Mobile Medication Adherence Platform for Buprenorphine-Naloxone During Treatment of Opioid Use Disorder: Phase I Study

Study Overview
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Brief Summary
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The investigators will conduct a phase I study involving 41 participants selected randomly among patients prescribed buprenorphine-naloxone for opioid misuse as a feasibility trial of the study of the Pillsy device. The study will track the effectiveness of the Pillsy technology and associated smartphone application by measuring adherence to buprenorphine-naloxone therapy and patient satisfaction with the application and the Pillsy device.

Detailed Description
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The purpose of this randomized, controlled trial in Phase I is to determine whether the Pillsy intervention can improve adherence to buprenorphine-naloxone compared to Service As Usual. This will be a collaborative study between WSU, Pillsy, Inc, and the clinical site Ideal Options (opioid use and other substance use disorders treatment center). The overarching goal is to evaluate if the use of the Pillsy system will improve treatment adherence. The study coordinator will work closely with the clinical site, conducting a scripted screening, by phone or in person, documenting substance use, addiction treatment history, medical and psychiatric history, medication, addiction treatment goals, and availability of social support. The Pillsy device is a smart cap that tracks pill bottle openings and uses lighted reminders to prompt patients when to take their medication. The Pillsy Helper feature is a smartphone application that sends text and phone reminders as well as links to the participant named family and friend support networks. The Pillsy Helpers feature allows participants to name friends and family members who will also receive a text message notification 1 hour after a missed dose to reach out to offer support. In addition, the prescriber will be contacted when the patient has missed a dose, giving the prescriber the opportunity to intervene. Study participants will be randomized to one of two groups. The control group will receive the Pillsy cap alone. The active group will receive the Pillsy cap and smartphone application with associated benefits. To measure adherence, all participants will provide a urine sample at each study visit and complete a questionnaire (ex: AUDIT, Fagerstrom, Addiction Severity Index, Timeline Follow-Back) and survey that assesses their satisfaction with treatment.

Official Title
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Connected Pharmacy Platform to Improve Adherence to Buprenorphine- Naloxone Prescription Treatment of Opioid Use Disorder.

Conditions
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Opioid-use Disorder

Intervention / Treatment
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* Behavioral: Reminders messages to improve adherence.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subject can and has signed an Institutional Review Board (IRB) approved informed consent form (ICF). Age ≥18 and ≤60 years. Meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for Opioid use disorder (OUD). In the professional opinion of the prescribing provider, the patient requires buprenorphine-naloxone for Opioid use disorder. Owns a working smartphone. Agrees to abstain from opioids other than Opioid Agonist Therapy (OAT) during the study. Able to read and speak English. Can identify one study partner/caregiver who agrees to participate. Exclusion Criteria: Have been prescribed chronic OAT treatment in the previous 12 months. Have known hypersensitivity to buprenorphine and/or naloxone. Are pregnant or lactating women or women of childbearing potential who are not using any form of birth control. Have a primary diagnosis of substance use disorder other than OUD or nicotine. Require opioids for the treatment of chronic pain. Have evidence of coagulopathy within 90 days prior to enrollment. Have clinically significant thrombocytopenia. Have screening serum aspartate (AST) and alanine aminotransferase (ALT) levels 3-fold higher than upper limits of normal. Have screening total bilirubin or creatinine levels 1.5-fold higher than the upper limits of normal. Use of other medications that are known to affect the outcome measures in this study including methadone. Are unable to provide voluntary informed consent. Have pending legal issues that could adversely affect the participant's freedom to participate. Cannot read or speak English.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Pillsy arm<br>Participants in the Pillsy arm will receive a prescription for buprenorphine-naloxone with an ''active'' Pillsy smart cap that will continuously collect data on pill bottle openings, missed doses, text messages sent, automated phone calls made. A participant who misses an entire day of buprenorphine-naloxone will automatically receive a survey about cravings and risk of relapse. | Behavioral: Reminders messages to improve adherence.<br>* If the participant does not take their medicine at the correct time, a light on the smart pill cap begins to flash. If the bottle is not opened within 20 minutes, the Pillsy application sends an SMS text reminder to the participant's phone. If the bottle is not opened within 60 minutes, the participant receives an automated phone call. The participant may also receive brief motivational phrases or craving surveys that can be tailored to participant needs and preferences. Also, based on pre-populated and adjustable craving and withdrawal levels, the participants' provider could be contacted automatically based on the thresholds being crossed. Pillsy also includes a Pillsy Helpers feature in which the patient can name friends and family members who will also receive a text message notification one hour after a missed dose.<br>* Other names: Automated phone call.;|
| No Intervention: Service as usual arm<br>Participants in the Service As Usual arm will receive a prescription for buprenorphine-naloxone with an ''inactive'' Pillsy smart cap that will track openings but will not provide reminders or any other messaging. They will receive a basic application that can deploy patient satisfaction surveys. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Medication Possession Ratio | Change in adherence to buprenorphine-naloxone treatment assessed by medication possession ratio (MPR). This was calculated as mean over the course of the trial. MPR is the sum of the days' supply for all fills of a given drug in a particular time period, divided by the number of days in the time period (time period varies based on length of prescription given by provider). MPR is typically expressed as a percentage, however below we express it as the result of the fraction. This measurement was based on pharmacy fills (days supply). | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Participant Engagement | Participant engagement quantified through days of retention in treatment. | 12 weeks (Assessed at screening visit, week 1 visit, week 6 visit and week 12 visit) | 
| Week 1, Number of Participants Satisfied With Pillsy Usability and Reminder Feedback System | Week 1 Pillsy Satisfaction Survey. Yes vs No question: Are you satisfied with the Pillsy system overall?. Outcome data measured is count of participants endorsing yes. | Week 1 | 
| Number of Days Participant Self-reported Other Substance Use | Participant self-report of other substance use (alcohol, cigarettes, and illicit opioids) is assessed with Timeline Follow-back measure | 12 weeks | 
| Change in Use of Non-prescribed Opioids | Use of non-prescribed opioids is assessed via urinalysis (UA) by the treatment team at Ideal Option, as a standard of care. Ideal Option will share this data with the study team (through signed data use agreement). Our study team will evaluate change in use of non-prescribed opioids over the course of the study, based on the data provided by the clinic. Below it is expressed as the mean number of illicit opioid positive UAs submitted out of the total number of UAs submitted for each arm. | 12 weeks | 
| Week 6, Number of Participants Satisfied With Pillsy Usability and Reminder Feedback System | Week 6 Pillsy Satisfaction Survey. Yes vs No question: Are you satisfied with the Pillsy system overall? Outcome data measured is count of participants endorsing yes. | Week 6 | 
| Week 12, Number of Participants Satisfied With Pillsy Usability and Reminder Feedback System | Week 12 Pillsy Satisfaction Survey. Yes vs No question: Are you satisfied with the Pillsy system overall? Outcome data measured is count of participants endorsing yes. | Week 12 |