%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55072 %T Patterns of Internet Use in People Diagnosed With Severe Mental Illness: Qualitative Interview Study %A Wadman,Ruth %A Walker,Lauren %A Taylor,Olivia %A Heron,Paul %A Newbronner,Elizabeth %A Spanakis,Panagiotis %A Crosland,Suzanne %A Peckham,Emily Jane %+ School of Medical and Health Sciences, Bangor University, Wrexham Technology Park,, Croesnewydd Road, Wrexham, LL13 7YP, United Kingdom, 44 7934877022, lrw24ltt@bangor.ac.uk %K severe mental illness %K internet use %K qualitative %K typology %K protective strategies %K digital divide %D 2025 %7 28.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: People with severe mental illness (SMI) face profound health inequalities, which may be exacerbated by increased rates of digital exclusion, especially as health services move to online provision. The activities that people carry out online can affect how they feel about the internet and may determine whether a person has a positive or negative experience when using the internet. This, in turn, could affect their mental health. To support people with SMI in using digital technology and the internet safely, it is important to understand the internet and digital technology use of those with SMI and their perceived positive or negative impact on their mental health. Objective: This study aimed to explore the internet and digital technology use of those with SMI, with particular focus on any association between greater use of the internet and poorer self-reported mental health. Methods: We carried out a qualitative interview study with 16 people with SMI. The sample was drawn from a wider investigation of the impact of the pandemic and its restrictions on the health and well-being of 367 people with SMI. We purposively sampled from the wider study based on age, gender, frequency of internet use, and self-reported mental health. The data were analyzed by 2 researchers using framework analysis. Results: Participant experiences fell into 3 broad categories: those who had a positive or neutral internet-based experience, those who had negative or difficult experiences, and low users or those with poor digital literacy. Those who had positive or neutral experiences could be broken down into 2 subcategories: first, those with positive or neutral experiences of the internet who were similar in terms of the activities participated in, feelings reported, and their concerns about the internet, and second, conscious users who were mindful of their interaction with the internet world. Participants with difficult experiences fell into 2 categories: those with worries and fears related to using the internet and those who had difficulty limiting their internet use. Conclusions: People with SMI, similarly the general population, are expected to conduct more of their activities of daily living online in the postpandemic world. This research shows that most internet users with SMI have positive or neutral experiences. However, our typology reveals subgroups of the population with SMI for whom there is a relationship between internet use and difficult feelings. These subgroups can be identified by asking questions about online activities; time spent online; feelings, difficulties, or issues experienced; and use of gambling, dating, adult content, and conspiracy theory websites. Our findings point to further work in collaboration with people with lived experience to modify and test this typology. %M 40153777 %R 10.2196/55072 %U https://www.jmir.org/2025/1/e55072 %U https://doi.org/10.2196/55072 %U http://www.ncbi.nlm.nih.gov/pubmed/40153777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59220 %T Implementation of Medication-Related Technology and Its Impact on Pharmacy Workflow: Real-World Evidence Usability Study %A Yu,Wei-Ning %A Cheng,Yih-Dih %A Hou,Yu-Chi %A Hsieh,Yow-Wen %+ , Department of Pharmacy, China Medical University Hospital, No 2, Yude Rd, North Dist, Taichung City, 404327, Taiwan, 886 422052121 ext 12272, tovis168@gmail.com %K medication error %K dispensing error %K medication-related technology %K pharmacy %K smart dispensing counter %D 2025 %7 27.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Medication errors constitute a major contributor to patient harm, driving up health care costs and representing a preventable cause of medical incidents. Over the past decade, many hospitals have integrated various medication-related technologies into their pharmacy operations. However, real-world evidence of the impact of these advanced systems on clinical prescription dispensing error rates remains limited. Objective: This study aims to prospectively detect and record the categories and rates of dispensing errors to illustrate how medication-related technologies, such as automated dispensing cabinet (ADC), barcode medication administration (BCMA), and smart dispensing counter (SDC), can be used to minimize dispensing errors. Methods: This study used a before-and-after design at a 2202-bed academic medical center in Taiwan to assess the impact of implementing medication-related technologies (ADC, BCMA, and SDC) on patient medication safety. Dispensing error rates were analyzed from January 1, 2017, to December 31, 2023, using data from the China Medical University Hospital Patient Safety Database. The study periods were defined as stage 0 (preintervention, January to November 2017), stage 1 (post-ADC intervention, December 2017 to June 2018), stage 2 (post-BCMA intervention, July 2018 to October 2020), and stage 3 (post-SDC intervention, November 2020 to December 2023). Medication errors were defined according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Chi-square or Fisher exact tests were used to analyze differences between intervention periods, with Bonferroni correction for multiple comparisons. Statistical significance was set at P<.05. Results: Following the introduction of medication-related technologies, the average dispensing error incidence rate significantly decreased by 39.68%, 44.44%, and 77.78%, from 0.0063% in stage 0 to 0.0038%, 0.0035%, and 0.0014% in stages 1, 2, and 3, respectively (P<.001). The frequency of “wrong drug” errors, the most common error type in stage 0, significantly decreased by 51.15%, 56.85%, and 81.26% in stages 1, 2, and 3, respectively. All error types, except for “wrong dosage form,” “wrong strength,” “wrong time,” and “others,” demonstrated statistically significant differences (P<.001). The majority of harm severities were categorized as “A” (no error; 97%-98.8%) and “B-D” (error, no harm; 1.2%-3%) according to the NCC MERP classification. The severity of “no error” (category A) significantly decreased at each stage (P<.001). Statistically significant differences in dispensing error rates were observed between all stages (P<.001), except between stages 2 and 1 (P>.99). Conclusions: This study provides significant evidence that the implementation of medication-related technologies, including ADC, BCMA, and SDC, effectively