Text messaging tool may help fight opioid epidemic

April 17, 2018 by Kristina Sauerwein, Washington University in St. Louis
Washington University School of Medicine in St. Louis and Epharmix, a digital health company, have created a new automated text messaging service that may curb opioid abuse and prevent relapse. Patients receive text messages to gauge if they're feeling OK or struggling with potential relapse. Patients also can activate a panic button to request immediate help. Credit: Epharmix

A new automated text messaging service may curb opioid abuse and reduce the likelihood of relapse while also decreasing treatment costs, according to researchers at Washington University School of Medicine and Epharmix, a St. Louis-based digital health company.

The service provides automated text messages and phone calls to patients being treated for addiction. Such messages ask patients if they're feeling OK or struggling with potential relapse. Patients also can activate a panic button for immediate help.

Time saved from monitoring patients through individual phone calls and in-person appointments may trim medical costs and permit health-care workers to treat more patients without accruing heavier workloads.

Findings of the small study are published April 17, 2018, in NEJM Catalyst, a publication of The New England Journal of Medicine Group.

"There is an urgent need to address the opioid crisis in powerful new ways," said the study's senior author, Avik Som, an MD/PhD student at Washington University. Som, who has completed his doctorate in biomedical engineering and will receive his medical degree in May, helped develop the text-messaging technology as chief medical officer at Epharmix, a digital health company he founded with classmates in 2015. The company creates mobile technologies aimed at managing chronic conditions such as diabetes, depression and hypertension.

"With the , time is of the essence because of how quickly it's grown and the lives that are lost," Som said.

Nearly 100 people die each day due to opioid overdoses, according to the Centers for Disease Control and Prevention. A highly addictive class of drugs, opioids include prescription painkillers, heroin and fentanyl.

The mobile technology is designed to supplement cognitive behavioral therapy, support services and other treatments aimed at combating opioid addiction. "This is not meant to replace important programs or face-to-face contact between patients and providers," Som said. "Rather, it is an additional tool that is affordable and immediate. It doesn't require costly, time-consuming measures such as opening substance-abuse centers, and training and hiring new staff.

The 21 patients in the study began using the texting service in late 2016 as part of their treatment at Preferred Family Healthcare, a community-based organization in St. Louis that offers treatment for substance abuse.

Data collected via the text messaging service found that at the time of enrollment, nine patients (43 percent) reported substance abuse use in the previous three days, and nine patients (43 percent) reported no use, while the remaining did not respond. After three months, half of the 21 total patients reported no substance use, while the number of patients using dropped to two (10 percent). The researchers can't attribute the positive trend solely to the app but said the data are encouraging.

"Opioid users face strong urges to relapse because of the addictive power of the drug," Som said. "As a result, health-care workers struggle to keep patients engaged."

Patients and caregivers reported that they preferred the ease and familiarity of text message communication. "Texting is convenient, immediate and nonjudgmental," Som said. "It has become an integral part of how we communicate in society. Patients reported feeling more connected to health-care providers."

The service includes a "panic button" for patients facing relapse or other health struggles. Once the button is activated, health-care workers phone patients and provide counseling, scheduling for in-person appointments, or other resources.

Additionally, texts allow caregivers to monitor patients daily with automated questions such as "Have you used in the last day?" and "Have you had urges to use?" Patients who reported struggling received automated follow-up questions that classified their risk for relapse as high, moderate or low. At the same time, health-care workers were alerted to intervene immediately.

"Health-care providers can be proactive," Som said. "It is so much more powerful to curb the temptation and break the cycle in advance of relapse rather than providing treatment only after the event has occurred."

The patients in the study were on Medicaid and individually had accrued more than $20,000 in medical costs related to and other health issues. Researchers calculated that per-patient costs for caregiver services specific to addiction-related care would drop 19 percent, from $926 annually to $753.

Reduced costs from staff time savings were attributed to the texting service, enabling more efficient patient follow-up and better targeting to provide treatment to the right patients. "Cost savings could be realized with this tool as opioid addiction continues to rise and caregivers increasingly are being asked to manage additional patients," said the study's first author, Jordan Feltes, an Epharmix researcher and a second-year medical student at Saint Louis University.

Further studies will allow researchers to examine the text-messaging strategy in a larger patient group, and better gauge potential savings in Medicaid funding and related costs.

"In the midst of this national emergency, it is critical that and providers have clear, open channels of communication in order to mitigate the devastating impact of the opioid crisis," said Will Ross, MD, associate dean for diversity and a professor of medicine at Washington University. He mentored the researchers as principal investigator for Epharmix.

Explore further: Medication assisted treatment is option for opioid use disorder

Related Stories

Medication assisted treatment is option for opioid use disorder

December 12, 2017
Of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, two million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin, ...

Opioid abuse can be treated successfully in primary care settings, study finds

September 5, 2017
Combining substance abuse treatment with regular medical care can successfully treat people with opioid or alcohol addiction, providing an option that might expand treatment and lower the cost of caring for people caught ...

Patients want physicians to have greater connectivity

February 16, 2018
(HealthDay)—Most patients want greater connectivity, online tools and text messaging, as well as more time with their physicians, according to a report published in Medical Economics.

Plastic surgeons get tips on managing opioid addiction risk

October 2, 2017
Opioid medications prescribed for pain management after plastic surgery may contribute to the ongoing opioid epidemic, according to a special topic paper in the October issue of Plastic and Reconstructive Surgery, the official ...

Team-based model reduces prescription opioid use among patients with chronic pain by 40 percent

July 17, 2017
A new, team-based, primary care model is decreasing prescription opioid use among patients with chronic pain by 40 percent, according to a new study out of Boston Medical Center's Grayken Center for Addiction Medicine, which ...

Patients receive most opioids at the doctor's office, not the ER

January 16, 2018
Around the country, state legislatures and hospitals have tightened emergency room prescribing guidelines for opioids to curb the addiction epidemic, but a new USC study shows that approach diverts attention from the main ...

Recommended for you

Shortcut strategy for screening compounds with clinical potentials for drug development

December 4, 2018
Developing a new drug often takes years and costs hundreds of millions of dollars. A shortcut has now been reported in a study led by City University of Hong Kong (CityU), which can potentially reduce the time and costs of ...

Drug wholesalers drove fentanyl's deadly rise, report concludes

December 4, 2018
Fentanyl, a powerful synthetic opioid implicated in nearly 29,000 overdose deaths in the United States last year, most likely spread because of heroin and prescription pill shortages, and also because it was cheaper for drug ...

Global review reports on administration of children's antibiotics

December 4, 2018
Researchers analyzing the sales of oral antibiotics for children in 70 high- and middle-income countries found that consumption varies widely from country to country with little correlation between countries' wealth and the ...

Opioid prescriptions from dentists linked to youth addiction risk

December 3, 2018
Teens and young adults who receive their initial opioid prescriptions from their dentists or oral surgeons are at increased risk for opioid addiction in the following year, a study from the Stanford University School of Medicine ...

Rise in meth and opioid use during pregnancy

November 29, 2018
Amphetamine and opioid use in pregnancy increased substantially over the last decade in the United States, a new Michigan Medicine-led study finds. And a disproportionate rise occurred in rural counties.

Mouse model aids study of immunomodulation

November 19, 2018
Because mice do not respond to immunomodulatory drugs (IMiDs), preclinical therapeutic and safety studies of the effects of IMiDs have not been possible in existing types of mice. This has led to an inability to accurately ...

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

LaPortaMA
not rated yet Apr 17, 2018
It's only missing one thing: humanity.
Oh, and humility.
Good luck with that and be careful what you ask for.
#disraelitwainstatistics

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.