%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60332 %T Text Message Intervention to Facilitate Secure Storage and Disposal of Prescription Opioids to Prevent Diversion and Misuse: Protocol for a Randomized Controlled Trial %A Egan,Kathleen L %A Cox,Melissa J %A Helme,Donald W %A Jackson,J Todd %A Richman,Alice R %+ Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, United States, 1 336 716 9354, klegan@wakehealth.edu %K prescription opioid %K storage %K disposal %K text message intervention %K randomized controlled trial %K mobile phone %D 2025 %7 17.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nonmedical use of prescription opioids remains a critical public health issue; 8.5 million people in the United States misused opioids in 2022. Most people obtain prescription opioids for misuse from family or friends. Thus, facilitating secure storage and disposal of opioid medications during and after treatment is needed to prevent medication diversion and subsequent misuse. Objective: The primary objective of this study is to test the feasibility and efficacy of a novel intervention that uses a persuasive, informational SMS text message reminder system to enhance the impact of secure storage and disposal of unused opioid medications. We hypothesize that the SMS text message intervention will increase secure storage during treatment and disposal of prescription opioids after treatment. Methods: We will use a 2-arm randomized controlled trial to test the intervention for feasibility and efficacy. Participants (aged 18+ years who have received an opioid prescription in the past 2 weeks) will be randomly assigned to either receive the SMS text message intervention or standard-of-care educational materials. Participants in the intervention will receive 4 SMS text messages related to secure storage and 3 messages related to disposal. All participants will complete baseline, midpoint (day 25), and postintervention (day 45) evaluation surveys. We will test whether receipt of the intervention is associated with two primary outcomes, which are (1) secure storage of prescription opioid medication (locked vs unlocked) and (2) disposal of unused prescription opioid medication (disposed vs not disposed). We will use multiple logistic regression to test the main hypotheses that the intervention will be positively associated with secure storage (locked vs unlocked) and disposal (yes vs no) behaviors, which will allow us to control for demographic variables known to influence the outcomes. This protocol represents the entire structure of the randomized controlled trial. Results: Recruitment for the randomized controlled trial was launched in April 2024, and data collection was completed in December 2024. The final sample size is 484. Data analyses for the main hypothesis will be completed by May 2025, and the main hypothesis manuscript will be submitted for publication by May 2025. Conclusions: Results from this study will indicate whether a text message reminder system can increase secure storage and disposal behaviors for individuals who receive opioid medication. This type of intervention has the potential to be integrated into currently used health care delivery systems, such as prescription pickup reminders at pharmacies. Thus, the intervention is scalable across systems of care, thus expanding the reach of secure storage and disposal programs to prevent prescription opioid misuse. Trial Registration: ClinicalTrials.gov NCT05503186; https://clinicaltrials.gov/study/NCT05503186 International Registered Report Identifier (IRRID): DERR1-10.2196/60332 %M 40245386 %R 10.2196/60332 %U https://www.researchprotocols.org/2025/1/e60332 %U https://doi.org/10.2196/60332 %U http://www.ncbi.nlm.nih.gov/pubmed/40245386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55621 %T Demographics and Use of an Addiction Helpline for Concerned Significant Others: Observational Study %A Chernick,Rachel %A Sy,Amanda %A Dauber,Sarah %A Vuolo,Lindsey %A Allen,Bennett %A Muench,Fred %+ Partnership to End Addiction, 711 Third Avenue, Fifth Floor, New York, NY, 10017, United States, 1 212 973 3526, rchernick@toendaddiction.org %K family %K hotline %K helpline %K warmline %K crisis continuum %K substance abuse %K addiction %K youth %K concerned significant other %K digital behavioral health %K parents %K substance use disorders %K well-being %K public health intervention %K cannabis %K treatment %K opioids %K men %K women %K assessments %D 2025 %7 14.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Concerned significant others (CSOs) play a significant role in supporting individuals with substance use disorders. There is a lack of tailored support services for these CSOs, despite their substantial contributions to the well-being of their loved ones (LOs). The emergence of helplines as a potential avenue for CSO support is outlined, culminating in the focus on the Partnership to End Addiction’s helpline service, an innovative public health intervention aimed at aiding CSOs concerned about an LO’s substance use. Objective: The article analyzes the demographics and use patterns of the Partnership to End Addiction’s helpline service, highlighting the critical role of such services, and advocating for expanded, tailored support models. Methods: This observational study draws data from 8 data platforms spanning April 2011 to December 2021, encompassing 24,096 client records. Surveys were completed by helpline specialists during synchronous telephone calls or self-reported by CSOs before helpline engagement. Collected information encompasses demographics, interaction language, substance of concern, CSO-LO relationship, and the LO’s “use state,” that is, their location on the continuum of substance use. Results: CSOs primarily comprised women (13,980/18,373, 76.1%) seeking support for their children (1062/1542, 68.9%). LOs were mostly male (1090/1738, 62.7%), aged 18-25 years (2380/7208, 33%), with primary substance concerns being cannabis (5266/12,817, 40.9%), opioids (2445/12,817, 19%), and stimulants (1563/12,817, 12.1%). CSOs primarily sought aid for LOs struggling with substances who were not in treatment (1102/1753, 62.9%). The majority of CSOs were looking for support in English (14,738/17,920, 82.2%), while the rest (3182/17,920, 17.8%) preferred to communicate in Spanish. Spanish-speaking CSOs were significantly more likely to call about cannabis (n=963, 53.7% vs n=4026, 38.6%) and stimulants (n=304, 16.9% vs n=1185, 11.3%) than English-speaking CSOs (P<.001). On the other hand, English-speaking CSOs were more likely to be concerned about opioids than Spanish-speaking CSOs (n=2215, 21.3% vs n=94, 5.2%; P<.001). Conclusions: The study illuminates the helpline’s pioneering role in aiding CSOs grappling with an LO’s substance use. It highlights helplines as crucial resources for CSOs, revealing key demographic, substance-related, and use-state trends. The dominant presence of women among users aligns with other helpline patterns and reflects traditional caregiving roles. While parents form a significant percentage of those reaching out, support is also sought by siblings, friends, and other family members, emphasizing the need for assistance for other members of an LO’s social