reduces dispensing errors in a hospital pharmacy setting. Specifically, we observed a substantial decrease in the average dispensing error rate across 3 stages of technology implementation. Importantly, this study appears to be the first to investigate the combined impact of these 3 specific technologies on dispensing error rates within a hospital pharmacy. %M 40019479 %R 10.2196/59220 %U https://www.jmir.org/2025/1/e59220 %U https://doi.org/10.2196/59220 %U http://www.ncbi.nlm.nih.gov/pubmed/40019479 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58410 %T Centering Birthing Experiences of Women of Color: Protocol for a Qualitative Maternal Near Miss Study %A Hernandez-Spalding,Kaitlyn %A Farinu,Oluyemi %A Clarke,Lasha %A Lewis,Tamiah %A Suarez,Angie %A Bugg,Kimarie %A Strickland,Kieauna %A Molleti,Ashley %A Maxy,Sherry %A Hernandez-Green,Natalie %+ Center for Maternal Health Equity, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, United States, 1 4047521523, nhernandez@msm.edu %K maternal health disparities %K maternal near miss %K minority health %K mental health %K narrative-based medicine %K experiences %K birthing experience %K women %K Black women %K United States %K maternal morbidity %K patient-centered %K racial %K ethnic %K disparities %K socioeconomically %K pregnancy %K childbirth %K postpartum %K antenatal %D 2025 %7 27.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, Black women are 3-4 times more likely to experience maternal near miss (MNM) or severe maternal morbidity (SMM) than non-Hispanic White women. However, there is a limited narrative-based investigation into Black and other marginalized women’s MNM experiences. Additionally, limited extant research on the impact of MNM and SMM on birthing women’s families or support persons and health care providers precludes the development of multilevel, patient-centered methods to eliminate these racial or ethnic disparities. Objective: This paper presents the protocol for a study that aims to draw insights from the experiences of racially and socioeconomically diverse mothers with MNM and SMM, their family or support persons (eg, partners), and health care providers to inform legislation, clinical practice, and infrastructure for optimal social support using PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guidelines. Using a storytelling approach to assess participants’ risk factors, document underlying causes, and research clinical causes of MNM, researchers hypothesize these data will inform policies to improve maternal conditions and provide safe and effective prevention and treatment options for birthing persons. Methods: Morehouse School of Medicine (MSM) will partner with health services and community-based organizations to promote inclusive participant recruitment for this multiphase study. In phase 1, qualitative interviews were conducted with birthing women (n≤87) who have experienced MNM and SMM. In phase 2, we will conduct qualitative interviews with the following groups: birthing women’s partners or support persons (n≤50), health care providers serving birthing women (n≤50), and adults who lost their mothers to pregnancy-related complications (n≤50). In each phase, the total number of participants interviewed will be based on theoretical saturation, that is, the point in iterative data collection and analysis when all important insights have been exhausted from the data already available. Results: Recruitment for phase 1 started in July 2021. As of March 2024, we have recruited 87 racially and socioeconomically diverse birthing women. Of those, 74% (64/87) self-identified as Black or African American, 20% (17/87) as Hispanic or Latina, and 9% (8/87) as Native American or Alaska Native. Severe preeclampsia accounted for 46% (40/87) of participants’ pregnancy-related adverse experiences. Qualitative interviews grounded in narrative-based medicine are ongoing. Recruitment for phase 2 will occur between July 2023 and December 2024. Study results will be published in peer-reviewed scientific journals. Conclusions: The findings from this research will deepen the understanding of how severe obstetric complications (1) are experienced by birthing women; (2) are perceived by their partners, support persons, and health providers; and (3) impact the lives of bereaved family and community members. %M 40146199 %R 10.2196/58410 %U https://www.researchprotocols.org/2025/1/e58410 %U https://doi.org/10.2196/58410 %U http://www.ncbi.nlm.nih.gov/pubmed/40146199 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65847 %T Theory-Based Social Media Intervention for Nonmedical Use of Prescription Opioids in Young Adults: Protocol for a Randomized Controlled Trial %A Tam,Cheuk Chi %A Young,Sean D %A Harrison,Sayward %A Li,Xiaoming %A Litwin,Alain H %+ Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States, 1 8037776883, ctam@mailbox.sc.edu %K nonmedical use of prescription opioids %K opioid misuse %K young adults %K social media %K psychosocial intervention %K randomized controlled trial %K mixed methods %D 2025 %7 26.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The nonmedical use of prescription opioids (NMUPO) in young adults in the United States is concerning and is robustly influenced by many psychosocial factors. Given the advantages of flexibility, wide coverage, and real-time responses and assessment, using social media appears to be a promising and innovative approach to delivering psychosocial intervention to young adults. However, few theory-based social media interventions are available for NMUPO targeting this at-risk population. Objective: Guided by the information-motivation-behavioral skills model, the proposed research aims to address critical gaps by theoretically exploring psychosocial content associated with NMUPO among young adults via formative assessment. These findings will then be used to develop and evaluate the feasibility and preliminary efficacy of a peer-led social media intervention to reduce NMUPO among young adults. Methods: The proposed study will comprise serial research activities. First, formative research will be conducted through semistructured interviews among 30 young adults engaged in NMUPO. Qualitative data will be synthesized using a pragmatic approach for identifying psychosocial content associated with NMUPO. Second, qualitative findings will be used for developing a peer-led social media intervention to reduce NMUPO among young adults by integrating promising psychotherapy principles and incorporating them with well-trained recovery coaches. Third, the social media intervention will be evaluated through a 12-week randomized controlled trial among 70 young adults (n=35, 50% in the intervention group and control group) engaged in NMUPO via mixed methods, including pre- and postintervention surveys, social media paradata (eg, time-series reactions to posts) collection, and ecological momentary assessment during the intervention. The control group will not receive an intervention but will complete