BACKGROUND
Medications for treatment of opioid use disorder (OUD), such as buprenorphine, are effective and essential for addressing the opioid epidemic. However, high dropout rates from medication remain a challenge. Behavioral treatment with contingency management plus cognitive behavioral counseling has shown promise for improving outcomes of buprenorphine treatment, but is complicated to deliver. Delivery of behavioral treatment through technology-based platforms has the potential to make it more feasible for widespread dissemination.
OBJECTIVE
reSET-O® is a Prescription Digital Therapeutic and a commercial adaptation of the Therapeutic Education System, an internet-based, interactive program with a Community Reinforcement Approach to cognitive behavioral therapy. It delivers cognitive behavioral therapy modules and contingency management rewards upon completion of modules and negative urine drug screens. A pilot study was performed to assess feasibility and acceptability of reSET-O® in a Hub and Spoke model of care as part of a larger strategy to maintain individuals in treatment. Objective and qualitative results, as well as acceptability and likeability of reSET-O®, were obtained from fifteen individuals.
METHODS
English-speaking individuals over the age of 18 with a diagnosis of current OUD were recruited after being on buprenorphine for at least one week of treatment. Two 12-week prescriptions for reSET-O® were written for a 24-week study. Patient report of drug use and likeability scales of reSET-O® were conducted at weeks 4,8, 12 and 24 of the study. Qualitative interviews were also conducted. Four providers were recruited and gave feedback on the acceptability and feasibility of reSET-O®.
RESULTS
Of 15 participants who entered this pilot study, 7 completed 24 weeks and 8 were unable to complete due to drop out after enrollment, attrition in treatment, or incarceration. An average of $96 in contingency management rewards were earned by the participants for completion of modules for the duration of the pilot study. Participants’ subjective feedback found that reSET-O® was easy to use, enjoyable, and helped provide a safe space to admit recurring substance use.
CONCLUSIONS
ReSET-O® was well accepted based on patient and provider feedback in this pilot study, but adherence and retention in treatment remain areas for improvement, as with traditional MOUD and CBT approaches. A randomized control trial in a Hub and Spoke model will be needed to assess if retention on buprenorphine treatment is enhanced through the use of technology based behavioral interventions such as reSET-O®.
CLINICALTRIAL
NCT03826966
Early postpartum resting‐state functional connectivity for mothers receiving buprenorphine treatment for opioid use disorder: A pilot study
