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

远程动机增强和 MySafeRX 对丁丙诺啡治疗中戒毒后参与度和保留度的影响

• 批准号: 9791130
• 负责人: Kathleen Anne Moore
• 金额: $ 75万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9791130
• 关键词: Effects; remote; motivational; enhancement; MySafeRX

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.

项目概要/摘要 阿片类药物使用障碍（OUD）是一个严重的公共卫生问题，在美国已达到流行程度 国家。自 1999 年以来，阿片类药物过量死亡增加了 400% 以上，目前已成为导致阿片类药物过量死亡的主要原因 过早死亡。当 OUD 患者离开监狱、住院戒毒 (detox) 或住院治疗时 治疗时，服药过量死亡的风险特别高。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充分的用药依从性。门诊 BUP 保留率较低 6 个月时剩余治疗人数不足 50%。 BUP 依从性不完全很常见，并且与 并复发。最近的研究表明，关注患者对 BUP 的信念可能是 在药物过量的高风险期增加 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患者的安全过渡 迫切需要为门诊 BUP 治疗提供环境，同时提高药物依从性 显着减少阿片类药物过量。我们已经进行了基于技术的试点研究 移动设备应用程序将远程激励增强 (RME) 课程与日常监督相结合 通过视频会议从安全电子药丸分配器给药，以鼓励 BUP 期间的依从性 治疗称为 MySafeRx。该计划证明了高危人群的药物依从性很高 年轻人使用 OUD 并导致非法阿片类药物使用减少 50%。然而，人们对最初的情况知之甚少 与 BUP 的接触时间以及是否在住院戒毒期间开始通过视频提供 RME 课程 可以帮助鼓励人们参与门诊 BUP 治疗并每日监督剂量。这个项目 将在 160 名 OUD 患者中进行一项随机对照试验，以评估 RME 疗程的效果 戒毒后每日服用 BUP 治疗。主要目的是检验效果 从住院戒毒到戒毒过渡期间，RME 课程与仅有关治疗参与度的信息相比 每日在门诊监督下服用丁丙诺啡。我们预计加入 RME 部门的参与者将是 参与门诊 BUP 治疗的比例显着较高，在 14 次观察到的 BUP 治疗中，接受 > 10 次的比例明显较高 第 2 周结束时的剂量与仅信息的比较。次要目标将检查 RME 中的效果 + MySafeRx 与信息 + 关于门诊 BUP 保留的标准护理（亲自、现场 BUP） 每日监督用药以及非法阿片类药物使用、阿片类药物过量和过量死亡的治疗 住院戒毒出院后 6 个月内的比率。我们期望这项研究将产生新知识 关于预防用药过量和让患者接受 BUP 治疗的最有效方法，每天观察 剂量，从而更容易提高 BUP 治疗的可及性和依从性。