the pre- and postintervention surveys. The primary outcomes will be feasibility, usability, and acceptability, while the secondary outcomes will be psychosocial and behavioral measures, such as past–3-month NMUPO, intention, psychological distress, self-efficacy, resilience, and coping strategies. Results: The proposed study was funded in May 2024. Social media campaigns have received responses from a total of 379 individuals, with 24 (6.3%) identified as eligible. As of February 10, 2025, we have completed formative interviews with 8 eligible participants. Conclusions: The proposed study will be one of the first efforts to develop and deliver a theory-based peer-led intervention on social media, incorporating empirical findings on the psychosocial mechanism of NMUPO. The findings of the proposed study will provide valuable insights into opioid risk reduction for young adults through an innovative approach. If the tested trial is found to be feasible, the proposed study will contribute to future scaled-up and fully powered psychosocial interventions among young adults and other key populations at risk for NMUPO. Trial Registration: ClincialTrials.gov NCT06469749; https://clinicaltrials.gov/study/NCT06469749 International Registered Report Identifier (IRRID): DERR1-10.2196/65847 %M 40139213 %R 10.2196/65847 %U https://www.researchprotocols.org/2025/1/e65847 %U https://doi.org/10.2196/65847 %U http://www.ncbi.nlm.nih.gov/pubmed/40139213 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65693 %T Treatment of Substance Use Disorders With a Mobile Phone App Within Rural Collaborative Care Management (Senyo Health): Protocol for a Mixed Methods Randomized Controlled Trial %A Oesterle,Tyler S %A Bormann,Nicholas L %A Paul,Margaret M %A Breitinger,Scott A %A Lai,Benjamin %A Smith,Jamie L %A Stoppel,Cindy J %A Arndt,Stephan %A Williams,Mark D %+ Department of Psychiatry, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 284 2511, bormann.nicholas@mayo.edu %K substance-related disorders %K mobile apps %K primary care %K clinical trial %K substance use disorder %K SUD %K addiction treatment %K telemedicine %K telepsychiatry %K care management %K community-based care %K behavioral health program %D 2025 %7 26.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 worsened an already existing problem in substance use disorder (SUD) treatment. However, it helped transform the use of telehealth, which particularly benefits rural America. The lack of specialty addiction treatment in rural areas places the onus on primary care providers. Screening, brief intervention, and referral to treatment (SBIRT) is an evidenced-based strategy commonly used in primary care settings to target SUD outcomes and related behaviors. The integration of telehealth tools within the SBIRT pathway may better sustain the program in primary care. Building on Mayo Clinic’s experience with collaborative care management (CoCM) for mental health treatment, we built a digitally native, integrated, behavioral health CoCM platform using a novel mobile app and web-based provider platform called Senyo Health. Objective: This protocol describes a novel use of the SBIRT pathway using Senyo Health to complement existing CoCM integration within primary care to deliver SUD treatment to rural patients lacking other access. We hypothesize that this approach will improve SUD-related outcomes within rural primary care clinics. Methods: Senyo Health is a digital tool to facilitate the use of SBIRT in primary care. It contains a web-based platform for clinician and staff use and a patient-facing mobile phone app. The app includes 16 learning modules along with data collection tools and a chat function for communicating directly with a licensed drug counselor. Beta-testing is currently underway to examine opportunities to improve Senyo Health prior to the start of the trial. We describe the development of Senyo Health and its therapeutic content and data collection instruments. We also describe our evaluation strategy including our measurement plan to assess implementation through a process guided by Consolidated Framework for Implementation Research methods and effectiveness through a waitlist control trial. A randomized controlled trial will occur where 30 participants are randomly assigned to immediately start the Senyo intervention compared to a waitlist control group of 30 participants who will start the active intervention after a 12-week delay. Results: The Senyo Health app was launched in May 2023, and the most recent update was in August 2024. Our funding period began in September 2023 and will conclude in July 2027. This protocol defines a novel implementation strategy for leveraging a digitally native, clinical platform that enables the delivery of CoCM to target an SUD-specific patient population. Our trial will begin in June 2025. Conclusions: We present a theory of change and study design to assess the impact of a novel and patient-centered mobile app to support the SBIRT approach to SUD in primary care settings. Trial Registration: ClinicalTrials.gov NCT06743282; http://clinicaltrials.gov/ct2/show/NCT06743282 International Registered Report Identifier (IRRID): PRR1-10.2196/65693 %M 40138685 %R 10.2196/65693 %U https://www.researchprotocols.org/2025/1/e65693 %U https://doi.org/10.2196/65693 %U http://www.ncbi.nlm.nih.gov/pubmed/40138685 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e72032 %T Unintended Prolonged Opioid Use: Protocol for a Case-Controlled Trial %A Hooten,W Michael %A Erickson,Darin J %A Chawarski,Marek %A Scholz,Natalie A %A Waljee,Jennifer F %A Brummett,Chad M %A Jeffery,Molly M %+ Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, United States, 1 507 266 9670, hooten.william@mayo.edu %K opioid use %K case-control %K unintended opioid use %K prolonged opioid use %K prospective %D 2025 %7 24.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Misuse of prescription opioids remains a public health problem. Appropriate short-term use of these medications in opioid-naive patients is indicated in selected settings but can result in unintended prolonged opioid use (UPOU), defined as the continuation of opioid therapy beyond the period by which acute pain would have been expected to resolve. Clinical strategies aimed at preventing UPOU are lacking due to the absence of information about how this poorly understood clinical phenomenon actually develops. Objective: In this research project, 3 Clinical and Translational Science Awards (CTSA) programs (Mayo Clinic, University of Michigan, and Yale University) leveraged the conceptual framework for UPOU to investigate how patient characteristics, practice environment characteristics, and opioid prescriber characteristics facilitate or impede UPOU. All data management and analyses were conducted at a fourth CTSA program (University of Minnesota). This work was accomplished by pursuing 3 specific aims. Methods: In aim 1, opioid-naive adults receiving an initial opioid prescription were recruited for