Center for Health Enhancement Systems Studies (D.H. Gustafson Sr., Landucci, Vjorn, Johnston, Pe-Romashko, D.H. Gustafson Jr.), Department of Industrial and Systems Engineering, College of Engineering (D.H. Gustafson Sr.), School of Nursing (Gicquelais), Department of Counseling Psychology, School of Education (Goldberg), Center for Healthy Minds (Goldberg), Department of Psychology, College of Letters and Science (Curtin), and School of Journalism and Mass Communication (Shah), University of Wisconsin-Madison; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Bailey); Stanley Street Treatment and Resources (SSTAR), Fall River, Mass. (Bailey).
Am J Psychiatry. 2024 Feb 1;181(2):115-124. doi: 10.1176/appi.ajp.20230055. Epub 2023 Oct 4.
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.
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.
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).
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.
阿片类药物使用障碍（MOUD）药物可改善治疗保留率并减少非法阿片类药物的使用。A-CHESS 是一种基于证据的智能手机干预措施，已被证明可改善与成瘾相关的行为。作者测试了 MOUD 单一疗法与 MOUD+A-CHESS 的疗效，以确定联合治疗是否能进一步改善结果。
在一项非盲平行组随机对照试验中，从门诊项目中招募了 414 名参与者，按照 1:1 的比例随机分配接受 MOUD 单一疗法或 MOUD+A-CHESS 治疗 16 个月，并在额外的 8 个月内进行随访。所有参与者均服用美沙酮、丁丙诺啡或纳曲酮注射剂。主要结局是非法阿片类药物使用的禁欲；次要结局是治疗保留率、卫生服务使用、其他物质使用和生活质量；调节剂是 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 个月进行一次的多项经过验证的量表组成的调查，以及尿液筛查。
在整个时间内，接受 MOUD+A-CHESS 和 MOUD 单一疗法的参与者之间的禁欲率没有差异（优势比=1.10，95%CI=0.90-1.33）。然而，禁欲率受到戒断症状严重程度（优势比=0.95，95%CI=0.91-1.00）和 MOUD 类型（优势比=0.57，95%CI=0.34-0.97）的调节。在没有戒断症状的参与者中，接受 MOUD+A-CHESS 治疗的参与者随着时间的推移，禁欲率更高（优势比=1.30，95%CI=1.01-1.67）。在服用美沙酮的参与者中，接受 MOUD+A-CHESS 治疗的参与者随着时间的推移更有可能保持禁欲（b=0.28，SE=0.09），而接受 MOUD 单一疗法的参与者则较少（b=0.06，SE=0.08），尽管两组之间没有显著差异（∆b=0.22，SE=0.11）。MOUD+A-CHESS 还与更高的就诊出勤率（优势比=1.25，95%CI=1.05-1.49）和减少急诊和紧急护理的使用相关（优势比=0.88，95%CI=0.78-0.99）。
总体而言，MOUD+A-CHESS 相对于 MOUD 单一疗法并没有改善禁欲率。然而，MOUD+A-CHESS 可能对某些患者群体有益，并可能影响治疗的使用。
