将是 接受门诊BUP治疗的比例明显高于接受&GT；14个观察到的BUP中的10个 第二周结束前的剂量与仅有信息。次要目标将检查RME中的那些影响 +MySafeRx与信息+标准护理(面对面、现场BUP)在门诊BUP中的保留 每日监督剂量治疗以及非法阿片类药物使用、阿片类药物过量和过量死亡 住院患者戒毒出院后6个月内的发生率。我们希望这项研究将产生新的知识 关于预防过量用药和让患者参与每日观察的BUP治疗的最有效方法 剂量，使增加BUP治疗的机会和依从性变得更容易。

PROJECT SUMMARY/ABSTRACT Opioid use disorder (OUD) is a serious public health problem that has reached epidemic levels in the United States. Opioid overdose deaths have increased by over 400% since 1999 and are now a leading cause of premature death. When people with OUD step down from prison, inpatient detoxification (detox), or residential treatment, the risk of overdose death is particularly high. Buprenorphine (BUP) can reduce opioid overdose risk by 50%, but its blocking effect depends on full medication adherence. Retention in outpatient BUP is low with less than 50% remaining in treatment at 6 months. Incomplete BUP adherence is common and is associated with relapse. Recent research has demonstrated that attention to patients' beliefs about BUP may be an important component to increase the use of BUP during high-risk periods for overdose. Novel innovative approaches to prevent opioid overdose deaths that can support safe transition from inpatient or locked environments to outpatient BUP treatment while enhancing medication adherence are rapidly needed to achieve meaningful reductions in opioid overdoses. We have conducted pilot studies of a technology-based mobile device application integrating remote motivational enhancement (RME) sessions with daily supervised dosing from secure electronic pill dispensers via videoconference to encourage adherence during BUP treatment called MySafeRx. This program demonstrated high levels of medication adherence among high-risk young adults with OUD and led to 50% reduction in illicit opioid use. However, less is known about the initial engagement period with BUP and whether offering RME sessions via video starting during inpatient detox could help encourage people participate in outpatient BUP treatment with daily supervised dosing. This project will conduct a randomized controlled trial among 160 people with OUD to evaluate the effect of RME sessions on post-detox engagement in BUP treatment with daily dosing. The primary aim is to examine the effect of RME sessions versus information alone on treatment engagement during the transition from inpatient detox to daily outpatient supervised dosing of buprenorphine. We expect that participants enrolled in RME arm will be engaged in outpatient BUP treatment with significantly higher proportion receiving > 10 of 14 observed BUP doses by the end of week 2 versus information alone. Secondary aims will examine the effect of those in RME + MySafeRx versus information + Standard Care (in-person, onsite BUP) on retention in outpatient BUP treatment with daily supervised dosing as well as on illicit opioid use, opioid overdoses, and overdose death rates in the 6-months after discharge from inpatient detox. We expect this study will generate new knowledge about the most effective way to prevent overdose and engage patients in BUP treatment with observed daily dosing, making it easier to increase BUP treatment access and adherence.