study participation. Opioid prescriptions were identified longitudinally, and patterns of use were categorized as short-term, episodic, or long-term use using established criteria. Using a prospective case-control design, patients progressing to UPOU were matched 1:1 with patients who did not develop UPOU, and differences in patient characteristics were assessed. In aim 2, clinicians who prescribed opioids to patients in aim 1 were identified and recruited for prospective assessments. Institutional and individual practice environments were assessed using a validated self-report survey. In aim 3, structural equation modeling was used to evaluate data collected in aims 1 and 2, and identified interactions were further evaluated in a large national administrative claims database. Results: Patient recruitment began on August 1, 2019. However, due to the COVID-19 pandemic, patient recruitment was slowed and intermittently interrupted over the ensuing 3-year period. As a result of regional variations in the impact of the COVID-19 pandemic on research activities, the majority of patient and clinician recruitment occurred at the Mayo Clinic site. Conclusions: Following complete data analyses, it is anticipated that electronic health record systems will be leveraged to help clinicians identify at risk patients and to develop direct-to-patient educational materials to raise awareness of the risk factors for developing UPOU. Trial Registration: ClinicalTrials.gov NCT04024397; https://clinicaltrials.gov/study/NCT04024397 International Registered Report Identifier (IRRID): DERR1-10.2196/72032 %M 39992690 %R 10.2196/72032 %U https://www.researchprotocols.org/2025/1/e72032 %U https://doi.org/10.2196/72032 %U http://www.ncbi.nlm.nih.gov/pubmed/39992690 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64459 %T A Brief Cognitive Behavioral Therapy–Based Digital Intervention for Reducing Hazardous Alcohol Use in South Korea: Development and Prospective Pilot Study %A Kwon,Manjae %A Moon,Daa Un %A Kang,Minjae %A Jung,Young-Chul %K alcohol %K hazardous alcohol use %K digital intervention %K cognitive behavioral therapy %K mobile apps %K prevention %K therapy-based %K cognitive behavioral %K alcohol use %K South Korea %K prospective pilot study %K pilot study %K alcohol consumption %K death %K disability %K chronic medical condition %K digital health interventions %K traditional treatment methods %K Korean %K hazardous drinking %K acceptability %K feasibility %K smartphone app %K alcohol use disorder %K psychiatric symptoms %K mobile phone %D 2025 %7 19.3.2025 %9 %J JMIR Form Res %G English %X Background: Alcohol consumption is a leading cause of death and disability worldwide, associated with numerous acute and chronic medical conditions. Digital health interventions offer a promising solution to overcome barriers associated with traditional treatment methods, providing accessible, scalable, and cost-effective means to support individuals in reducing hazardous drinking. Objective: This pilot study aims to evaluate the feasibility, acceptability, and preliminary efficacy of the Sober smartphone app in individuals with hazardous alcohol use. Methods: This single-group, pre- and postpilot study included 20 participants with risky alcohol use, identified using the Alcohol Use Disorder Identification Test. Participants used the Sober app for 4 weeks, incorporating cognitive behavioral therapy–based interventions. Feasibility was assessed by study and session completion rates, acceptability by participant satisfaction and perceived usefulness, and preliminary efficacy by changes in alcohol consumption and psychiatric symptoms. Semistructured interviews with participants and clinicians provided qualitative perspectives on the app’s usability, efficacy, and areas for improvement. Results: Of the 20 enrolled participants, 17 completed the study. The app demonstrated high feasibility with an 85% (17/20) study completion rate, and 59% (10/17) completed all cognitive behavioral therapy sessions. Participants reported positive acceptability, with average satisfaction and usefulness ratings of 3.8 and 3.7 of 5, respectively. Preliminary efficacy outcomes showed significant improvements: abstinence days increased from 67% to 85% (z=−3.17; P=.002), heavy drinking episodes decreased from 3.3 to 1.9 (t16=−2.97; P=.003), and total alcohol consumption reduced from 456.8 to 195.9 mL (t16=3.16; P=.002). Alcohol Use Disorder Identification Test scores dropped from 17.5 to 10.7 (t16=4.51; P<.001). Additionally, depression (Patient Health Questionnaire-9) scores decreased from 5.8 to 4.4 (t16=2.91; P=.01), and anxiety (Generalized Anxiety Disorder-7) scores from 3.4 to 2.1 (z=−2.80; P=.005). No adverse events were reported. Qualitative analysis found participants valued daily logging but noted usability issues, while clinicians called for tailored goals, enhanced communication features, and age-specific content. Conclusions: The mobile app Sober shows promise as an effective tool for reducing hazardous alcohol consumption and improving related psychiatric symptoms. The study demonstrated high feasibility and positive acceptability, with significant preliminary efficacy in reducing alcohol use. Qualitative findings provided actionable evidence for refining the app’s usability and clinical integration. Further research through a randomized controlled trial is warranted to confirm these findings and optimize the app’s features and content. Trial Registration: ClinicalTrials.gov NCT06502756; https://clinicaltrials.gov/study/NCT06502756 %R 10.2196/64459 %U https://formative.jmir.org/2024/1/e64459 %U https://doi.org/10.2196/64459 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65025 %T Evaluating Perceptions of the CANreduce 2.0 eHealth Intervention for Cannabis Use: Focus Group Study %A Folch-Sanchez,Daniel %A Pellicer-Roca,Maria %A Sestelo,María Agustina %A Zuluaga,Paola %A Arias,Francisco %A Guzmán Cortez,Pablo %A Amechat,Salma %A Gil-Berrozpe,Gustavo %A Lopez Montes,Estefania %A Mercadé,Clara %A Fonseca,Francina %A Miquel,Laia %A Mestre-Pintó,Joan I %+ Health and Addictions Research Group, Addictions Unit, Psychiatry and Psychology Service, Institut Clínic de Neurociències (ICN), Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c villarroel 170, Barcelona, Spain, 34 932275400 ext 1719, miquel@clinic.cat %K addiction %K cannabis %K drug use disorder %K eHealth %K digital health intervention %K qualitative research %K focus groups %K user-centered design %K user-centered intervention %D 2025 %7 19.