Abstract
BackgroundPrescription methadone or buprenorphine enables people with opioid use disorder to stop heroin use safely while avoiding withdrawal. To ensure methadone is taken as prescribed and to prevent diversion onto the illicit market, people starting methadone take their daily dose under a pharmacist’s supervision. Many patients miss their daily methadone dose risking withdrawal, craving for heroin and overdose due to loss of heroin tolerance. Contingency management (CM) can improve medication adherence, but remote delivery using technology may be resource-light and cost-effective. We developed an innovative way to deliver CM by mobile telephone. Software monitors patients’ attendance and supervised methadone consumption through an internet self-login at the pharmacy and sends reinforcing text messages to patients’ mobile telephones. A linked system sends medication adherence reports to prescribers and provides early warning alerts of missed doses. A pre-paid debit card system provides financial incentives.MethodsA cluster randomised controlled trial design was used to test the feasibility of conducting a future trial of mobile telephone CM to encourage adherence to supervised methadone in community pharmacies. Each cluster (drug service/3 allied pharmacies) was randomly allocated to provide patient’s presenting for a new episode of opiate agonist treatment (OAT) with either (a) mobile telephone text message CM, (b) mobile telephone text message reminders, or (c) no text messages. We assessed acceptability of the interventions, recruitment, and follow-up procedures.ResultsFour drug clinics were approached and three recruited. Thirty-three pharmacists were approached and 9 recruited. Over 3 months, 173 individuals were screened and 10 enrolled. Few patients presented for OAT and high numbers were excluded due to receiving buprenorphine or not attending participating pharmacies. There was 96% consistency in recording medication adherence by self-login vs. pharmacy records. In focus groups, CM participants were positive about using self-login, the text messages, and debit card. Prescribers found weekly reporting, time saving, and allowed closer monitoring of patients. Pharmacists reported that the tablet device was easy to host.ConclusionMobile telephone CM worked well, but a planned future trial will use modified eligibility criteria (existing OAT patients who regularly miss their methadone/buprenorphine doses) and increase the number of participating pharmacies.Trial registrationThe trial is retrospectively registered, ISRCTN 58958179.
Highlights
Prescription methadone or buprenorphine enables people with opioid use disorder to stop heroin use safely while avoiding withdrawal
Few patients presented for opioid agonist treatment (OAT) and high numbers were excluded due to receiving buprenorphine or not attending participating pharmacies
This study focuses on an innovative intervention we have developed to encourage medication adherence by delivering Contingency management (CM) via mobile telephone text messages, with a linked system for monitoring and reporting patients’ attendance to prescribers, including early warning alerts of missed doses [14]
Summary
Prescription methadone or buprenorphine enables people with opioid use disorder to stop heroin use safely while avoiding withdrawal. To ensure methadone is taken as prescribed and to prevent diversion onto the illicit market, people starting methadone take their daily dose under a pharmacist’s supervision. Many patients miss their daily methadone dose risking withdrawal, craving for heroin and overdose due to loss of heroin tolerance. A pre-paid debit card system provides financial incentives The majority of those with an opioid addiction are prescribed opioid agonist treatment (OAT) with methadone or buprenorphine for which there is an extensive evidence base [1, 2]. Methadone and buprenorphine need to be taken on a daily basis in order to achieve effective maintenance and enable patients to stop heroin use safely and without experiencing excessive symptoms of withdrawal or craving. Ten per cent of pharmacists in England stated they would “never” or “rarely” report one or two missed doses to prescribers but would “usually” report three missed doses [6]
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