MySafeRx: An integrated mobile platform for buprenorphine adherence

MySafeRx：用于丁丙诺啡依从性的集成移动平台

基本信息

批准号：
9253360
负责人：
Zev David Schuman Olivier
金额：
$ 24.3万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-04-15 至 2019-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9253360
关键词：
Abstinence Adherence Adult Aftercare Age Agonist Area Buprenorphine Caring Cellular Phone Cessation of life Clinical Cost Analysis Dose Dropout Drops Elderly Enrollment Ensure Euphoria Evaluation Failure Foundations Funding Goals HIV Health Care Costs Health Personnel Hepatitis C Hepatitis C Transmission Individual Infection Intervention Link Manuals Measures Motivation Naloxone National Institute of Drug Abuse Opiate Addiction Opioid Opioid Analgesics Outpatients Overdose Participant Patient Self-Report Patients Pharmaceutical Preparations Physicians Poisoning Prevention Process Protocols documentation Public Health Randomized Recovery Recruitment Activity Relapse Reporting Resources Risk Rural Sampling Secure Self Administration Standardization Supervision Support System System Systems Integration Technology Testing Text Therapeutic Therapeutic Effect Time Toxicology Treatment Failure Treatment outcome Urine Ventilatory Depression Vermont Videoconferences Videoconferencing Visit Vulnerable Populations Youth base behavioral health clinical efficacy craving dual diagnosis high risk high risk population improved mobile computing motivational enhancement therapy mu opioid receptors opioid abuse opioid use opioid withdrawal overdose death pill pilot trial prescription opioid misuse prevent programs public health relevance randomized trial rural area standard care therapy development treatment effect treatment program trial comparing usability week trial young adult

项目摘要

DESCRIPTION (provided by applicant): Opioid Dependence is a serious public health issue. Opioid-related overdose deaths are the leading cause of drug-related overdose and more than 100 people die each day in the US due to drug overdose. Rates of Hepatitis C infections have increased dramatically among young adults. Buprenorphine/naloxone (B/N) is a medication that can prevent opioid overdose and block the ability to get high from illicit opioids. B/N also averts opioid withdrawal and decreases craving. Therefore, taking B/N daily reduces relapse and prevents overdose each day it is taken. Extended treatment with B/N increases rates of recovery and keeps people engaged in treatment. When an opioid abuser is in B/N treatment, the risk of transmitting Hepatitis C and HIV are reduced. Staying in treatment is important because dropout is associated with relapse and a high risk of overdose death. While many people with opioid dependence achieve stability in B/N treatment, 50% relapse or drop out within the first year; B/N treatment failure is strongly associated with younger age. Taking B/N every day can be critical for helping young people stay in treatment and avoid relapse. In a study of opioid dependent youth, 93% of those who took B/N at least 5 days each week were still in treatment after 12 weeks compared with only 57% of less adherent participants. Also, when patients prescribed B/N do not take their full dose, then they may sell it or share it with others; this diversion is worrisome and intensifies physician reluctance to treat people with opioid dependence. The MySafeRx integrative therapy platform provides a higher level of care for vulnerable adults with opioid dependence during periods of instability by providing daily motivational recovery support delivered remotely via videoconference in combination with supervised self-administration of B/N from a secure electronic pill dispenser. By offering this higher level of care during risky periods and ensuring daily medication-taking, MySafeRx could improve treatment and save lives. The goal of the MySafeRx project is to integrate text messaging reminders, secure electronic pill organizers, and daily remote brief motivational recovery support visits with a standardized protocol for supervised self- administration of B/N via videoconferencing. This systems integration approach could become the foundation for a nationwide adjunctive treatment program supporting office-based opioid treatment providers and caring for vulnerable patients. This program could expand access to B/N for marginalized, high-risk groups and those living in areas with minimal treatment resources. Providing targeted motivational recovery support each day at the moment of medication-taking when patients are most receptive to participating in treatment is central to the concept of MySafeRx. We will recruit 70-96 vulnerable, unstable opioid dependent patients (<35 years old) from rural physician practices in Southwest Vermont by enrolling patients during buprenorphine induction and after illicit opioid lapse during treatment. We will conduct a pilot trial comparing MySafeRx versus standard care on rates of B/N adherence, opioid use, and treatment retention.

描述（由申请人提供）：阿片类药物依赖是一个严重的公共卫生问题，阿片类药物过量死亡是药物过量的主要原因，美国每天有超过 100 人因药物过量死亡。丁丙诺啡/纳洛酮 (B/N) 是一种可以预防阿片类药物过量并阻止因非法阿片类药物感染而产生兴奋感的药物。避免因此，每天服用 B/N 可以减少复发，并防止每天服用过量。继续治疗很重要，因为退出治疗会导致复发和过量死亡的高风险，尽管许多阿片类药物依赖者在 B/N 治疗中达到稳定，但 50% 的复发或死亡。降低在对阿片类药物依赖的青少年进行的一项研究中，每天服用 B/N 对于帮助年轻人坚持治疗并避免复发至关重要。每周至少服用 5 天 B/N 的患者在 12 周后仍在接受治疗，而依从性较低的参与者中只有 57% 的人仍在接受治疗。此外，当服用 B/N 的患者没有服用全部剂量时，他们可能会出售或分享药物。与其他人一起；这种转移是MySafeRx 综合治疗平台通过视频会议远程提供每日动机恢复支持并结合监督的自我管理，为不稳定时期阿片类药物依赖的弱势成年人提供更高水平的护理。通过在危险时期提供更高水平的护理并确保每日服药，MySafeRx 可以改善治疗并挽救生命。 MySafeRx 项目旨在将短信提醒、安全电子药丸组织者和每日远程简短激励恢复支持访问与标准化协议相结合，以便通过 B/N 进行监督自我管理这种系统集成方法可以成为支持基于办公室的阿片类药物治疗提供者和照顾弱势患者的全国辅助治疗计划的基础。该计划可以扩大边缘化、高风险群体和居住在地区的人获得 B/N 的机会。每天在患者最愿意参与治疗的服药时刻提供有针对性的动机恢复支持是 MySafeRx 概念的核心。通过在丁丙诺啡诱导期间和治疗期间非法阿片类药物失效后招募来自佛蒙特州西南部乡村医生诊所的 70-96 名脆弱、不稳定的阿片类药物依赖患者（<35 岁），我们将进行一项试点试验，比较 MySafeRx 与标准护理的发生率。 B/N 依从性、阿片类药物使用和治疗保留。