Objective:

Medication for opioid use disorder (MOUD) improves treatment retention and reduces illicit opioid use. A-CHESS is an evidence-based smartphone intervention shown to improve addiction-related behaviors. The authors tested the efficacy of MOUD alone versus MOUD plus A-CHESS to determine whether the combination further improved outcomes.

Methods:

In an unblinded parallel-group randomized controlled trial, 414 participants recruited from outpatient programs were assigned in a 1:1 ratio to receive either MOUD alone or MOUD+A-CHESS for 16 months and were followed for an additional 8 months. All participants were on methadone, buprenorphine, or injectable naltrexone. The primary outcome was abstinence from illicit opioid use; secondary outcomes were treatment retention, health services use, other substance use, and quality of life; moderators were MOUD type, gender, withdrawal symptom severity, pain severity, and loneliness. Data sources were surveys comprising multiple validated scales, as well as urine screens, every 4 months.

Results:

There was no difference in abstinence between participants in the MOUD+A-CHESS and MOUD-alone arms across time (odds ratio=1.10, 95% CI=0.90–1.33). However, abstinence was moderated by withdrawal symptom severity (odds ratio=0.95, 95% CI=0.91–1.00) and MOUD type (odds ratio=0.57, 95% CI=0.34–0.97). Among participants without withdrawal symptoms, abstinence rates were higher over time for those in the MOUD+A-CHESS arm than for those in the MOUD-alone arm (odds ratio=1.30, 95% CI=1.01–1.67). Among participants taking methadone, those in the MOUD+A-CHESS arm were more likely to be abstinent over time (b=0.28, SE=0.09) than those in the MOUD-alone arm (b=0.06, SE=0.08), although the two groups did not differ significantly from each other (∆b=0.22, SE=0.11). MOUD+A-CHESS was also associated with greater meeting attendance (odds ratio=1.25, 95% CI=1.05–1.49) and decreased emergency department and urgent care use (odds ratio=0.88, 95% CI=0.78–0.99).

Conclusions:

Overall, MOUD+A-CHESS did not improve abstinence relative to MOUD alone. However, MOUD+A-CHESS may provide benefits for subsets of patients and may impact treatment utilization.

中文翻译：

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捆绑药物治疗阿片类药物使用障碍与针对成瘾的移动健康干预措施的效果：随机临床试验

客观的：

阿片类药物使用障碍 (MOUD) 药物可改善治疗保留并减少阿片类药物的非法使用。A-CHESS 是一种基于证据的智能手机干预措施，被证明可以改善与成瘾相关的行为。作者测试了单独使用 MOUD 与 MOUD 加 A-CHESS 的疗效，以确定该组合是否进一步改善了结果。

方法：

在一项非盲平行组随机对照试验中，从门诊项目招募的 414 名参与者按 1:1 的比例分配，接受单独 MOUD 或 MOUD+A-CHESS 治疗 16 个月，并随访 8 个月。所有参与者均服用美沙酮、丁丙诺啡或注射纳曲酮。主要结果是戒除非法阿片类药物的使用；次要结局是治疗保留、卫生服务使用、其他物质使用和生活质量；调节因素包括 MOUD 类型、性别、戒断症状严重程度、疼痛严重程度和孤独感。数据来源是每 4 个月进行的调查，包括多个经过验证的量表以及尿液筛查。

结果：

随着时间的推移，MOUD+A-CHESS 组和单独 MOUD 组的参与者的禁欲率没有差异（比值比 = 1.10，95% CI = 0.90-1.33）。然而，戒断症状严重程度（比值比=0.95，95% CI=0.91-1.00）和MOUD类型（比值比=0.57，95% CI=0.34-0.97）调节了戒断症状。在没有戒断症状的参与者中，随着时间的推移，MOUD+A-CHESS 组的戒断率高于单独 MOUD 组的戒断率（比值比 = 1.30，95% CI = 1.01–1.67）。在服用美沙酮的参与者中，随着时间的推移，MOUD+A-CHESS 组的参与者比单独 MOUD 组的参与者 (b=0.06，SE=0.08) 更有可能戒酒 (b=0.28，SE=0.09)，尽管两组之间没有显着差异（Δb=0.22，SE=0.11）。MOUD+A-CHESS 还与更高的会议出席率（比值比=1.25，95% CI=1.05–1.49）以及减少急诊科和紧急护理使用（比值比=0.88，95% CI=0.78–0.99）相关。

结论：

总体而言，与单独使用 MOUD 相比，MOUD+A-CHESS 并未改善戒欲。然而，MOUD+A-CHESS 可能为部分患者带来益处，并可能影响治疗利用率。