Six-month outcomes of the HOPE smartphone application designed to support treatment with medications for opioid use disorder and piloted during an early statewide COVID-19 lockdown

Users' Acceptability and Perceived Efficacy of mHealth for Opioid Use Disorder: Scoping Review

BACKGROUND

The opioid crisis continues to pose significant challenges to global public health, necessitating the development of novel interventions to support individuals in managing their substance use and preventing overdose-related deaths. Mobile health (mHealth), as a promising platform for addressing opioid use disorder, requires a comprehensive understanding of user perspectives to minimize barriers to care and optimize the benefits of mHealth interventions.

OBJECTIVE

This study aims to synthesize qualitative insights into opioid users' acceptability and perceived efficacy of mHealth and wearable technologies for opioid use disorder.

METHODS

A scoping review of PubMed (MEDLINE) and Google Scholar databases was conducted to identify research on opioid user perspectives concerning mHealth-assisted interventions, including wearable sensors, SMS text messaging, and app-based technology.

RESULTS

Overall, users demonstrate a high willingness to engage with mHealth interventions to prevent overdose-related deaths and manage opioid use. Users perceive mHealth as an opportunity to access care and desire the involvement of trusted health care professionals in these technologies. User comfort with wearing opioid sensors emerged as a significant factor. Personally tailored content, social support, and encouragement are preferred by users. Privacy concerns and limited access to technology pose barriers to care.

CONCLUSIONS

To maximize benefits and minimize risks for users, it is crucial to implement robust privacy measures, provide comprehensive user training, integrate behavior change techniques, offer professional and peer support, deliver tailored messages, incorporate behavior change theories, assess readiness for change, design stigma-reducing apps, use visual elements, and conduct user-focused research for effective opioid management in mHealth interventions. mHealth demonstrates considerable potential as a tool for addressing opioid use disorder and preventing overdose-related deaths, given the high acceptability and perceived benefits reported by users.

Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study

BACKGROUND

Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient's recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers.

OBJECTIVE

This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs.

METHODS

We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual's patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual's changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes.

RESULTS

In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use.

CONCLUSIONS

KIOS tracks key clinical variables and generates advice specifically relevant to the patient's current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse-funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted.

Effects of Bundling Medication for Opioid Use Disorder With an mHealth Intervention Targeting Addiction: A Randomized Clinical Trial

OBJECTIVE

Medication for opioid use disorder (MOUD) improves treatment retention and reduces illicit opioid use. A-CHESS is an evidence-based smartphone intervention shown to improve addiction-related behaviors. The authors tested the efficacy of MOUD alone versus MOUD plus A-CHESS to determine whether the combination further improved outcomes.

METHODS

In an unblinded parallel-group randomized controlled trial, 414 participants recruited from outpatient programs were assigned in a 1:1 ratio to receive either MOUD alone or MOUD+A-CHESS for 16 months and were followed for an additional 8 months. All participants were on methadone, buprenorphine, or injectable naltrexone. The primary outcome was abstinence from illicit opioid use; secondary outcomes were treatment retention, health services use, other substance use, and quality of life; moderators were MOUD type, gender, withdrawal symptom severity, pain severity, and loneliness. Data sources were surveys comprising multiple validated scales, as well as urine screens, every 4 months.

RESULTS

There was no difference in abstinence between participants in the MOUD+A-CHESS and MOUD-alone arms across time (odds ratio=1.10, 95% CI=0.90-1.33). However, abstinence was moderated by withdrawal symptom severity (odds ratio=0.95, 95% CI=0.91-1.00) and MOUD type (odds ratio=0.57, 95% CI=0.34-0.97). Among participants without withdrawal symptoms, abstinence rates were higher over time for those in the MOUD+A-CHESS arm than for those in the MOUD-alone arm (odds ratio=1.30, 95% CI=1.01-1.67). Among participants taking methadone, those in the MOUD+A-CHESS arm were more likely to be abstinent over time (b=0.28, SE=0.09) than those in the MOUD-alone arm (b=0.06, SE=0.08), although the two groups did not differ significantly from each other (∆b=0.22, SE=0.11). MOUD+A-CHESS was also associated with greater meeting attendance (odds ratio=1.25, 95% CI=1.05-1.49) and decreased emergency department and urgent care use (odds ratio=0.88, 95% CI=0.78-0.99).

CONCLUSIONS

Overall, MOUD+A-CHESS did not improve abstinence relative to MOUD alone. However, MOUD+A-CHESS may provide benefits for subsets of patients and may impact treatment utilization.

Mobile health supported multi-domain recovery trajectories after major arthroplasty or spine surgery: a pilot feasibility and usability study

BACKGROUND

Recovery after surgery intersects physical, psychological, and social domains. In this study we aim to assess the feasibility and usability of a mobile health application called PositiveTrends to track recovery in these domains amongst participants undergoing hip, knee arthroplasty or spine surgery. Our secondary aim was to generate procedure-specific, recovery trajectories within the pain and medication, psycho-social and patient-reported outcomes domain.

METHODS

Prospective, observational study in participants greater than eighteen years of age. Data was collected prior to and up to one hundred and eighty days after completion of surgery within the three domains using PositiveTrends. Feasibility was assessed using participant response rates from the PositiveTrends app. Usability was assessed quantitatively using the System Usability Scale. Heat maps and effect plots were used to visualize multi-domain recovery trajectories. Generalized linear mixed effects models were used to estimate the change in the outcomes over time.

