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

项目总结/摘要 阿片类药物使用障碍（OUD）是一个严重的公共卫生问题，在美国已达到流行水平 States.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OUD患者从监狱、住院戒毒（Detox）或住院治疗中退出时， 在治疗过程中，过量死亡的风险特别高。丁丙诺啡（BUP）可以降低阿片类药物过量的风险 50%，但其阻断效果取决于完全的药物依从性。门诊BUP的保留率较低， 在6个月时仍有不到50%的患者接受治疗。不完全BUP依从性很常见， 复发。最近的研究表明，关注患者对BUP的信念可能是一种有效的方法。 在过量的高风险时期增加BUP使用的重要组成部分。新颖创新 预防阿片类药物过量死亡的方法，可以支持从住院或锁定 在提高药物依从性的同时， 实现阿片类药物过量的显著减少。我们进行了一项以科技为本的试验研究， 集成远程激励增强（RME）会话和日常监督的移动终端应用 通过视频会议从安全的电子药丸分配器给药，以鼓励BUP期间的依从性 MySafeRx治疗该计划表明，高风险患者的药物依从性高， OUD的年轻成年人，并导致非法阿片类药物使用减少50%。然而，对最初的 与BUP的参与期以及是否在住院排毒期间开始通过视频提供RME会话 可以帮助鼓励人们参与门诊BUP治疗，每天监督给药。这个项目 将在160名OUD患者中进行随机对照试验，以评估RME治疗的效果 在BUP治疗中每日给药的排毒后参与。主要目的是检查 RME会话与从住院排毒过渡到治疗参与的单独信息 每日门诊监督下的丁丙诺啡给药。我们预计入组RME组的受试者将 接受门诊BUP治疗的患者中，接受14例观察到的BUP治疗的比例明显较高，> 10例 第2周结束时的剂量与仅提供信息相比。次要目标将检查RME中的影响 + MySafeRx与信息+标准护理（亲自，现场BUP）在门诊BUP中的保留 每日监督给药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 出院后6个月的发病率。我们希望这项研究能产生新的知识， 关于预防药物过量和让患者参与BUP治疗的最有效方法，每日观察 给药，更容易增加BUP治疗的可及性和依从性。

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.