network. Spanish-speaking individuals’ significant outreach underscores the necessity for bilingual support services. Substance concerns revolve around cannabis, opioids, and stimulants, influenced by age and language preferences. The helpline serves as an essential intermediary for CSOs, filling a gap between acute crisis intervention services and formalized health care and treatment services. Overall, the study highlights this helpline’s crucial role in aiding CSOs with tailored, accessible support services. %M 40228240 %R 10.2196/55621 %U https://www.jmir.org/2025/1/e55621 %U https://doi.org/10.2196/55621 %U http://www.ncbi.nlm.nih.gov/pubmed/40228240 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e54753 %T Sociodemographic Differences in Logins and Engagement With the Electronic Health Coach Messaging Feature of a Mobile App to Support Opioid and Stimulant Use Recovery: Results From a 1-Month Observational Study %A Filiatreau,Lindsey M %A Szlyk,Hannah %A Ramsey,Alex T %A Kasson,Erin %A Li,Xiao %A Zhang,Zhuoran %A Cavazos-Rehg,Patricia %+ Division of Infectious Diseases, School of Medicine, Washington University in St Louis, 620 S Taylor Ave, St Louis, MO, 63110, United States, 1 3142737579, flindsey@wustl.edu %K substance misuse %K substance use recovery %K opioid use disorder %K stimulant use disorder %K uptake %K engagement %K mHealth %K digital health intervention %K sociodemographic %K mobile app %K stimulant use %K observational study %K mobile health %K smartphone %K St. Louis %K eCoach messaging %K Wilcoxon rank-sum tests %K Pearson chi-square %K recovery %K app %D 2025 %7 10.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps can serve as a critical tool in supporting the overall health of uninsured and underinsured individuals and groups who have been historically marginalized by the medical community and may be hesitant to seek health care. However, data on uptake and engagement with specific app features (eg, in-app messaging) are often lacking, limiting our ability to understand nuanced patterns of app use. Objective: This study aims to characterize sociodemographic differences in uptake and engagement with a smartphone app (uMAT-R) to support recovery efforts in a sample of individuals with opioid and stimulant use disorders in the Greater St. Louis area. Methods: We enrolled individuals into the uMAT-R service program from facilities providing recovery support in the Greater St. Louis area between January 2020 and April 2022. Study participants were recruited from service project enrollees. We describe the number of logins and electronic health coach (eCoach) messages participants sent in the first 30 days following enrollment using medians and IQRs and counts and proportions of those who ever (vs never) logged in and sent their eCoach a message. We compare estimates across sociodemographic subgroups, by insurance status, and for those who did and did not participate in the research component of the project using Wilcoxon rank-sum tests and Pearson chi-square tests. Results: Of all 695 participants, 446 (64.2%) logged into uMAT-R at least once during the 30 days following enrollment (median 2, IQR 0-8 logins). Approximately half of those who logged in (227/446) used the eCoach messaging feature (median 1, IQR 0-3 messages). Research participants (n=498), who could receive incentives for app engagement, were more likely to log in and use the eCoach messaging feature compared to others (n=197). Younger individuals, those with higher educational attainment, and White, non-Hispanic individuals were more likely to log in at least once compared to their counterparts. The median number of logins was higher among women, and those who were younger, employed, and not on Medicaid compared to their counterparts. Among those who logged in at least once, younger individuals and those with lower educational attainment were more likely to send at least one eCoach message compared to others. Conclusions: Mobile apps are a viable tool for supporting individuals in recovery from opioid and stimulant use disorders. However, older individuals, racial and ethnic minorities, and those with lower educational attainment may need additional login support, or benefit from alternative mechanisms of recovery support. In addition, apps may need to be tailored to achieve sustained engagement (ie, repeat logins) among men, and individuals who are older, unemployed, or on Medicaid. Older individuals and those with higher educational attainment who may be less likely to use eCoach messaging features could benefit from features tailored to their preferences. %M 40210205 %R 10.2196/54753 %U https://mhealth.jmir.org/2025/1/e54753 %U https://doi.org/10.2196/54753 %U http://www.ncbi.nlm.nih.gov/pubmed/40210205 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e49981 %T Substance-Related Acute Toxicity Deaths in Canada From 2016 to 2017: Protocol for a Retrospective Chart Review Study of Coroner and Medical Examiner Files %A Rotondo,Jenny %A VanSteelandt,Amanda %A Kouyoumdjian,Fiona %A Bowes,Matthew J %A Kakkar,Tanya %A Jones,Graham %A Abele,Brandi %A Murray,Regan %A Schleihauf,Emily %A Halverson,Jessica %A Leason,Jennifer %A Huyer,Dirk %A Jackson,Beth %A Bozat-Emre,Songul %A Shah,Devanshi %A Rees,Erin E %+ Substance-Related Harms Division, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada, 1 613 614 9487, jenny.rotondo@phac-aspc.gc.ca %K acute toxicity %K Canada %K chart review study %K coroner %K death investigations %K drug overdose %K medical examiner %K mortality %K poisoning %K protocol %D 2025 %7 10.4.2025 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: Canada continues to experience a national overdose crisis. While studies are available at the regional, provincial, and territorial levels, detailed national data regarding the burden and context of substance-related acute toxicity deaths are limited, particularly in subpopulations. In response to the overdose crisis, the Public Health Agency of Canada, in collaboration with provincial and territorial ministries of health and chief coroner and chief medical examiner offices, has undertaken a national chart review study. Objective: This study was conducted to describe and compare the characteristics of substance-related acute toxicity deaths that occurred in Canada between 2016 and 2017, including descriptions of those who died, the substances involved, and the circumstances surrounding their deaths. This paper describes the study methodology in detail. Methods: This retrospective, population-based, and cross-sectional study involved the review of coroner and medical examiner files for deaths that met the study case definition. Data were collected on demographic and socioeconomic characteristics, medical and substance use history, proximal circumstances surrounding the death, and toxicology findings using a standardized data collection tool that underwent 2 pilot studies. Data abstractors underwent training and regular intrarater reliability exercises with a fictitious death investigation file. Data quality was assessed based on the consistency of abstractor intrarater reliability scores and the completeness of core variables and variables for key concepts. Data were linked to national datasets to allow for