RESULTS

Forty-two participants were enrolled over a four-month recruitment period. Proportion of app responses was highest for participants who underwent spine surgery (median = 78, range = 36-100), followed by those who underwent knee arthroplasty (median = 72, range = 12-100), and hip arthroplasty (median = 62, range = 12-98). System Usability Scale mean score was 82 ± 16 at 180 days postoperatively. Function improved by 8 and 6.4 points per month after hip and knee arthroplasty, respectively. In spine participants, the Oswestry Disability Index decreased by 1.4 points per month. Mood improved in all three cohorts, however stress levels remained elevated in spine participants. Pain decreased by 0.16 (95% Confidence Interval: 0.13-0.20, p < 0.001), 0.25 (95% CI: 0.21-0.28, p < 0.001) and 0.14 (95% CI: 0.12-0.15, p < 0.001) points per month in hip, knee, and spine cohorts respectively. There was a 10.9-to-40.3-fold increase in the probability of using no medication for each month postoperatively.

CONCLUSIONS

In this study, we demonstrate the feasibility and usability of PositiveTrends, which can map and track multi-domain recovery trajectories after major arthroplasty or spine surgery.

Use of Mobile Applications in Smoking, Alcohol and Substance Use Disorders

Currently, technology and mobile health applications are developing and being applied in different fields every day. Especially the use of mobile technology in many health fields offers various opportunities for the use of mobile applications in smoking, alcohol and substance use disorders, which is an important public mental health problem. The aim of this review study was to examine 16 mobile applications designed for the treatment and monitoring of smoking, alcohol and substance use. It was concluded that self-monitoring, notification and warning systems, location services, peer and expert support services were frequently used in the analyzed mobile applications. As a result of the studies, the use of mobile applications as a preventive intervention in the prevention of addiction and as an additional treatment option in addiction treatment is promising. However, this situation brings along various harms, risks and obstacles. This review of the relevant literature provides a critical update of mobile applications used in smoking, alcohol and substance use disorders. This review is expected to be an important guide for mental health professionals and mobile application designers working on addiction.

Principal component regression analysis of familial psychiatric histories and suicide risk factors among adults with opioid use disorder

This study explores familial psychiatric risk factors that are closely linked to suicide risk among patients with opioid use disorder (OUD) as measured by the Family History Assessment Module (FHAM). Data was derived from adults diagnosed with OUD (N = 389). To analyze the covariance between the 11 items of the FHAM, principal component analysis was applied to infer principal components (PC) scores. Log-binominal regression was conducted to quantify the associations between PC scores and mental health symptoms (e.g., lifetime suicidal attempt, P30D suicidal ideation, depression, and anxiety). Analyses revealed that the first 3 three PCs could account for 56% of the total variance of the FHAM items within the data. Family history of substance misuse (PC1) was positively associated with lifetime suicide attempts and severe anxiety. Family history of serious mental illness (PC2) and of suicidal behavior (PC3) were not significantly associated with any outcomes. Our findings suggest current suicide risk is associated with an array of familial psychiatric issues among people with OUD. However, family history of suicide attempts and death by suicide has less bearing on current suicide risk in OUD patients whereas family history of substance use confers significant risk. Findings underscore suicide-related preventive interventions as necessary components of treatment plans among people with OUD, who commonly report family histories of substance misuse.

Accessibility of Treatment Among Women With Opioid Use Disorder: A Brief Review

Opioid-use disorder (OUD) has become a social pandemic with a rising incidence and prevalence among women. Notably, women with OUD were more likely to have psychiatric comorbidities like major depressive disorder, anxiety disorder, and bipolar disorder. Evidence suggests that opioid exposure and subsequent disease among women compared to men is unique and attributable to hormonal estrogen levels. However, there remains a dearth of literature on their ability to access treatment when needed. There is also a gap in the perceived access to women as compared to men. Hence, our review will focus on factors that may affect women from seeking OUD treatment as compared to men.

The current evidence for substance use disorder apps

PURPOSE OF REVIEW

New mHealth (smartphone) apps for substance use disorders (SUD) are emerging at an accelerated rate, with consumer choice typically guided by app-store user ratings rather than their effectiveness. The expansive reach, low-cost and accessibility of mHealth apps have driven their popularity and appeal as alternatives to traditional treatment; as such, rigorously establishing their effectiveness is of paramount importance.

RECENT FINDINGS

Several systematic reviews conclude that the evidence-base for mHealth SUD apps is weak, inconclusive and hampered by substantial heterogeneity in study designs. However, there have been a number of interesting and novel developments in this area in recent years, which have not been synthesised to date.

SUMMARY

Most mHealth apps deliver either multiple-component behaviour change techniques, discrete psychological interventions or cognitive training interventions, or are designed to act as adjuncts to facilitate the delivery of clinical or continuing care. There are promising signals of their feasibility, acceptability and preliminary effectiveness in numerous open-label pilot studies of mHealth apps targeting alcohol and smoking. However, only a handful of sufficiently-powered, well-designed randomised controlled trials have been conducted to date with mixed findings. Furthermore, there has been limited recent attention on mHealth apps aiming to improve outcomes for individuals using other drugs.