What is the research about?
The United States faces a crisis of Opioid Use Disorder (OUD) and overdose. Overdose deaths claimed 93,000 lives in 2020—up 30% from the year before. Buprenorphine is a safe and effective medication that can be taken at home to treat opioid addiction. It has been shown to cut the risk of dying in the next year by half. However, nationwide only 1 in 6 emergency department (ED) patients with OUD receive addiction treatment in the weeks after they are discharged, and Black patients are half as likely to receive this treatment.
The research team seeks to increase the number of patients with OUD who engage in buprenorphine treatment after an ED visit and to address the racial gap in who receives treatment. It is testing two strategies separately and in combination. One involves a daily text messaging, telehealth program that encourages patients to take their medication and connects those who need help with a trained care coordinator. The other involves paying patients who start and continue receiving addiction treatment.
Who can this research help?
Health systems can use results from this study to augment their usual care with one or more strategies to increase the number of patients with OUD who receive potentially life-saving treatments following discharge.
What is the research team doing?
The team is working across three US health systems that serve diverse, low-income, OUD patient populations. They are recruiting 1,649 patients ages 18 and older with OUD who are discharged from the ED with a prescription for buprenorphine. Patients receive a text message describing the research and asking for their consent to participate. Those who consent are assigned, by chance, to one of four treatments:
- Augmented usual care. Patients receive a text message with a reminder to fill their prescription and the phone number for a local care coordinator who can help them navigate treatment.
- Telehealth. Patients receive daily text-message check-ins reminding them to take their medication and attend outpatient treatment appointments. Those who text back that they need help will receive a call from a care coordinator supported by a team of clinicians.
- Incentives. Patients receive modest financial incentives for filling their buprenorphine prescription, attending their first outpatient treatment appointment, and for being engaged in addiction treatment at 30 days.
- Telehealth and incentives. Patients receive both the telehealth check-ins and the monetary incentives.
After enrolling, patients are assessed at 1 day, 15 days, 30 days, 3 months, and 6 months. At each of these times, patients are asked about their current substance use, self-care, relationships, resources, and outlook on life. Engagement in treatment, the primary outcome, is measured from day 15 onward by contacting treatment clinics. Whether patients filled their buprenorphine prescriptions is assessed via their state Prescription Drug Monitoring Programs at days 15 and 30. Electronic health records provide information about patient demographics, medical conditions, and ED visits.