Integrating Text Messaging in a Low Threshold Telebuprenorphine Program for New York City Residents with Opioid Use Disorder during COVID-19: A Pilot Randomized Controlled Trial

• Published in: Journal of addiction medicine Vol. 17; no. 5; p. e281
• Main Authors: Tofighi, Babak, Badiei, Beita, Badolato, Ryan, Lewis, Crystal Fuller, Nunes, Edward, Thomas, Anil, Lee, Joshua D
• Format: Journal Article
• Language: English
• Published: Netherlands 01.09.2023
• Subjects: Adult; Buprenorphine - therapeutic use; Cell Phone; COVID-19; Humans; New York City; Opioid-Related Disorders - drug therapy; Pandemics; Pilot Projects; Text Messaging; New York City
• ISSN: 1935-3227
• DOI: 10.1097/ADM.0000000000001161

Pragmatic innovations are needed to optimize clinical outcomes among people who use opioids initiating buprenorphine. This pilot randomized controlled trial assessed the feasibility of integrating text messaging in a low threshold telebuprenorphine bridge program for people who use opioids during the COVID-19 pandemic. Eligible adult patients with opioid use disorder inducted on buprenorphine (N = 128) in the NYC Health+Hospitals Virtual Buprenorphine Clinic between May and November 2020 were randomized to an automated texting intervention based on the medical management model versus treatment as usual. A participant feedback survey was administered at 8 weeks (n = 18). Primary outcomes consisted of acceptability (eg, study enrollment, engagement with the intervention) and feasibility (eg, lack of phone number and/or mobile phone ownership) of integrating texting in clinical care. A secondary outcome included retention in treatment at week 8 (ie, active buprenorphine prescription within the prior 7 days). Nearly all eligible patients consented to enroll in the study (90.8%) and few were excluded because of lack of mobile phone ownership (n = 27, 14.6%). Requests to discontinue receipt of texts (n = 6, 9.4%) was attributed to excessive message frequency, perceived lack of relevancy, and reduced interest in the intervention. Respondents completing the follow-up feedback survey were generally satisfied with the frequency of software-generated messages (14/18, 77.8%) and half shared text content with peers (9/18, 50%). There were no perceived issues with privacy, intrusiveness, or ease of use. Retention did not differ between participants randomized to the texting (M = 5.23 weeks, SD = 3.41) and treatment as usual groups (M = 4.98 weeks, SD = 3.34) at week 8 ( P = 0.676). This pilot randomized controlled trial confirms high acceptability and feasibility of integrating an automated texting tool in a telebuprenorphine bridge program. Future studies should assess whether text messaging may be efficacious when combined with staff contact and content addressing social determinants of health.