PROJECT SUMMARY Over 2 million Americans suffer from Opioid Use Disorder (OUD) and another 9 million misuse opioids. Treatments for opioid addiction exist, but effectiveness is compromised when subjects use illicit opiates during treatment. Reuse rates during treatment can be high, and reducing illicit opiate use during treatment has thus recently become a major NIDA policy goal. Elevated reuse rates not only compromise treatment effectiveness, but this behavior predicts, and likely drives, treatment dropout. With the support of a NIDA basic science R01, we developed a set of easy-to-use instruments that predict opioid reuse events with about twice the accuracy of any existing tool. The 5-minute battery we developed indicates the numerical probability that a patient will reuse illicit opiates within the next 7-10 days. In a pilot cohort, we successfully migrated this battery to a commercial smartphone platform, and demonstrated 100% retention and >85% compliance (median compliance > 95%) over a use period of up to 4 months. In a survey of our largely homeless MOUD patients we found that 85% already had smartphones and data contracts appropriate for using this platform as a part of their treatment. In a survey of OUD treatment physicians, we found that our system and the reuse prediction it provides, was both highly desirable and usable as implemented. Finally, we found in a reanalysis of data from CTN-0051 that dynamic dosing of this very kind reduces relapse rates. Our primary goal in this mid-scale clinical trial is to test the hypothesis that clinicians who use the output of our mobile system to adjust buprenorphine and methadone dosing achieve lower opiate reuse rates than physicians who provide care-as-usual. Our secondary goal is to examine the usability and desirability of this solution for clinicians with an eye to usability and large-scale deployment. Our third and final goal is to measure the cost-effectiveness of this solution from multiple perspectives. If we are successful it will be possible to employ an algorithmic and measurement-based approach to OUD treatment with methadone and buprenorphine which reduces reuse rates and relapse rates amongst OUD patients.

PROJECT NARRATIVE We recently published an easy-to-use battery that can predict upcoming reuse events in patients being treated for opioid use disorder (OUD), and we then migrated that battery to a smartphone platform and demonstrated retention and compliance of over 85% in an OUD population. Our analysis of existing clinical trial data suggests that adjusting buprenorphine dosing in response to reuse events reduces relapse rates. Here we propose to: (1) test the hypothesis that our battery can be used to trigger dose adjustments before reuse events and that this has the effect of reducing reuse and relapse in medication-based OUD treatment; (2) examine the willingness of clinicians to employ this strategy; and (3) examine the cost-effectiveness of these adjustments.