OUD Patients Will Take Video of Their Buprenorphine Dosing

Will patients who are prescribed buprenorphine for treatment of an opioid use disorder (OUD) be more likely to stay on their medication regimen if they're asked to submit video of themselves taking the drug?

Researchers at treatment sites in Massachusetts and Washington have launched a 12-week randomized study in which buprenorphine outpatients will use a mobile app allowing for direct observation of their use of the medication. To be conducted at Boston Medical Center and Harborview Medical Center, the trial will compare adherence outcomes between patients who use the app and those who receive standard care.

Patients using the app, developed by Baltimore-based technology company emocha Mobile Health, will be asked to submit a video of themselves taking the film or tablet formulation of buprenorphine once a day. With adherence to a medication that is taken outside of a controlled setting being a challenge, “This is an extra reminder, an extra incentive,” says Alicia S. Ventura, MPH, director of special projects and research for the Office-Based Addiction Treatment (OBAT) team at Boston Medical Center.

“This may help patients overcome [opioid] cravings,” Ventura tells Addiction Professional, referring to one of the main precipitating factors for relapse to opioid use.

Second phase of research

Financed by the National Institute on Drug Abuse (NIDA) through its Small Business Innovation Research initiative, the study represents the second phase of an analysis of the feasibility and effectiveness of the mobile app. The first phase, conducted at Harborview, gauged patient and provider viewpoints on possible reasons for poor adherence to buprenorphine and whether directly observed therapy could improve the situation.

Some providers who participated in the first phase suggested that the process could prove too burdensome to patients and might even discourage use of the medication. This helped to inform the protocol for phase two, in which patients who take more than one buprenorphine dose a day will not be required to take video of every session.

Forty patients apiece are being recruited for the two study sites. Those who are randomized to the mobile app condition will be familiarized with the process for taking video of their dosing. They will be asked to clearly show their medication in the video, show themselves taking the medication, and continue the video as the drug is being absorbed in their mouth.

The videos will be uploaded to a central portal, where a researcher will be able to observe them and evaluate whether they meet the agreed-upon standards. Reasons why a particular video might not be considered acceptable could include not being able to verify that the drug being taken is buprenorphine, or that the drug was fully absorbed.

Patients in the study also will submit urine drug tests, so that researchers can evaluate the presence of both buprenorphine and any illicit substances the patients may be taking, says Ventura, whose treatment team at Boston Medical Center serves around 700 OUD patients annually. .

In real-world practice, the theory would be that the outpatient clinician's ability to monitor dosing might help to create more conversations and a better working relationship between the patient and the provider.