Providing patients with a video smartphone app they could use to confirm their adherence to taking medications to treat opioid addiction failed to reduce illicit drug use or increase patient engagement, according to a small, randomized-controlled trial.
In the study, patients were provided smartphones with a secure video app that allowed them to document their use of the medication buprenorphine. Buprenorphine reduces the craving for opioids and the symptoms of drug withdrawal. One of the advantages of buprenorphine is that, unlike methadone, another common therapy for opioid addiction, it does not require patients to make daily clinic visits to receive their medication. Instead, patients can pick up their buprenorphine prescriptions from a doctor's office and take the drug on their own. Nevertheless, adherence to treatment is poor, with many patients failing to take their buprenorphine regularly. Dropout rates are high.
One strategy to improve medication adherence is to employ a practice called directly observed therapy (DOT) in which healthcare workers watch patients take their medicine. DOT with case management has been used, for example, to improve adherence in tuberculosis treatment, which involves a difficult-to-follow medication schedule for patients. The use of DOT with or without video enablement is not a standard practice with buprenorphine treatment.
In the study, researchers wanted to see if patients would do better taking their buprenorphine if they were provided a smartphone that allowed them to confirm medication adherence via a secure video app.
The study was conducted in Seattle and Boston and was funded by the National Institutes of Health. The researchers reported their findings in the journal Drug and Alcohol Dependence. The principal investigator of the study was Dr. Judith I. Tsui, associate professor of medicine at the University of Washington School of Medicine.
The researchers enrolled 78 patients who were just starting office-based buprenorphine treatment. The patients were assigned randomly to two groups: one received prescribed buprenorphine to take at home and were required to come into the clinic for monitoring at the provider's discretion, usually weekly at the onset of treatment.
In the smartphone-app group, participants received usual care but were also provided the app - with phone if they did not have their own - and were asked to upload at least one video a day showing them taking buprenorphine. Reminders were sent if a patient did not submit a video by a certain time of day, and patients were provided calendar summaries and positive messaging for videos submitted.
Researchers compared the two groups after 12 weeks of participation to see if there was a difference in the percentage of urine tests that were positive for the presence of drugs over time, as well as the percentage of participants who were still engaged in the program at the study's conclusion.
The researchers found that use of the video-DOT smartphone app with minimal engagement support did not improve outcomes. On average, participants uploaded the DOT videos only 31% of the time. There was no statistical difference in the results of the urine drug tests nor the percentage of participants that continued to be engaged in treatment at 12 and 24 weeks.
The researchers noted that adherence may have been difficult for these patients because they were quite impoverished: 80% were unemployed and 40% homeless. In addition, many suffered psychiatric illnesses. But some patients did regularly upload their videos, a finding that suggested that such mobile health interventions may appeal to a subset of patients.
"Future research should explore whether video DOT for buprenorphine may be effective when offered with financial rewards or in exchange for reduced need for in-person visits, or coupled with greater human supports," they stated.
This research was supported by a Small Business Innovation Research grant from National Institutes of Health/National Institute on Drug Abuse (R44DA044053) and a grant from the UW Center for AIDS Research for HIV related research and prevention. That program is funded through National Institute of Allergy and Infectious Diseases (P30AI027757).
