Smartphone app enhances retention and reduces opioid use in patients

Patients with opioid use disorder can reduce days of opioid use and stay in treatment longer when they use a smartphone app as adjunctive therapy to medication, a new study from the University of Texas Health Science Center at San Antonio (UT Health San Antonio). shows

The cohort study of 600 underserved patients found that those who chose to use the app – which combines emergency behavioral therapy and peer recovery support – alongside medication treatment, reduced days of opioid use by 35% compared to those treated with medication alone. Additionally, app users stayed in treatment nearly 19% longer than those treated with medication alone.

These findings suggest that augmenting opioid use disorder medication with app-based emergency management may provide clinical benefits to underserved patients. Expanding the availability of app-based emergency management can help reduce the enormous social, economic, and personal burden of opioid use.”

Elise Marino, PhD, director of research at UT Health San Antonio’s Be Well Institute on Substance Use and Related Disorders

Marino is lead author of the study, titled “Smartphone App-Smartphone Contingency Management and Opioid Use Disorder Treatment Outcomes,” published Dec. 2 in JAMA Network Open. The other authors are also with the UT Health San Antonio Department of Psychiatry and Behavioral Sciences and the Be Well Institute.

Need to increase medication

Opioid use disorder continues to be a national crisis, contributing to significant morbidity and mortality. Its annual social cost in the United States reached $968.9 billion in 2018, the study notes.

Medication for opioid use disorder, or MOUD – including methadone, buprenorphine and naltrexone – is recognized as the only evidence-based treatment for the condition. This first-line treatment has been shown to significantly reduce opioid-related morbidity and mortality with consistent cost-saving benefits.

However, some patients still have difficulty reducing their opioid use and maintaining their treatment, indicating the need to increase MOUD. Many conditions benefit from dual therapy of drugs and therapy. One treatment is contingency management, or CM, which provides financial incentives to achieve treatment goals.

This treatment has traditionally been given in clinics, with the goal of a negative opioid urine drug test. While findings have been mixed, several reviews and studies have found that subjects treated with MOUD plus CM had better retention and fewer opioid positives than urine drug screening.

A long-standing limitation, however, is that patients are required to attend multiple appointments per person per week for treatment. With the recent COVID-19 pandemic, many were reluctant to make CM visits in person. Additional barriers to access, such as transportation, distance from the clinic, and child care arrangements, have supported other options such as telehealth and the use of new technologies.

There is an app

One such technology is the WEconnect Health CM app for smartphones. The application provides evidence-based CM embedded in a recovery-oriented framework. In addition to providing substance-related behavioral goals, it allows patients to set personally meaningful daily goals, both related to substance use and otherwise, such as attending a Narcotics Anonymous meeting, walk or reading.

The app also includes a platform to track patient progress and payments and provides encouragement for completing their daily goals. In addition, WEconnect offers 1-to-1 peer support and online meetings facilitated by certified peers. Unlike traditional CM, the app allows patients to make decisions about their own treatment goals and explore recovery through peer support services that are available anywhere and accessible outside of regular clinic hours.

For the new research, the scientists set out to assess whether application-based CM augmentation of MOUD is associated with fewer days of opioid use at the end of treatment and greater retention than MOUD-only treatment.

The retrospective cohort study, which refers to research that follows a group of people over time, used data from Nov. 1, 2020, to Nov. 30, 2023, which was collected from opioid treatment programs across Texas. The cohort included 600 individuals aged 18 years or older who were uninsured or underinsured and elected to receive MOUD alone or MOUD plus CM delivered by the WEconnect smartphone app.

Those who chose to receive MOUD plus app-based CM reported a mean duration of opioid use of 8.4 days at the end of treatment compared with 12 days for those who chose to receive MOUD alone. Retention analysis showed that patients who chose to receive MOUD plus application-based CM remained on their treatment for a mean duration of 290.2 days, compared with 236.1 days for those who chose to receive MOUD alone.

“These results are promising and highlight the potential importance of a patient’s decision to use app-based CM,” the researchers concluded. “Despite the challenges of engaging patients in other app-based interventions, adding recovery-oriented, app-based CM may be a way to enhance clinical care and meet the growing needs of historically underserved patients receiving MOUD.”