New research funded by the National Institute on Drug Abuse (NIDA) will address a challenge to successful buprenorphine treatment for opioid dependence: the traditional inability to monitor regular compliance with medication schedules in the way clinic-based methadone treatment programs can.
A $1.7 million award from NIDA will allow a Baltimore-based startup company and two academic medical centers to test the potential of video-enabled directly observed therapy (DOT) to enhance retention in buprenorphine treatment and to improve drug use and quality-of-life outcomes.
“Buprenorphine has tremendous potential but is also tremendously underutilized,” says Katrina Rios,. research lead for the Baltimore company, emocha Mobile Health. Rios tells Addiction Professional that this technology could achieve benefits “for patients who want autonomy and structure at the same time.”
The autonomy will come in the form of still being able to take the medication for opioid dependence at home, at work, or wherever convenient. The structure will involve using a mobile app that will allow for direct observation of the patient taking the medication. High dropout rates from treatment pose a problem in buprenorphine maintenance, particularly in the earliest stages of treatment.
emocha Mobile Health, established more than three years ago under the direction of a Johns Hopkins University student at the time, has used its video-based DOT technology to assist public health agencies in monitoring tuberculosis patients, and has applied the technology to hepatitis C care as well. Rios says the technology can offer peace of mind to treatment programs, patients, and insurers as well.
The company is working with the University of Washington School of Medicine and Boston Medical Center on the research project. The first phase of the research, Rios explains, will take place at the University of Washington and will test the feasibility of the technology with a group of 10 to 12 patients for six to eight weeks. Information from the first phase will help determine how a multi-site clinical trial in phase two will be structured, she says, such as in the timing of when the DOT technology will be offered and to whom. In phase two, 40 patients at each study site will be randomized to the DOT protocol or standard treatment for 12 weeks.
Findings from the first phase will help answer questions such as whether it would be most effective to offer DOT on a widespread basis at treatment initiation or if it should be used more as a last-resort intervention for patients who struggle under the typical buprenorphine treatment structure.
Rios says the research will measure numerous outcomes, including results on urine drug screens, retention in treatment, indicators of medication diversion, use of other illicit substances such as cocaine, and quality-of-life measures.