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Cannabis is the most widely used illicit drug, and admissions for cannabis use disorders (CUDs) are increasing globally, posing a significant public health challenge. Despite its negative consequences, a substantial proportion of individuals with problematic use do not seek treatment. In recent years, digital health interventions (DHIs) have emerged as accessible and cost-effective solutions, empowering users to manage their health care. CANreduce is one such eHealth intervention that has demonstrated effectiveness in reducing cannabis use (CU); however, its suboptimal adherence rates underscore the need for strategies to enhance user engagement and motivation. Objective: This study aims to improve the effectiveness, adherence, and user experience of the Spanish version of CANreduce 2.0 by employing focus groups (FGs) within a user-centered design approach that actively involves both users and professionals. Methods: Separate FGs were conducted for users and professionals, involving a total of 10 participants. Users were recruited from individuals registered on the CANreduce 2.0 platform and active cannabis users, while professionals comprised addiction specialists familiar with the platform. Each session was held remotely and moderated by 2 interviewers following a semistructured script. Qualitative analysis of the transcripts was performed using MAXQDA software and content analysis methodology to identify key themes related to the acceptability, usability, and utility of CANreduce 2.0. Results: The qualitative analysis identified 3 main themes, encompassing 15 subcodes. Within the “motivation and awareness” theme, both users (n=6, mean age 31.8 years, SD 4.1 years) and professionals (n=4, mean age 37.25 years, SD 1.71 years) frequently discussed the importance of “motivation” and “problem awareness” as crucial for the success of CANreduce 2.0. In the “guidance and use” theme, the subcode “complement to face-to-face therapy” was the most emphasized. Professionals supported CANreduce 2.0 as a valuable adjunct to in-person therapy, serving as both an educational and monitoring tool, with no objections raised by either group. Lastly, within the “content and design” theme, “information,” “small achievements,” and “personalized content” emerged as key areas for improvement, highlighting the need to enhance motivation and adherence through gamification and tailored content. Conclusions: Personalization, robust motivational strategies, and an engaging, interactive design are essential for the success of DHIs, particularly in addiction treatment. Collaboration among technology developers, health care professionals, and users should be central to the development process, fostering the cocreation of practical and effective solutions that are responsive to the needs of those seeking treatment. This approach ensures that DHIs are not only functional but also widely accepted and impactful. Insights from this study will inform the ongoing refinement of CANreduce 2.0, enhancing its relevance and effectiveness in addressing CU. %M 40106809 %R 10.2196/65025 %U https://www.jmir.org/2025/1/e65025 %U https://doi.org/10.2196/65025 %U http://www.ncbi.nlm.nih.gov/pubmed/40106809 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66487 %T HIV Incidence and Associated Risk Factors Among Young Men Who Have Sex With Men in Tianjin, China: Retrospective Cohort Study %A Guo,Yan %A Gong,Hui %A Yan,Xiangyu %A Zhang,Xinying %A Ning,Tielin %A Liu,Zhongquan %A Li,Long %A Yang,Jie %A Li,Liu %A Ma,Changxu %A Cui,Zhuang %A Yu,Maohe %K young men who have sex with men %K YMSM %K incidence %K HIV %K cohort study %K risk factor %D 2025 %7 19.3.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Young men who have sex with men (YMSM) have a higher risk of HIV infection. However, evidence of HIV incidence from large cohort studies is limited in this key population, particularly among Chinese YMSM. Objective: This study aimed to investigate the HIV incidence and associated risk factors among YMSM aged 16‐24 years in Tianjin, China. Methods: We conducted a retrospective cohort study among men who have sex with men aged 16‐24 years from October 2017 to December 2022 through the largest local nongovernmental organization serving men who have sex with men in Tianjin. Participants who responded to the investigations at least twice during the study period were included. They completed questionnaires on demographic information, sexual behaviors, psychoactive substance use, and sexually transmitted infection status. Simultaneously, their blood samples were collected for HIV testing. HIV incidence was calculated by dividing the sum of observed HIV seroconversions by the observed person-years (PYs). A Cox proportional hazards regression model was used to identify risk factors associated with HIV incidence. Results: A total of 1367 HIV-negative YMSM were included in the cohort, among whom 62 seroconversions occurred, contributing 2384.2 observed PYs; the total incidence was 2.6 (95% CI 2.0‐3.2) per 100 PYs. The segmented HIV incidence rates were 3 (95% CI 1.5‐4.5), 2.4 (95% CI 1.5‐3.3), and 2.7 (95% CI 1.5‐3.9) per 100 PYs for 2017‐2018, 2019‐2020, and 2021‐2022, respectively. Compared to YMSM who had been followed up fewer than three times, those followed up three or more times had a relatively lower risk of HIV infection (Adjusted hazard ratio [AHR] 0.553, 95% CI 0.325‐0.941). YMSM who preferred finding sexual partners offline had a higher risk of HIV infection compared to those who preferred finding sexual partners online (AHR 2.207, 95% CI 1.198‐4.066). Compared to YMSM without syphilis, those infected with syphilis had an increased risk of HIV infection (AHR 2.234, 95% CI 1.137‐4.391). Additionally, YMSM who used psychoactive substances had a higher risk of HIV infection compared to those who did not use such substances (AHR 2.467, 95% CI 1.408‐4.321). Conclusions: Our study complements data on HIV incidence among YMSM in large cities across China. Syphilis infection and the use of psychoactive substances were risk factors associated with HIV occurrence, demonstrating an urgent need for tailored prevention and control interventions for this key population. %R 10.2196/66487 %U https://publichealth.jmir.org/2025/1/e66487 %U https://doi.org/10.2196/66487 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64664 %T Use of Wearable Transdermal Alcohol Sensors for Monitoring Alcohol Consumption After Detoxification With Contingency Management: Pilot Randomized Feasibility Trial %A Brobbin,Eileen %A Drummond,Colin %A Parkin,Stephen %A Deluca,Paolo %+ King's College London, 4 Windswor Walk, Denmark Hill, London, SE5 8BB, United Kingdom, 44 07758287265, eileen.brobbin@kcl.ac.uk %K alcohol %K alcohol dependence %K alcohol monitoring %K alcohol treatment %K contingency management %K transdermal alcohol sensor %K transdermal technology %K wearable %K wearable alcohol biosensor %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Wearable transdermal alcohol sensor (TAS) devices generate continuous data on alcohol consumption through the indiscernible sweat vapors on the skin. This continuous alcohol monitoring capability could provide a new method for alcohol services to monitor service users at various stages of their alcohol treatment. Objective: We aimed to assess the feasibility of using a TAS as part of alcohol treatment with alcohol service users using the device with or without contingency