New Technology Aims to Improve Buprenorphine Treatment in Young Adults

New Technology Aims to Improve Buprenorphine Treatment in Young Adults- Join Together News Service from the Partnership for Drug-Free KidsWhen addiction treatment specialist Zev Schuman-Olivier, MD, found that young adults taking buprenorphine to treat their opioid addiction often stopped using the medication, he began looking for a novel way to address the problem. He is now testing an integrated mobile system that incorporates smartphone videoconferencing and a secure electronic medicine dispenser to allow young adults to take their daily buprenorphine at home, under remote supervision of a recovery coach.

The system, called “MySafeRx,” allows a person taking buprenorphine at home to have a daily videoconference with a mobile recovery coach. After a recovery check-in, the coach uses the MySafeRx Android smartphone app, which has been designed to interface with the Medicasafe pill dispenser, to request a unique access code, which the coach releases through the app to the participant’s smartphone. The participant enters the code into the medicine dispenser, which then releases that day’s buprenorphine dose. By providing daily support each morning at the time of medication-taking, it offers a crucial opportunity to help support recovery.

The recovery coach sends a status update to the patient’s prescriber, to let them know if the patient has taken their daily dose, used any substances, and achieved their recovery daily goals.

Dr. Schuman-Olivier explains that a big advantage of buprenorphine over methadone is that a person does not have to come into a clinic daily to get their medicine. Patients generally receive a prescription for a month’s worth of buprenorphine from their doctor at a time. However, many people being treated for opioid addiction benefit from the structure of checking in with someone every day, he said. Having someone supervise them taking the medication ensures that the patient is taking it, and not diverting it—giving or selling it to someone else.

“I thought, what if we could provide that support and structure at home, ensure they take their medication, and also have the opportunity to have recovery coaching every morning?” said Dr. Schuman-Olivier, Instructor in Psychiatry, Harvard Medical School and Geisel School of Medicine at Dartmouth, Medical Director, Addictions at Cambridge Health Alliance and Investigator, Center for Technology and Behavioral Health at Dartmouth. “The empathy from another person can be very helpful in recovery. But it would be too expensive and time-consuming to have a person drive to the patient’s house every morning.” MySafeRx is a more cost-effective and time-saving solution, he added.

In a study published in 2014, Dr. Schuman-Olivier found that compared to older adults, young adults ages 18-25 remained in treatment at significantly lower rates at three months and 12 months, and were significantly more likely to test positive for illicit opioid, relapse, or drop out of treatment. After one year, only 17 percent of young adults were still in treatment, compared with 45 percent of older adults. Young adults were more likely to keep using opioids during the first three months, which is likely due to not taking the medication daily, since taking the medication every day blocks any euphoria from illicit opioid use and sharply reduces overdose risk.

He notes that retaining young adults in buprenorphine treatment is important because dropout is linked with relapse and overdose death. The first month or two of buprenorphine treatment is especially critical, he said. “If we can do something to help people adhere to buprenorphine treatment during the high-risk time of early recovery and get to abstinence even for a month or two, it gives them a chance to get a hold over the power of opiate addiction and get a good foothold in recovery,” said Dr. Schuman Olivier.

With funding from the National Institute on Drug Abuse, he will be running two pilot studies of MySafeRx in vulnerable young adults, ages 18 to 34, who have been prescribed buprenorphine but continue to use illicit opioids or who have had a relapse. The first study of 12 patients, in Somerville, Massachusetts, will offer MySafeRx for four weeks, while the second study in Bennington, Vermont, with 70 to 96 young adults, will be six weeks long.

The Vermont study will evaluate how patients and prescribers rate the system’s acceptability and usability. It will also look at the efficacy of MySafeRx compared with patients receiving standard buprenorphine treatment, based on weekly self-reports of medication adherence. Patients in both groups will undergo weekly urine testing to verify whether they are abstaining from opioid use.

Dr. Schuman-Olivier hopes the next step will be to design a study that would compare groups of people who use MySafeRx for varying amounts of time, to determine the optimal time a person can benefit from the program.

MySafeRx is not commercially available, Dr. Schuman-Olivier noted. “Our hope is if the pilot testing goes well, it will teach us a lot about how we could roll this out on a much larger level,” he said. “With nearly half of all adults dropping out of buprenorphine treatment within a year, this really has the potential to provide the extra level of support that is needed during high-risk periods of treatment.”