the examination of area-level geographic and socioeconomic characteristics. Descriptive analyses will examine differences across subpopulations and the general Canadian population. Latent class, spatiotemporal, qualitative, and premature death analyses are also planned. Where possible, analyses will be stratified by the manner of death and sex. Results: The study began in the summer of 2018, and abstraction was delayed due to the COVID-19 pandemic. All activities are expected to be completed by early 2025. A total of 9414 coroner and medical examiner files met the study case definition. Most abstractors (25/26, 96%) met the established threshold for consistency throughout abstraction without the need for remedial training. In general, core study variables, including geographic variables and substances contributing to death, had very good availability. Study variables related to the person’s health, history of substance use, and events surrounding the acute toxicity event were available for most records. Socioeconomic variables and variables describing socially constructed identities and potentially traumatic life events were mostly unavailable. Conclusions: This study provides the most detailed national information on substance-related acute toxicity deaths in Canada to date and can serve as a pre–COVID-19 pandemic baseline for assessing the evolution of the overdose crisis. Results can inform policies and programs to address the overdose crisis, the development of common approaches to medicolegal death investigations, and future research activities. %M 40208661 %R 10.2196/49981 %U https://publichealth.jmir.org/2025/1/e49981 %U https://doi.org/10.2196/49981 %U http://www.ncbi.nlm.nih.gov/pubmed/40208661 %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 e68292 %T Zoom-Delivered Empowered Relief for Chronic Pain: Observational Longitudinal Pilot Study Exploring Feasibility and Pain-Related Outcomes in Patients on Long-Term Opioids %A Edwards,Karlyn A %A Dildine,Troy C %A You,Dokyoung S %A Herrick,Ashley M %A Darnall,Beth D %A Mackey,Sean C %A Ziadni,Maisa S %+ Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Rd, Suite 200, Stanford, CA, 94304, United States, 1 650 497 7671, mziadni@stanford.edu %K Empowered Relief %K single session %K chronic pain %K prescription opioids %K telehealth %K daily data %K pain intensity %K pain catastrophizing %D 2025 %7 11.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic pain on long-term opioid therapy often face barriers to accessing effective nonpharmacological treatments, including the burden of multiple sessions, lack of trained clinicians, and travel time. Empowered Relief (ER), a 2-hour, single-session pain relief skills class, can improve pain and quality of life among patients with chronic pain when delivered in person or virtually. Objective: This study examined the impact of Zoom-delivered ER among people with chronic pain on long-term opioid therapy. We assessed (1) the feasibility and acceptability of Zoom-delivered ER; (2) changes in pain and opioid use outcomes at 3 and 6 months after treatment; and (3) daily associations among pain, opioid dose, and the Pain Catastrophizing Scale (PCS) before and after treatment. Methods: During the early COVID-19 pandemic, we conducted an uncontrolled pilot study of a Zoom-delivered ER among 60 adults (n=45, 76% female participants; n=52, 88% White participants) experiencing chronic pain who were receiving daily prescribed opioids (≥10 morphine-equivalent daily dose). Participants completed assessments at enrollment, before class, after class, 3 months after treatment, and 6 months after treatment. Furthermore, participants completed 2 daily assessment periods (spanning 14 consecutive days) before and after the class. We used a multilevel modeling approach to examine (1) the raw changes in PCS, average pain intensity, pain interference, and self-reported opioid dose at 3 and 6 months after treatment and (2) daily-level changes in average pain intensity and opioid dose before and after the class. Results: Of the 60 participants enrolled, 41 (68%) attended the class and 24 (59% of the 41 class attendees) reported satisfaction with the Zoom-delivered class. PCS score was significantly reduced at 3 months (β=–3.49, P=.01; Cohen d=0.35) and 6 months after treatment (β=–3.61, P=.01; Cohen d=0.37), and pain intensity was significantly reduced at 3 months (β=–0.56, P=.01; Cohen d=0.39) compared to enrollment. There were no significant reductions in pain interference or opioid dose. Across daily assessments, higher daily pain catastrophizing was associated with worse daily pain (β=.42, P<.001) and higher self-reported opioid use (β=3.14, P<.001); daily pain intensity significantly reduced after the class (β=–.50, P<.001). People taking prescribed opioids as needed trended toward decreasing their daily opioid use after the class (β=–9.31, P=.02), although this result did not survive correction for multiplicity. Conclusions: Improvements to future Zoom-delivered ER iterations are needed to improve feasibility and acceptability among people with chronic pain and daily prescribed opioid use. Despite this, findings show a promising preliminary impact of the intervention on pain outcomes. A larger randomized controlled trial of Zoom-delivered ER among this patient population is currently under way. %M 40068160 %R 10.2196/68292 %U https://formative.jmir.org/2025/1/e68292 %U https://doi.org/10.2196/68292 %U http://www.ncbi.nlm.nih.gov/pubmed/40068160 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59954 %T Supplementing Consent for a Prospective Longitudinal Cohort Study of Infants With Antenatal Opioid Exposure: Development and Assessment of a Digital Tool %A Newman,Jamie E %A Clarke,Leslie %A Athimuthu,Pranav %A Dhawan,Megan %A Owen,Sharon %A Beiersdorfer,Traci %A Parlberg,Lindsay M %A Bangdiwala,Ananta %A McMillan,Taya %A DeMauro,Sara B %A Lorch,Scott %A Peralta-Carcelen,Myriam %A Wilson-Costello,Deanne %A Ambalavanan,Namasivayam %A Merhar,Stephanie L %A Poindexter,Brenda %A Limperopoulos,Catherine %A Davis,Jonathan M %A Walsh,Michele %A Bann,Carla M %K informed consent digital tool %K avatars %K video-assisted consent %K MRI %K antenatal opioid exposure %K infant %K antenatal %K opioid exposure %K caregiver %K survey %K magnetic resonance imaging %K Outcomes of Babies With Opioid Exposure %D 2025 %7 4.3.2025 %9 %J JMIR Form Res %G English %X Background: The Outcomes of Babies With Opioid Exposure (OBOE) study is an observational cohort study examining the impact of antenatal opioid exposure on outcomes from birth to 2 years of age. COVID-19 social distancing measures presented challenges to research coordinators discussing the study at length with potential participants during the birth hospitalization, which impacted recruitment, particularly among caregivers of unexposed (control) infants. In response, the OBOE study developed a digital tool (consenter video) to supplement the informed consent process, make it more engaging, and foster greater identification with the research procedures among potential participants. Objective: We aim to examine knowledge of the study, experiences with the consent process, and perceptions of the consenter video among potential participants