management (CM). Methods: A feasibility study was conducted of a convenience sample of 29 current service users from 3 South London alcohol services. Participants were randomized into either a control (treatment as usual) or CM group (treatment as usual+CM). We assessed the feasibility of enrollment, participation, device tampering and return, and device wearability and the accuracy of data capture. These data were reported descriptively where appropriate, the groups were compared, and alcohol self-report data were compared to the transdermal alcohol concentration to assess accuracy. Results: A total of 34 individuals were approached, and 32 (94%) were enrolled and randomized (n=17, 53% to the control group and n=15, 47% to the CM group) over 5 months. In total, 3 participants withdrew (n=2, 67% from the control group and n=1, 33% from the CM group). There was a total of 203 meetings arranged (29 participants × 7 meetings), and 185 (91.1%) were attended. Only 1 of the 29 participants (3%) admitted to turning the TAS off to avoid monitoring. There were some issues with the TAS not functioning properly and not being able to be cleaned. Removals were recorded, but the definition of TAS removal may need to be improved for future trials. There was a high TAS return rate (28/29, 97% of the participants returned the TAS). Secondary outcomes suggest that the BACtrack Skyn remains an accurate tool to monitor alcohol consumption compared to self-report data and that it is acceptable to wearers over 2 weeks, with many participants (27/28, 96%) answering that they would wear it again and for longer but that the CM procedure could be made clearer. Conclusions: The delivery of CM via a TAS was feasible in this study, but recommendations for a future larger trial include that the study design should be changed to provide an operationalized rather than manual method of checking whether TAS data meet CM criteria. This would reduce researcher burden and researcher and participant time. Current recruitment and research meeting design seem suitable for a future larger trial. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN46845361; https://www.isrctn.com/ISRCTN46845361 %M 40085839 %R 10.2196/64664 %U https://humanfactors.jmir.org/2025/1/e64664 %U https://doi.org/10.2196/64664 %U http://www.ncbi.nlm.nih.gov/pubmed/40085839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62805 %T Machine Learning–Based Prediction of Substance Use in Adolescents in Three Independent Worldwide Cohorts: Algorithm Development and Validation Study %A Kim,Soeun %A Kim,Hyejun %A Kim,Seokjun %A Lee,Hojae %A Hammoodi,Ahmed %A Choi,Yujin %A Kim,Hyeon Jin %A Smith,Lee %A Kim,Min Seo %A Fond,Guillaume %A Boyer,Laurent %A Baik,Sung Wook %A Lee,Hayeon %A Park,Jaeyu %A Kwon,Rosie %A Woo,Selin %A Yon,Dong Keon %+ Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 269352476, yonkkang@gmail.com %K adolescents %K machine learning %K substance %K prediction %K XGBoost %K random forest %K ML %K substance use %K adolescents %K adolescent %K South Korea %K United States %K Norway %K web-based survey %K survey %K risk behavior %K smoking %K alcohol %K intervention %K interventions %D 2025 %7 24.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: To address gaps in global understanding of cultural and social variations, this study used a high-performance machine learning (ML) model to predict adolescent substance use across three national datasets. Objective: This study aims to develop a generalizable predictive model for adolescent substance use using multinational datasets and ML. Methods: The study used the Korea Youth Risk Behavior Web-Based Survey (KYRBS) from South Korea (n=1,098,641) to train ML models. For external validation, we used the Youth Risk Behavior Survey (YRBS) from the United States (n=2,511,916) and Norwegian nationwide Ungdata surveys (Ungdata) from Norway (n=700,660). After developing various ML models, we evaluated the final model’s performance using multiple metrics. We also assessed feature importance using traditional methods and further analyzed variable contributions through SHapley Additive exPlanation values. Results: The study used nationwide adolescent datasets for ML model development and validation, analyzing data from 1,098,641 KYRBS adolescents, 2,511,916 YRBS participants, and 700,660 from Ungdata. The XGBoost model was the top performer on the KYRBS, achieving an area under receiver operating characteristic curve (AUROC) score of 80.61% (95% CI 79.63-81.59) and precision of 30.42 (95% CI 28.65-32.16) with detailed analysis on sensitivity of 31.30 (95% CI 29.47-33.20), specificity of 99.16 (95% CI 99.12-99.20), accuracy of 98.36 (95% CI 98.31-98.42), balanced accuracy of 65.23 (95% CI 64.31-66.17), F1-score of 30.85 (95% CI 29.25-32.51), and area under precision-recall curve of 32.14 (95% CI 30.34-33.95). The model achieved an AUROC score of 79.30% and a precision of 68.37% on the YRBS dataset, while in external validation using the Ungdata dataset, it recorded an AUROC score of 76.39% and a precision of 12.74%. Feature importance and SHapley Additive exPlanation value analyses identified smoking status, BMI, suicidal ideation, alcohol consumption, and feelings of sadness and despair as key contributors to the risk of substance use, with smoking status emerging as the most influential factor. Conclusions: Based on multinational datasets from South Korea, the United States, and Norway, this study shows the potential of ML models, particularly the XGBoost model, in predicting adolescent substance use. These findings provide a solid basis for future research exploring additional influencing factors or developing targeted intervention strategies. %M 39993291 %R 10.2196/62805 %U https://www.jmir.org/2025/1/e62805 %U https://doi.org/10.2196/62805 %U http://www.ncbi.nlm.nih.gov/pubmed/39993291 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e60038 %T Usability and Acceptability of a Pregnancy App for Substance Use Screening and Education: A Mixed Methods Exploratory Pilot Study %A Fitzgerald,Haley %A Frank,Madison %A Kasula,Katelyn %A Krans,Elizabeth E %A Krishnamurti,Tamar %K substance use disorder %K substance use screening %K mHealth %K mobile health apps %K pregnancy %K technology %D 2025 %7 13.2.