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    Aileen Dodge

    June 15, 2016 at 10:29 AM

    I am sure your studies will prove very successful. I hope this Medical tool is developed and approved and that Training for its use is implemented ASAP. This Medical tool is long over due. Currently we are all hyper focused on the number of heroin and opioid related deaths in this country. But those overdose deaths are soon going to be replaced with illegally purchased (street sold) Suboxone. Currently there are Statistic for the illicit sale of take home Methadone and the number of deaths related to the illegal sale of take home doses of Methadone. However, there seems to be a Media Black out when it comes to educating the public about just how DANGEROUS Methadone is!! This totally amazes me.
    I know this medical tool if approved would pay for itself within 6 months of use. This tool could create Jobs though out a number of industries. And the greatest benefit of having the use of this medical tool is the number of lives it would save and improve!!!
    I believe this Medical tool could prove to be VERY USEFUL through out the MEDICAL COMMUNITY! Specialties such as Mental Health, Oncology, Endocrinology just to name a few.
    I know young adults on both spectrum’s of this issue. Some of them were on Methadone and had to beg to get off and go see the ONE DR. at the same public health clinic that is authorized to prescribe Suboxone. These few young adults are very serious about getting clean. What I have heard a majority of them say since they have gotten on the Suboxone is that there is a light at the end of the tunnel and they can see it!! When they were on Methadone there was NO light at the end of the tunnel. They felt like the rest of their lives would revolve around the availability of a Methadone clinic. Now they have a chance of getting totally clean of having to take a daily drug for their opioid addiction. I also have spoken to some adults that actually sell their Suboxon on the street. But they also manage to take a dose every day that keeps them from using too!! I asked one of them how this was possible and that person told me it was because of how the guide lines the prescribing DR. follows regarding the levels reported when you went through detox. At least that’s what this person thinks it is. They tried to tell the Doctor that they didn’t need that much and they were told if they didn’t take what they were prescribed then they couldn’t come to the clinic!!! So this person has just gone along with the program and takes what they are prescribed and never complains or talks to anyone about how they feel or any changes or side effects. This patient says that all the other patients that go there do the same thing. NO one complains and no one talks to anyone about anything. Because if you object or complain you run the risk of being discharged from the clinic and that would mean you would have to go back to buying heroin and shooting up!! None of them want this and a lot of them are there because of the Courts.
    And when I hear about this it really irritates the hell out of me!!! There are patients that can’t get off of Methadone because if they trey to leave that clinic they are told that the DR who Prescribes Suboxone will not prescribe their anti anxiety medication, that the psychiatrist who serves the Methadone clinic prescribed them so very long ago. And what is that medication? Oh it is Valium or Klonopin or some other strong and very addictive benzodiazipine!! And so that patient will Never leave the Methadone Clinic out of the fear of not getting another drug they are now addicted too!!!

    So the Need for this Medical tool came a long time ago. And I will look forward to it being approved, developed, and then properly released to the Medical Community.

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    Joseph Neuberger

    June 10, 2016 at 9:20 AM

    I apologize for a error in my email in my sigh-off. It should read with only ONE “E” in the last portion.

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    Joseph Neuberger

    June 10, 2016 at 9:15 AM

    Cost, Cost, COST!! I believe that Cost needs to be added as an element in any study of why patients stay in treatment for times not conducive to success in MAT treatments. The costs for many are prohibitive, especially with insurance companies not adhering to the parity act that is now in full effect, but the federal government is doing nothing to require adherence If the parity act.were being adhered to I believe we’d see much better adherence to program requirements and better success with this form of MAT. The law was passed for a reason –ENFORCE IT!! And save many lives in the process. MD’s soon forget their code when those EASY dollars are waved in front of their faces. treating addicts like third world patients because another is waiting to gain admittance to their programs. It’s not right, and until the federal government in the form of NIDA steps in to force adherence these numbers will continue to increase and so will the deaths. And all when we’ve got the patient in hand. A sad situation indeed.
    Kind regards,
    J.R. Neuberger
    Member, Board of Directors
    National Alliance for Medication Assisted Recovery (NAMA-Recovery)
    Elkton, Maryland

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