Innovative treatment for opioid use disorder
Despite the effectiveness of agonist (e.g., methadone, buprenorphine) maintenance treatment for opioid dependence and alarming recent increases in overdose deaths, waiting lists for treatment persist. Opioid-dependent individuals can remain on waitlists for months, during which they are at substantial risk for illicit drug use, criminal activity, infectious disease, overdose and premature death. We recently developed a novel Interim Buprenorphine Treatment (IBT) to mitigate these risks during treatment delays that includes technology-aided components to deliver life-saving pharmacotherapy while minimizing nonadherence: (a) Participants receive buprenorphine (BUP) maintenance with bi-monthly clinic visits and the remaining doses dispensed at home via a secure computerized portable device. Participants also receive (b) nightly calls from an automated Interactive Voice Response (IVR) phone system to assess any drug use, withdrawal and craving, (c) IVR-generated random call-backs for urinalysis and pill counts, and (d) HIV+Hepatitis education and Opioid Overdose prevention delivered via iPad.
In a prior small pilot study, we demonstrated the initial feasibility of IBT, with 50 participants randomized to IBT (n=25) achieving significantly greater improvements in illicit opioid use, intravenous drug use, HIV/HCV knowledge and psychiatric distress compared to those randomized to a Waitlist Control (WLC; n=25) condition (Sigmon et al., 2016, The New England Journal of Medicine).
We are currently conducting a larger-scale randomized clinical trial to replicate these exciting initial findings, wherein 100 untreated opioid-dependent adults across multiple rural geographic areas are randomized to receive 6 months of IBT vs. WLC conditions. Thus far, outcomes are extremely promising with substantially greater biochemically-verified illicit opioid abstinence among participants randomized to the IBT vs. control condition (95% vs. 20% negative urine specimens, respectively; n=25). We have dispensed 1,356 BUP doses and distributed 42 doses of Narcan for emergency opioid overdose reversal. Our automated IVR system has placed 1,410 daily monitoring calls, of which 94% were successfully answered and completed by participants. Of the 80 random call-back visits generated by the IVR system, 81% were satisfactorily completed.
Taken together, these preliminary data are extremely promising and suggestive of IBT efficacy among the extremely vulnerable population of untreated opioid abusers. At the October 2019 Lisbon Addictions meeting we will present data from the completed randomized trial as well as discuss the broader implications of innovative technology-assisted approaches for expanding addiction treatment more generally.