MHealth Incentivized Adherence Plus Patient Navigation

Patient Navigator Plus Remote mHealth Adherence Support With Incentives to Improve Linkage and Retention Among Hospitalized Patients With Opioid and Methamphetamine Use Who Initiate Buprenorphine

Polysubstance use involving opioids and methamphetamine is emerging as a new public health crisis. Patients with opioids and methamphetamine use often experience serious medical complications requiring hospitalization, which provides an opportunity to offer addiction treatment. Yet linkage to outpatient treatment post-discharge is suboptimal and methamphetamine exacerbates outcomes. The investigators propose to pilot test "MHealth Incentivized Adherence Plus Patient Navigation" (MIAPP) to promote treatment linkage and retention for patients with opioid use disorder (OUD) and methamphetamine use who initiate buprenorphine in the hospital. The investigators Aim is to perform a two-arm, pilot randomized clinical trial (n=40) comparing MIAPP + treatment-as-usual (TAU) versus TAU alone on outpatient medication for opioid use disorder (MOUD) linkage within 30 days (primary) and 90-day retention on medications (secondary) among hospitalized patients with OUD and methamphetamine use.

Inclusion Criteria:

• Adult greater than or equal to 18 years of age
• Admitted to Harborview Medical Center (HMC) on any inpatient service
• Initiated on buprenorphine for OUD while in the hospital or at the time of discharge and planning to continue outpatient
• Used methamphetamine within the past 30 days (any route of administration or frequency)
• Willing to be randomized to video-DOT
• Willing and able to use a smartphone (study can provide) and work with patient navigator
• Discharge setting does not preclude the use of video-DOT (i.e., nursing home, inpatient psychiatry, etc.)

Exclusion Criteria:

• Unable or unwilling to use smartphone (phones to be provided when needed)
• Cognitive impairment (acute or chronic) resulting in inability to provide informed consent
• Currently incarcerated and will discharge to jail or prison
• Plans to discontinue buprenorphine in the near future (<3 months)
• Lives far away such that cannot keep study visit at 30 days post-discharge
• Not English speaking
• Behavioral risk per discretion of research staff