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Increasing opioid and other substance use has led to a crisis of epidemic proportions, with substance use now recognized as a leading cause of maternal morbidity and mortality in the United States. Interventions will only be effective if those who would benefit are identified early and connected to care. Apps are a ubiquitous source of pregnancy information, but their utility as a platform for evaluating substance use during pregnancy is unknown. Objective: This study aims to explore the usability and acceptability of a pregnancy app for opioid and other substance use screening and education. Methods: This mixed methods, exploratory pilot study examined adult pregnant people with a history of substance use who were recruited from outpatient and inpatient settings at a tertiary care obstetric hospital. After completing a baseline survey collecting demographics, substance use, and technology use, participants accessed an existing pregnancy support app for 4 weeks. Qualitative methods were used to measure the acceptability of embedding substance use screening, education, and information within the tool. App use frequency and access to substance use educational content and treatment referral information were evaluated. Results: The 28 female participants had a mean (SD) age of 31 (0.46) years; most were White (21/28, 75%) and Medicaid insured (26/28, 93%), with an annual household income of 1 million cardiopulmonary resuscitation (CPR) layperson responders and 4800 emergency responder agencies linked through a mobile phone app called PulsePoint Respond. PulsePoint responders certify that they are trained to administer CPR and are willing to respond to possible cardiac events in public. When such an event occurs near their mobile phone’s location, they receive an alert to respond. These motivated citizens are ideally positioned to carry naloxone and reverse overdoses that occur in public. Objective: This randomized controlled trial will examine the feasibility of recruiting first responder agencies and layperson CPR responders who already use PulsePoint to obtain overdose education and carry naloxone. Methods: This will be a 3-arm parallel-group randomized controlled trial. We will randomly select 180 first responder agencies from the population of agencies contracting with the PulsePoint Foundation. The 3 study arms will include a standard recruitment arm, a misperception-correction recruitment arm, and a control arm (1:1:1 allocation, with random allocation stratified by zip code designation [rural or nonrural]). We will study agency recruitment and, among the agencies we successfully recruit, responder certification of receiving overdose and naloxone education, carrying naloxone, or both. Hypothesis 1 contrasts agency recruitment success between arms 1 and 2, and hypothesis 2 contrasts the ratios of layperson certification across all 3 arms. The primary analyses will be a logistic regression comparing the recruitment rates among the arms, adjusting for rural or nonrural zip code designation. Results: This study was reviewed by the Indiana University Institutional Review Board (20218 and 20219). This project was funded beginning September 14, 2023, by the National Institute on Drug Abuse. Conclusions: The hypotheses in this study will test whether a specific type of messaging is particularly effective in recruiting agencies and layperson responders. Although we hypothesize that arm 2 will outperform the other arms, our intention is to use the best-performing approach in the next phase of this study if any of our approaches demonstrates feasibility. Trial Registration: OSF Registries osf.io/egn3z; https://osf.io/egn3z International Registered Report Identifier (IRRID): PRR1-10.2196/57280 %M 38551636 %R 10.2196/57280 %U https://www.researchprotocols.org/2024/1/e57280 %U https://doi.org/10.2196/57280 %U http://www.ncbi.nlm.nih.gov/pubmed/38551636 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e53094 %T Evaluation of a Cannabis Harm Reduction Intervention for People With First-Episode Psychosis: Protocol for a Pilot Multicentric Randomized Trial %A Coronado-Montoya,Stephanie %A Abdel-Baki,Amal %A Côté,José %A Crockford,David %A Dubreucq,Simon %A Fischer,Benedikt %A Lachance-Touchette,Pamela %A Lecomte,Tania %A L'Heureux,Sophie %A Ouellet-Plamondon,Clairélaine %A Roy,Marc-André %A Tatar,Ovidiu %A Tibbo,Phillip %A Villeneuve,Marie %A Wittevrongel,Anne %A Jutras-Aswad,Didier %+ Research Centre, Centre Hospitalier de l’Université de Montréal, CHUM Research Centre, 900 St-Denis, Viger Tower, room R05.746, Montréal, QC, H2X 1P1, Canada, 1 514 890 8000 ext 35703, didier.jutras-aswad@umontreal.ca %K cannabis, psychosis, harm reduction, pilot, mobile health %K psychological intervention %K mHealth %K young adult %K schizophrenia %K motivational interviewing %K intervention %K RCT %K randomized %K controlled trial %K controlled trials %K multi-centric %K young people %K clinical trials %K feasibility %K perspectives %K perspective %K evidence-based %D 2023 %7 18.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cannabis use is highly prevalent in young people with first-episode psychosis (FEP). Most report cannabis use and are often diagnosed with a cannabis use disorder upon admission to specialized services for psychosis. Cannabis use in this population is associated with worse clinical and psychosocial outcomes, rendering it an important clinical target. Despite this, few cannabis-specific interventions have been developed for FEP and empirically evaluated through randomized controlled trials. Most evaluated interventions have targeted cannabis abstinence, with limited efficacy, but none have centered on harm reduction outcomes for people with FEP who use cannabis. Early intervention services (EIS), the standard of care for FEP, have not successfully addressed problematic cannabis use in people with FEP either. Clinical trials are needed to explore the potential of harm reduction strategies, although these should be preceded by robust pilot studies to establish optimal design and approaches. Objective: Recognizing the need for harm reduction strategies for individuals with FEP who use cannabis and based on research on patients’ preferences supporting harm reduction interventions, we developed a mobile app–based cannabis harm reduction intervention for this population. This intervention is called Cannabis Harm–reducing Application to Manage Practices Safely (CHAMPS). Here, we describe the protocol for a multicenter, 2-arm, parallel group, randomized pilot trial evaluating the acceptability of CHAMPS for people with FEP who use cannabis and the feasibility of conducting a full-scale trial in this population using CHAMPS. The impact on key clinical outcomes will also be explored. Methods: This pilot trial aims to recruit 100 young people with FEP using cannabis from 6 Canadian EIS clinics. Participants will be randomized in a 1:1 ratio to CHAMPS+EIS or EIS-only. CHAMPS acceptability will be assessed using completion rates for the intervention arm. Trial feasibility will be assessed using a retention rate for randomized participants. Secondary outcomes will explore tendencies of change in the use of protective behavioral strategies and in motivation to change strategies. Exploratory outcomes include cannabis use–related problems, other substance use, the severity of dependence, psychotic symptoms, and health care service use. Results: Recruitment began in December 2021. Data collection and analysis are expected to be completed in early 2024. Study results describing CHAMPS acceptability and trial feasibility will then be submitted for publication in a peer-reviewed journal. Conclusions: CHAMPS uniquely combines