of the OBOE study. Methods: Analyses included 129 caregivers who were given the option to view the consenter video as a supplement to the consent process. Participants selected from 3 racially and ethnically diverse avatars to guide them through the 11-minute video with recorded voice-overs. After viewing the consenter video, participants completed a short survey to assess their knowledge of the study, experiences with the consent process, and perceptions of the tool, regardless of their decision to enroll in the main study. Chi-square tests were used to assess differences between caregivers of opioid-exposed and unexposed infants in survey responses and whether caregivers who selected avatars consistent with their racial or ethnic background were more likely to enroll in the study than those who selected avatars that were not consistent with their background. Results: Participants demonstrated good understanding of the information presented, with 95% (n=123) correctly identifying the study purpose and 88% (n=112) correctly indicating that their infant would not be exposed to radiation during the magnetic resonance imaging. Nearly all indicated they were provided “just the right amount of information” (n=123, 98%) and that they understood the consent information well enough to decide whether to enroll (n=125, 97%). Survey responses were similar between caregivers of opioid-exposed infants and unexposed infants on all items except the decision to enroll. Those in the opioid-exposed group were more likely to enroll in the main study compared to the unexposed group (n=49, 89% vs n=38, 51%; P<.001). Of 81 caregivers with known race or ethnicity, 35 (43%) chose avatars to guide them through the video that matched their background. Caregivers selecting avatars consistent with their racial or ethnic background were more likely to enroll in the main study (n=29, 83% vs n=43, 57%; P=.01). Conclusions: This interactive digital tool was helpful in informing prospective participants about the study. The consenter tool enhanced the informed consent process, reinforced why caregivers of unexposed infants were being approached, and was particularly helpful as a resource for families to understand magnetic resonance imaging procedures. Trial Registration: ClinicalTrials.gov NCT04149509; https://clinicaltrials.gov/study/NCT04149509 %R 10.2196/59954 %U https://formative.jmir.org/2025/1/e59954 %U https://doi.org/10.2196/59954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59338 %T Teenager Substance Use on Reddit: Mixed Methods Computational Analysis of Frames and Emotions %A Zhang,Xinyu %A Zhu,Jianfeng %A Kenne,Deric R %A Jin,Ruoming %+ , Department of Computer Science, Kent State University, 241 Mathematical Sciences Building, Kent, OH, 44224, United States, 1 330 672 9980, jzhu10@kent.edu %K teenager %K substance use %K Reddit %K emotional analysis %K bidirectional encoder representations from transformers %K BERT %K frame approach %D 2025 %7 19.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescent substance use disorder is a pressing public health issue, with increasing prevalence as individuals age. Social media platforms like Reddit (Reddit Inc) serve as significant venues for teenagers to discuss and navigate substance use. Social media platforms, such as Reddit, serve as increasingly important spaces where teenagers discuss, share, and navigate their experiences with substance use, presenting unique opportunities and challenges for understanding and addressing this issue. Objective: This study aims to explore how teenagers frame substance-use discussions on the r/teenagers subreddit, focusing on their personal interpretations, causal attributions, and the social and psychological contexts that shape these online support groups. By identifying these interpretive frames, we aimed to better understand the complex drivers of adolescent substance use behavior and their potential interventions. Methods: Using natural language processing techniques, we analyzed 32,674 substance use–related posts from 2018 to 2022. A framing approach was used to identify and categorize prevalent themes, supplemented by emotional profiling using the EmoLLaMA-chat-13B model developed by Liu and colleagues. Results: In total, 7 primary frames emerged: normalization, risk awareness, social integration, autonomy and rebellion, coping mechanisms, media influence, and stigmatization. These frames varied in prevalence and were associated with distinct emotional profiles, highlighting the complex interplay between substance use and adolescent experiences. We observed that, for example, the normalization frame was often associated with a mix of sadness and anxiety, while the coping frame exhibited elevated levels of anger, sadness, and anxiety. These distinctive emotional landscapes associated with each frame reveal unique insights into the mental state of adolescents navigating substance use. Conclusions: The findings underscore the multifaceted nature of adolescent substance-use discussions on social media. Interventions must address underlying emotional and social factors as well as identity to effectively mitigate substance use disorder among adolescents. By understanding the frames teenagers use to interpret substance use, we can pave the way for more effective and personalized public health campaigns, and support services designed to resonate with adolescents’ unique lived experiences. %M 39970428 %R 10.2196/59338 %U https://www.jmir.org/2025/1/e59338 %U https://doi.org/10.2196/59338 %U http://www.ncbi.nlm.nih.gov/pubmed/39970428 %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 50. Conclusions: To our knowledge, this is the first peer comparison effort with high-quality evidence-based metrics of this scale published in the literature. By sharing this process for designing the metrics and the process of distribution, the authors hope to influence other health systems to attempt to curb the opioid pandemic through peer comparison. Future research examining the effects of this intervention could demonstrate significant reductions in opioid prescribing, thus potentially reducing the progression of individual patients to opioid use disorder and the associated increased risk of morbidity and mortality. %R 10.2196/44662 %U https://humanfactors.jmir.org/2024/1/e44662 %U https://doi.org/10.2196/44662 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51525 %T Lessons Learned From Developing Dashboards to Support Decision-Making for Community Opioid Response by Community Stakeholders: Mixed Methods and Multisite Study %A Fareed,Naleef %A Olvera,Ramona G %A Wang,Yiting %A Hayes,Michael %A Larimore,Elizabeth Liz %A Balvanz,Peter %A Langley,Ronald %A Noel,Corinna A %A Rock,Peter %A Redmond,Daniel %A Neufeld,Jessica %A Kosakowski,Sarah %A Harris,Daniel %A LaRochelle,Marc %A Huerta,Timothy R %A Glasgow,LaShawn %A Oga,Emmanuel %A Villani,Jennifer %A Wu,Elwin %+ Department of Biomedical Informatics, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, United States, 1 614 685 3251, naleef.fareed@osumc.edu %K data visualizations %K dashboards %K public health %K overdose epidemic %K human-centered design %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Data dashboards are published tools