Impact on opioid use of bundling medication-assisted treatment with mHealth
This project pairs medication-assisted treatment (MAT) with an evidence-based, smartphone-delivered relapse prevention system (A-CHESS) to improve long-term recovery from opioid-use disorders.
The goal is to help patients transfer the skills they learn in treatment into their daily lives after treatment and as a result, have greater success in sustained recovery. The project also seeks to understand which elements of treatment work for whom and why so that interventions, especially mobile health interventions, can be made more effective.
The bundle we propose pairs proven MAT with an innovation called A-CHESS.
As Dr. Nora Volkow, Director, NIDA, testified before the House in April 2014, effective treatment for opioid dependence requires medication, behavioral interventions, screening for infectious disease, and overdose protection. Yet few patients receive such a bundle of services.
Opioid dependence has devastating consequences on patients, family members, and communities. In the US in 2012, an estimated 2.1 million people had opioid use disorders (OUDs) related to prescription opioids and 467,000 people had OUDs related to heroin. Healthcare costs related to prescription opioid abuse were estimated at $25.0 billion in 2007, and total societal costs at $55.7 billion. OUDs also drive new infections with hepatitis C virus (HCV) and HIV. Very few patients with OUD get treatmentÃ¢â‚¬â€in 2012, only 10.7% of those who needed it. Of those who do receive treatment, most relapse. Even those who receive MAT generally do not maintain long-term abstinence (a key goal of this project). Innovation is urgently needed to improve access and long-term outcomes for OUD.
We propose to randomly assign 440 opioid users from 3 addiction treatment centers to receive MAT + A-CHESS or MAT alone and follow patients for 24 months. We will use quantitative and qualitative analyses to compare long-term impact, with data collected every 4 months over the 24-month period. Specific aims are:
- Aim 1 (Primary). Detect the difference in illicit opioid use between patients who have MAT + A-CHESS vs. MAT alone.
- Aim 2 (Secondary). Detect differences between patients who have MAT + A-CHESS vs. MAT alone in terms of: quality of life; retention in treatment; unscheduled use of health services; and, for HCV and HIV, screening rates, risk behaviors, testing, and among those infected, treatment initiation.
- Aim 3 (Secondary) Understand how the 3 constructs of self-determination theory (competence, relatedness, and intrinsic motivation) and negative affect act as mediators between outcomes and MAT + A-CHESS vs. MAT alone.
- Aim 4 (Secondary). Understand whether gender moderates the impact of MAT + A-CHESS vs. MAT alone.
- Aim 5 (Secondary). Understand whether communication style in A-CHESS predicts opioid use.
- Aim 6 (Exploratory). Describe: (1) the differences between people who respond better to MAT + A-CHESS vs. those who do not, (2) the struggles in implementing and sustaining the interventions, and (3) the relationship between outcomes and using A-CHESS.
Partners / Participant Sites
- SSTAR Addiction Treatment, Fall River, MA
- Gosnold on the Cape, Cape Cod, MA
- Access Community Health Center, Madison, WI
- Funding Period:
- July 1, 2015 - May 31, 2020
- Principal Investigators:
- David Gustafson Sr., Ph.D
- Gina Landucci, Study Coordinator