evidence-based approaches, patient perspectives, and mobile health technology to support harm reduction in people with FEP who use cannabis. Attaining adequate acceptability and feasibility through this trial may justify further exploration of harm reduction tools, particularly within the context of conducting a larger-scale randomized controlled trial. This pilot trial has the potential to advance knowledge for researchers and clinicians regarding a feasible and user-acceptable research design in the cannabis and early psychosis fields. Trial Registration: ClinicalTrials.gov NCT04968275, https://clinicaltrials.gov/ct2/show/NCT04968275 International Registered Report Identifier (IRRID): DERR1-10.2196/53094 %M 38109196 %R 10.2196/53094 %U https://www.researchprotocols.org/2023/1/e53094 %U https://doi.org/10.2196/53094 %U http://www.ncbi.nlm.nih.gov/pubmed/38109196 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42418 %T A Novel Capacity-Strengthening Intervention for Frontline Harm Reduction Workers to Support Pre-exposure Prophylaxis Awareness-Building and Promotion Among People Who Use Drugs: Formative Research and Intervention Development %A Glick,Jennifer L %A Zhang,Leanne %A Rosen,Joseph G %A Yaroshevich,Karla %A Atiba,Bakari %A Pelaez,Danielle %A Park,Ju Nyeong %+ Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Suite 904A, Baltimore, MD, 21205, United States, 1 3603937426, jglick5@jhu.edu %K formative research %K harm reduction %K intervention development %K pre-exposure prophylaxis (PrEP) %K people who use drugs (PWUD) %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV prevalence among people who use drugs (PWUD) in Baltimore, Maryland, is higher than among the general population. Pre-exposure prophylaxis (PrEP) is a widely available medication that prevents HIV transmission, yet its usefulness is low among PWUD in Baltimore City and the United States. Community-level interventions to promote PrEP uptake and adherence among PWUD are limited. Objective: We describe the development of a capacity-strengthening intervention designed for frontline harm reduction workers (FHRWs) to support PrEP awareness-building and promotion among PWUD. Methods: Our study was implemented in 2 phases in Baltimore City, Maryland. The formative phase focused on a qualitative exploration of the PrEP implementation environment, as well as facilitators and barriers to PrEP willingness and uptake, among cisgender women who use drugs. This work, as well as the existing literature, theory, and feedback from our community partners, informed the intervention development phase, which used an academic-community partnership model. The intervention involved a 1-time, 2-hour training with FHRWs aimed at increasing general PrEP knowledge and developing self-efficacy promoting PrEP in practice (eg, facilitating PrEP dialogues with clients, supporting client advancement along a model of PrEP readiness, and referring clients to PrEP services). In a separate paper, we describe the conduct and results of a mixed methods evaluation to assess changes in PrEP-related knowledge, attitudes, self-efficacy, and promotion practices among FHRWs participating in the training. Results: The pilot was developed from October to December 2021 and implemented from December 2021 through April 2022. We leveraged existing relationships with community-based harm reduction organizations to recruit FHRWs into the intervention. A total of 39 FHRWs from 4 community-based organizations participated in the training across 4 sessions (1 in-person, 2 online synchronous, and 1 online asynchronous). FHRW training attendees represented a diverse range of work cadres, including peer workers, case managers, and organizational administrators. Conclusions: This intervention could prevent the HIV burden among PWUD by leveraging the relationships that FHRWs have with PWUD and by supporting advancement along the PrEP continuum. Given suboptimal PrEP uptake among PWUD and the limited number of interventions designed to address this gap, our intervention offers an innovative approach to a burgeoning public health problem. If effective, our intervention has the potential to be further developed and scaled up to increase PrEP awareness and uptake among PWUD worldwide. %M 37052977 %R 10.2196/42418 %U https://formative.jmir.org/2023/1/e42418 %U https://doi.org/10.2196/42418 %U http://www.ncbi.nlm.nih.gov/pubmed/37052977 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e33310 %T Classification of Patients for Whom Benefit of Long-term Opioid Therapy No Longer Outweighs Harm: Protocol for a Delphi Study %A Van Cleve,Raymond %A Edmond,Sara %A Snow,Jennifer %A Black,Anne C %A Pomeranz,Jamie L %A Becker,William %+ Center for Innovation to Implementation, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, United States, 1 (650) 617 2746, vancleve.raymond@gmail.com %K modified Delphi technique %K long-term opioid treatment %K chronic pain %K opioid therapy %K opioids %K pain management %K Delphi study %D 2022 %7 4.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with chronic pain prescribed long-term opioid therapy may come to a point where the benefits of the therapy are outweighed by the risks and tapering is indicated. At the 2019 Veterans Health Administration State of the Art Conference, there was an acknowledgment of a lack of clinical guidance with regard to treating this subset of patients. Some of the participants believed clinicians and patients would both benefit from a new diagnostic entity describing this situation. Objective: The aim of this study was to determine if a new diagnostic entity was needed and what the criteria of the diagnostic entity would be. Given the ability of the Delphi method to synthesize input from a broad range of experts, we felt this technique was the most appropriate for this study. Methods: We designed a modified Delphi technique involving 3 rounds. The first round is a series of open-ended questions asking about the necessity of this diagnostic entity, how this condition is different from opioid use disorder, and what its possible diagnostic criteria would be. After synthesizing the responses collected, a second round will be conducted to ask participants to rate the different responses offered by their peers. These ratings will be collected and analyzed, and will generate a preliminary definition for this clinical phenomena. In the third round, we will circulate this definition with the aim of achieving consensus. Results: The modified Delphi study was initiated in July of 2020 and analysis is currently underway. Conclusions: This protocol has been approved by the Internal Review Board at the Connecticut Veterans Affairs and the study is in process. This protocol may assist other researchers conducting similar studies. International Registered Report Identifier (IRRID): DERR1-10.2196/33310 %M 35254277 %R 10.2196/33310 %U https://www.researchprotocols.org/2022/3/e33310 %U https://doi.org/10.2196/33310 %U http://www.ncbi.nlm.nih.gov/pubmed/35254277