that present visualizations; they are increasingly used to display data about behavioral health, social determinants of health, and chronic and infectious disease risks to inform or support public health endeavors. Dashboards can be an evidence-based approach used by communities to influence decision-making in health care for specific populations. Despite widespread use, evidence on how to best design and use dashboards in the public health realm is limited. There is also a notable dearth of studies that examine and document the complexity and heterogeneity of dashboards in community settings. Objective: Community stakeholders engaged in the community response to the opioid overdose crisis could benefit from the use of data dashboards for decision-making. As part of the Communities That HEAL (CTH) intervention, community data dashboards were created for stakeholders to support decision-making. We assessed stakeholders’ perceptions of the usability and use of the CTH dashboards for decision-making. Methods: We conducted a mixed methods assessment between June and July 2021 on the use of CTH dashboards. We administered the System Usability Scale (SUS) and conducted semistructured group interviews with users in 33 communities across 4 states of the United States. The SUS comprises 10 five-point Likert-scale questions measuring usability, each scored from 0 to 4. The interview guides were informed by the technology adoption model (TAM) and focused on perceived usefulness, perceived ease of use, intention to use, and contextual factors. Results: Overall, 62 users of the CTH dashboards completed the SUS and interviews. SUS scores (grand mean 73, SD 4.6) indicated that CTH dashboards were within the acceptable range for usability. From the qualitative interview data, we inductively created subthemes within the 4 dimensions of the TAM to contextualize stakeholders’ perceptions of the dashboard’s usefulness and ease of use, their intention to use, and contextual factors. These data also highlighted gaps in knowledge, design, and use, which could help focus efforts to improve the use and comprehension of dashboards by stakeholders. Conclusions: We present a set of prioritized gaps identified by our national group and list a set of lessons learned for improved data dashboard design and use for community stakeholders. Findings from our novel application of both the SUS and TAM provide insights and highlight important gaps and lessons learned to inform the design of data dashboards for use by decision-making community stakeholders. Trial Registration: ClinicalTrials.gov NCT04111939; https://clinicaltrials.gov/study/NCT04111939 %M 39250216 %R 10.2196/51525 %U https://humanfactors.jmir.org/2024/1/e51525 %U https://doi.org/10.2196/51525 %U http://www.ncbi.nlm.nih.gov/pubmed/39250216 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e49924 %T Public Perceptions of Treating Opioid Use Disorder With Deep Brain Stimulation: Comment Analysis Study %A Henegan,Patricia %A Koczara,Jack %A Bluhm,Robyn %A Cabrera,Laura Y %+ Department of Engineering Science and Mechanics, Pennsylvania State University, MSC 491 Pollock Road, Suite W-316, University Park, PA, 16802, United States, 1 8148650940, lcabrera@psu.edu %K deep brain stimulation %K DBS %K comment analysis %K refractory opioid use disorder %K substance abuse %K opioid addiction %K opioid %K substance use %K opioid use %K treatment %K addiction %K mental health %K therapeutic %K psychiatric disorder %D 2024 %7 16.8.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: The number of opioid-related deaths in the United States has more than tripled over the past 7 years, with a steep increase beginning at the same time as the COVID-19 pandemic. There is an urgent need for novel treatment options that can help alleviate the individual and social effects of refractory opioid use disorder (OUD). Deep brain stimulation (DBS), an intervention that involves implanting electrodes in the brain to deliver electrical impulses, is one potential treatment. Currently in clinical trials for many psychiatric conditions, including OUD, DBS’s use for psychiatric indications is not without controversy. Several studies have examined ethical issues raised by using DBS to counter treatment-resistant depression, obsessive-compulsive disorder, and eating disorders. In contrast, there has been limited literature regarding the use of DBS for OUD. Objective: This study aims to gain empirical neuroethical insights into public perceptions regarding the use of DBS for OUD, specifically via the analysis of web-based comments on news media stories about the topic. Methods: Qualitative thematic content analysis was performed on 2 Washington Post newspaper stories that described a case of DBS being used to treat OUD. A total of 292 comments were included in the analysis, 146 comments from each story, to identify predominant themes raised by commenters. Results: Predominant themes raised by commenters across the 2 samples included the hopes and expectations with treatment outcomes, whether addiction is a mental health disorder, and issues related to resource allocation. Controversial comments regarding DBS as a treatment method for OUD seemingly decreased when comparing the first printed newspaper story to the second. In comparison, the number of comments relating to therapeutic need increased over time. Conclusions: The general public’s perspectives on DBS as a treatment method for OUD elucidated themes via this qualitative thematic content analysis that include overarching sociopolitical issues, positions on the use of technology, and technological and scientific issues. A better understanding of the public perceptions around the use of DBS for OUD can help address misinformation and misperceptions about the use of DBS for OUD, and identify similarities and differences regarding ethical concerns when DBS is used specifically for OUD compared to other psychiatric disorders. %M 39151160 %R 10.2196/49924 %U https://ojphi.jmir.org/2024/1/e49924 %U https://doi.org/10.2196/49924 %U http://www.ncbi.nlm.nih.gov/pubmed/39151160 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e48139 %T A Geospatial Drug Abuse Risk Assessment and Monitoring Dashboard Tailored for School Students: Development Study With Requirement Analysis and Acceptance Evaluation %A Al-Aboosi,Ahmad Mustafa %A Sheikh Abdullah,Siti Norul Huda %A Ismail,Rozmi %A Abdul Maulud,Khairul Nizam %A Nahar,Lutfun %A Zainol Ariffin,Khairul Akram %A Lam,Meng Chun %A bin Talib,Muhamad Lazim %A Wahab,Suzaily %A Elias,Mahadzir %+ Faculty of Information Science & Technology, Universiti Kebangsaan Malaysia, Jln Bangi, Bangi, Selangor, 43600, Malaysia, 60 03 8921 6179, snhsabdullah@ukm.edu.my %K geospatial %K statistics %K map %K youth %K drugs %K dashboard %K evaluation %K drug abuse %K monitoring %K risk assessment %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The enormous consequences of drugs include suicides, traffic accidents, and violence, affecting the individual, family, society, and country. Therefore, it is necessary to constantly identify and monitor the drug abuse rate among school-going youth. A geospatial dashboard is vital for the monitoring of drug abuse and related crime incidence in a decision