Digital Health Intervention to Augment Outpatient Buprenorphine Treatment

Background: Buprenorphine-naloxone is an evidence-based treatment for Opioid Use Disorder (OUD)1. However, despite its efficacy, nearly half of participants discontinue treatment prematurely2. Novel intervention strategies that may be delivered outside of traditional treatment settings are needed to support buprenorphine uptake and maintenance. The goal of this study was to elucidate key elements surrounding acceptability/feasibility and structure of an interactive computer- and text message-delivered personalized feedback intervention for adults initiating outpatient buprenorphine treatment.

Methods: Twenty-four adults engaged in treatment at two outpatient addiction treatment centers completed semi-structured interviews exploring preferences around digital health interventions. Interviews were conducted by trained interviewers, audio-recorded, and transcribed verbatim. A coding structure was iteratively developed using thematic
and content analysis and entered into a framework matrix3. Each transcript was double-coded.

Results: The sample was balanced by gender, primary type of opioid use (prescription pills; heroin/fentanyl), and phase of recovery [early (≤8 weeks of treatment) vs. late (>8 weeks of treatment)]. Saturation was reached after 24 interviews (mean age = 38.9; 70.8% white; 8.3% Hispanic/Latino). (1) Acceptability/feasibility themes: Participants perceived intervention content and delivery methods to be useful tools in early recovery. Participants were especially enthusiastic about the accessibility of the intervention. There were no concerns about privacy. (2) Structural themes: Automated messages were perceived as acceptable, but participants also encouraged personalization. Both predetermined (automatic) and on-demand messages were suggested. Participants requested at least two messages per day (morning and early evening), with the option to elicit additional messages as needed. Incorporating multimedia such as emojis, gifs, and links to videos was welcomed to promote interactivity.

Conclusions: Overall, adults engaged in outpatient buprenorphine treatment were receptive to an interactive computer- and text messaged-delivered personalized feedback intervention to support recovery. Incorporating thematic results on suggested structural changes may increase the usability of this intervention to improve treatment outcomes by reducing illicit opioid use, increasing adherence/retention, and preventing future overdose and other complications of illicit opioid use.

References: 1. National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. https://doi.org/10.17226/25310.
2. Hser, Y.I., Saxon, A.J., Huang, D., Hasson, A., Thomas, C., Hillhouse, M., et al. Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. Addiction. 2014;109:79-87.
3. Gale, N.K., et al. Using the framework method for the analysis of qualitative data in multidisciplinary health research. BMC Medical Research Methodology. 2013;13,117.