support system. Objective: This paper mainly focuses on developing MyAsriGeo, a geospatial drug abuse risk assessment and monitoring dashboard tailored for school students. It introduces innovative functionality, seamlessly orchestrating the assessment of drug abuse usage patterns and risks using multivariate student data. Methods: A geospatial drug abuse dashboard for monitoring and analysis was designed and developed in this study based on agile methodology and prototyping. Using focus group and interviews, we first examined and gathered the requirements, feedback, and user approval of the MyAsriGeo dashboard. Experts and stakeholders such as the National Anti-Drugs Agency, police, the Federal Department of Town and Country Planning, school instructors, students, and researchers were among those who responded. A total of 20 specialists were involved in the requirement analysis and acceptance evaluation of the pilot and final version of the dashboard. The evaluation sought to identify various user acceptance aspects, such as ease of use and usefulness, for both the pilot and final versions, and 2 additional factors based on the Post-Study System Usability Questionnaire and Task-Technology Fit models were enlisted to assess the interface quality and dashboard sufficiency for the final version. Results: The MyAsriGeo geospatial dashboard was designed to meet the needs of all user types, as identified through a requirement gathering process. It includes several key functions, such as a geospatial map that shows the locations of high-risk areas for drug abuse, data on drug abuse among students, tools for assessing the risk of drug abuse in different areas, demographic information, and a self-problem test. It also includes the Alcohol, Smoking, and Substance Involvement Screening Test and its risk assessment to help users understand and interpret the results of student risk. The initial prototype and final version of the dashboard were evaluated by 20 experts, which revealed a significant improvement in the ease of use (P=.047) and usefulness (P=.02) factors and showed a high acceptance mean scores for ease of use (4.2), usefulness (4.46), interface quality (4.29), and sufficiency (4.13). Conclusions: The MyAsriGeo geospatial dashboard is useful for monitoring and analyzing drug abuse among school-going youth in Malaysia. It was developed based on the needs of various stakeholders and includes a range of functions. The dashboard was evaluated by a group of experts. Overall, the MyAsriGeo geospatial dashboard is a valuable resource for helping stakeholders understand and respond to the issue of drug abuse among youth. %M 39078685 %R 10.2196/48139 %U https://humanfactors.jmir.org/2024/1/e48139 %U https://doi.org/10.2196/48139 %U http://www.ncbi.nlm.nih.gov/pubmed/39078685 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60671 %T Leveraging Parents and Peer Recovery Supports to Increase Recovery Capital in Emerging Adults With Polysubstance Use: Protocol for a Feasibility, Acceptability, and Appropriateness Study of Launch %A Drazdowski,Tess K %A Castedo de Martell,Sierra %A Sheidow,Ashli J %A Chapman,Jason E %A McCart,Michael R %+ Lighthouse Institute, Chestnut Health Systems, 1003 Martin Luther King Jr Dr., Bloomington, IL, 61701, United States, 1 541 525 0821, tkdrazdowski@chestnut.org %K peer recovery support services %K contingency management %K emerging adults %K rural %D 2024 %7 22.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Emerging adults (aged 18-26 years) are the most at-risk yet underserved age group among people with substance use disorder, especially rural emerging adults, and polysubstance use is common. Recovery capital is lower among emerging adults than older adults, and evidence-based treatments are typically unavailable or not developmentally tailored, especially in rural areas. Both supportive parents (or parental figures) and peer recovery support services (PRSS) can be leveraged to better support these emerging adults. Previous research indicates parents can be engaged to deliver contingency management (CM), an extensively researched evidence-based intervention for substance use. Objective: This protocol describes a funded pilot of Launch, a novel, scalable service package that pairs web-based coaching for parents to deliver CM for emerging adults (CM-EA) at home and in-person PRSS with educational and vocational goal setting. Specifically, this protocol describes feasibility, acceptability, and appropriateness testing (implementation-related outcomes) and steps taken to prepare for a future large-scale trial of Launch. Methods: Upon the recruitment of 48 emerging adult and parent pairs from sites serving primarily rural clients, participants will be randomized into 1 of 3 conditions for this randomized controlled trial: virtual parent coaching to deliver CM-EA, in-person PRSS for emerging adults, or both sets of services. Emerging adult eligibility includes polysubstance use, a substance use disorder, and availability of a consenting parent. Emerging adults will be interviewed at baseline and 6 months about substance use, quality of life, recovery capital, parental relationship, and Launch implementation-related outcomes (6-month follow-up only). Parents, peer workers delivering PRSS, and parent CM-EA coaches will be interviewed about implementation-related outcomes at the end of the study period. Peer workers and CM-EA coaches will be asked to complete checklists of services delivered after each session. Finally, payers and providers will be interviewed for additional insights into Launch implementation and to identify key outcomes of Launch. Data analysis for emerging adult outcomes will be primarily descriptive, but parent CM-EA training adherence will be assessed using nested mixed-effects regression models of repeated measures. Results: Launch is currently ongoing, with funding received in August 2023, and is expected to end in September 2025, with data analysis and results in December 2026. Participants are expected to begin enrolling in June 2024. Conclusions: While this pilot is limited by the small sample size and restriction to emerging adults with an involved parent, this is mitigated by the study’s strengths and is appropriate for the pilot stage. Launch uses an innovative combination of existing strategies to generate better outcomes for emerging adults while remaining scalable. This pilot will provide insights into the feasibility and acceptability of Launch from the perspectives of service recipients, providers, and payers to inform a larger-scale effectiveness trial. Trial Registration: ClinicalTrials.gov NCT06414993; https://clinicaltrials.gov/study/NCT06414993 International Registered Report Identifier (IRRID): PRR1-10.2196/60671 %M 39037768 %R 10.2196/60671 %U https://www.researchprotocols.org/2024/1/e60671 %U https://doi.org/10.2196/60671 %U http://www.ncbi.nlm.nih.gov/pubmed/39037768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56755 %T Barriers to, and Facilitators of, Checking Drugs for Adulterants in the Era of Fentanyl and Xylazine: Qualitative Study %A Aronson,Ian David %A Ardouin-Guerrier,Mary-Andrée %A Baus,Juan Esteban %A Bennett,Alex S %+ Center for Technology-based Education and Community Health, NDRI-USA, 31 W 34th St Suite 8006, New York, NY, 10001, United States, 1 212 845 4444, aronson@ndri-usa.org %K overdose %K overdoses %K fentanyl %K xylazine %K benzodiazepines %K adulterants %K drug %K drugs %K substance %K substances %K illicit drug %K illicit drugs %K drug test %K drug testing %K drug checking %K qualitative %K interview %K interviews %K digital health %K digital technology %K digital intervention %K digital interventions %K technological intervention %K technological interventions %K technology-based intervention %K technology-based interventions %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Overdose deaths continue to reach new records in New York City and nationwide, largely driven by adulterants such as fentanyl and xylazine in the illicit drug supply. Unknowingly consuming adulterated substances dramatically increases risks of overdose and other health problems, especially when individuals consume multiple adulterants and are exposed to a combination of drugs they did not intend to take. Although test strips and more sophisticated devices enable people to check drugs for adulterants including fentanyl and xylazine prior to consumption and are often available free of charge, many people who use drugs decline to use them. Objective: We sought to better understand why people in the New York City area do or do not check drugs before use. We plan to use study findings to inform the development of technology-based interventions to encourage consistent drug checking. Methods: In summer 2023, team members who have experience working with people who use drugs conducted 22 semistructured qualitative interviews with a convenience sample of people who reported illicit drug use within the past 90 days. An interview guide examined participants’ knowledge of and experience with adulterants including fentanyl, xylazine, and benzodiazepines; using drug testing strips; and whether they had ever received harm reduction services. All interviews were audio recorded, transcribed, and analyzed for emerging themes. Results: Most participants lacked knowledge of adulterants, and only a few reported regularly checking drugs. Reasons for not checking included lacking convenient access to test supplies, or a place to check samples out of the public’s view, as well as time considerations. Some participants also reported a strong belief that they were not at risk from fentanyl, xylazine, or other adulterants because they exclusively used cocaine or crack, or that they were confident the people they bought drugs from would not sell them adulterated substances. Those who did report testing their drugs described positive interactions with harm reduction agency staff. Conclusions: New forms of outreach are needed not only to increase people’s knowledge of adulterated substances and awareness of the increasing risks they pose but also to encourage people who use drugs to regularly check their substances prior to use. This includes new intervention messages that highlight the importance of drug checking in the context of a rapidly changing and volatile drug supply. This messaging can potentially help normalize drug checking as an easily enacted behavior that benefits public health. To increase effectiveness, messages can be developed with, and outreach can be conducted by, trusted community members including people who use drugs and, potentially, people who sell drugs. Pairing this messaging with access to no-cost drug-checking supplies and equipment may help address the ongoing spiral of increased overdose deaths nationwide. %M 38959505 %R 10.2196/56755 %U https://formative.jmir.org/2024/1/e56755 %U https://doi.org/10.2196/56755 %U http://www.ncbi.nlm.nih.gov/pubmed/38959505 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 7 %N %P e54926 %T Postsurgical Pain Risk Stratification to Enhance Pain Management Workflow in Adult Patients: Design, Implementation, and Pilot Evaluation %A Görges,Matthias %A Sujan,Jonath %A West,Nicholas C %A Sreepada,Rama Syamala %A Wood,Michael D %A Payne,Beth A %A Shetty,Swati %A Gelinas,Jean P %A Sutherland,Ainsley M %+ Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Rm V3-324, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 6048752000 ext 5616, mgoerges@bcchr.ca %K patient-oriented research %K patient-reported outcome measures %K risk prediction %K pain %K individualized risk %K surgery %K anesthesia %K opioid analgesia %K short-term opioid use %K care planning %K digital health platforms %D 2024 %7 2.7.2024 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Exposure to opioids after surgery is the initial contact for some people who develop chronic opioid use disorder. Hence, effective postoperative pain management, with less reliance on opioids, is critical. The Perioperative Opioid Quality Improvement (POQI) program developed (1) a digital health platform leveraging patient-survey-reported risk factors and (2) a postsurgical pain risk stratification algorithm to personalize perioperative care by integrating several commercially available digital health solutions into a combined platform. Development was reduced in scope by the COVID-19 pandemic. Objective: This pilot study aims to assess the screening performance of the risk algorithm, quantify the use of the POQI platform, and evaluate clinicians’ and patients’ perceptions of its utility and benefit. Methods: A POQI platform prototype was implemented in a quality improvement initiative at a Canadian tertiary care center and evaluated from January to September 2022. After surgical booking, a preliminary risk stratification algorithm was applied to health history questionnaire responses. The estimated risk guided the patient assignment to a care pathway based on low or high risk for persistent pain and opioid use. Demographic, procedural, and medication administration data were extracted retrospectively from the electronic medical record. Postoperative inpatient opioid use of >90 morphine milligram equivalents per day was the outcome used to assess algorithm performance. Data were summarized and compared between the low- and high-risk groups. POQI use was assessed by completed surveys on postoperative days 7, 14, 30, 60, 90, and 120. Semistructured patient and clinician interviews provided qualitative feedback on the platform. Results: Overall, 276 eligible patients were admitted for colorectal procedures. The risk algorithm stratified 203 (73.6%) as the low-risk group and 73 (26.4%) as the high-risk group. Among the 214 (77.5%) patients with available data, high-risk patients were younger than low-risk patients (age: median 53, IQR 40-65 years, vs median 59, IQR 49-69 years, median difference five years, 95% CI 1-9; P=.02) and were more often female patients (45/73, 62% vs 80/203, 39.4%; odds ratio 2.5, 95% CI 1.4-4.5; P=.002). The risk stratification was reasonably specific (true negative rate=144/200, 72%) but not sensitive (true positive rate=10/31, 32%). Only 39.7% (85/214) patients completed any postoperative quality of recovery questionnaires (only 14, 6.5% patients beyond 60 days after surgery), and 22.9% (49/214) completed a postdischarge medication survey. Interviewed participants welcomed the initiative but noted usability issues and poor platform education. Conclusions: An initial POQI platform prototype was deployed operationally; the risk algorithm had reasonable specificity but poor sensitivity. There was a significant loss to follow-up in postdischarge survey completion. Clinicians and patients appreciated the potential impact of preemptively addressing opioid exposure but expressed shortcomings in the platform’s design and implementation. Iterative platform redesign with additional features and reevaluation are required before broader implementation. %M 38954808 %R 10.2196/54926 %U https://periop.jmir.org/2024/1/e54926 %U https://doi.org/10.2196/54926 %U http://www.ncbi.nlm.nih.gov/pubmed/38954808 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e52686 %T The Association of Broadband Internet Use With Drug Overdose Mortality Rates in the United States: Cross-Sectional Analysis %A Karakis,Ioannis %A Kostandini,Genti %A Tsamakis,Konstantinos %A Zahirovic-Herbert,Velma %+ Department of Neurology, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, United States, 1 404 727 6123, ioannis.karakis@emory.edu %K opioids %K broadband internet %K mortality %K public health %K digital divide %K access %K availability %K causal %K association %K correlation %K overdose %K drug abuse %K addiction %K substance abuse %K demographic %K United States %K population %D 2024 %7 26.6.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: The availability and use of broadband internet play an increasingly important role in health care and public health. Objective: This study examined the associations between broadband internet availability and use with drug overdose deaths in the United States. Methods: We linked 2019 county-level drug overdose death data in restricted-access multiple causes of death files from the National Vital Statistics System at the US Centers for Disease Control and Prevention with the 2019 county-level broadband internet rollout data from the Federal Communications Commission and the 2019 county-level broadband usage data available from Microsoft’s Airband Initiative. Cross-sectional analysis was performed with the fixed-effects regression method to assess the association of broadband internet availability and usage with opioid overdose deaths. Our model also controlled for county-level socioeconomic characteristics and county-level health policy variables. Results: Overall, a 1% increase in broadband internet use was linked with a 1.2% increase in overall drug overdose deaths. No significant association was observed for broadband internet availability. Although similar positive associations were found for both male and female populations, the association varied across different age subgroups. The positive association on overall drug overdose deaths was the greatest among Hispanic and Non-Hispanic White populations. Conclusions: Broadband internet use was positively associated with increased drug overdose deaths among the overall US population and some subpopulations, even after controlling for broadband availability, sociodemographic characteristics, unemployment, and median household income. %M 38922664 %R 10.2196/52686 %U https://ojphi.jmir.org/2024/1/e52686 %U https://doi.org/10.2196/52686 %U http://www.ncbi.nlm.nih.gov/pubmed/38922664 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48776 %T Investigating the Interrelationships Among Mental Health, Substance Use Disorders, and Suicidal Ideation Among Lesbian, Gay, and Bisexual Adults in the United States: Population-Based Statewide Survey Study %A Chan,Alex Siu Wing %A Tam,Hon Lon %A Wong,Florence Kwai Ching %A Wong,Gordon %A Leung,Lok Man %A Ho,Jacqueline Mei Chi %A Tang,Patrick Ming Kuen %A Yan,Elsie %+ Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, ELB704B, Hong Kong, 999077, China, 852 39439306, hltam@cuhk.edu.hk %K mental health %K adults %K lesbian, gay, and bisexual %K depression %K drug abuse %K drug dependence %K suicidality risk %K mental illness %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mental health disparities have been documented among lesbian, gay, and bisexual (LGB) adults in the United States. Substance use disorders and suicidal ideation have been identified as important health concerns for this population. However, the interrelationships among these factors are not well understood. Objective: This study aims to investigate the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States using a population-based statewide survey. Methods: Our study was an observational cross-sectional analysis, and the data for this study were collected from a sample of LGB adults who participated in the statewide survey. The survey collected information on mental health, substance use disorders, and suicidal ideation using validated measures. Descriptive statistics and inferential data analysis were conducted to explore the interrelationships among these factors. Results: The results showed that LGB adults who reported higher levels of depression and drug abuse and dependence also reported higher levels of suicidal tendency and mental illness. Inferential data analysis using χ2 tests revealed significant differences in depression score (χ22=458.241; P<.001), drug abuse and dependence score (χ22=226.946; P<.001), suicidal tendency score (χ22=67.795; P<.001), and mental illness score (χ22=363.722; P<.001) among the 3 sexual identity groups. Inferential data analysis showed significant associations between sexual identity and mental health outcomes, with bisexual individuals reporting the highest levels of depression, drug abuse and dependence, suicidal tendency, and mental illness. Conclusions: This study provides important insights into the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States. The findings underscore the need for targeted interventions and research aimed at addressing the mental health needs of sexual minority populations. Future research should aim to better understand the underlying mechanisms driving these disparities and develop culturally sensitive and tailored interventions that meet the unique needs of LGB individuals. Reducing stigma and discrimination against sexual minority populations is also crucial to improving their mental health outcomes. %M 38916938 %R 10.2196/48776 %U https://publichealth.jmir.org/2024/1/e48776 %U https://doi.org/10.2196/48776 %U http://www.ncbi.nlm.nih.gov/pubmed/38916938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50452 %T Relapse Prevention Group Therapy in Indonesia Involving Peers via Videoconferencing for Substance Use Disorder: Development and Feasibility Study %A Siste,Kristiana %A Ophinni,Youdiil %A Hanafi,Enjeline %A Yamada,Chika %A Novalino,Reza %A Limawan,Albert P %A Beatrice,Evania %A Rafelia,Vania %A Alison,Peter %A Matsumoto,Toshihiko %A Sakamoto,Ryota %+ Department of Environmental Coexistence, Center for Southeast Asian Studies, Kyoto University, 46 Yoshidashimoadachicho, Sakyo Ward, Kyoto, 606-8304, Japan, 81 757537351, chika128@cseas.kyoto-u.ac.jp %K substance use disorder %K cognitive behavioral therapy %K telemedicine %K peer involvement %K Indonesia %K substance use disorders %K digital intervention %K COVID-19 %K psychotherapy %K drug %K mobile phone %D 2024 %7 18.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use disorder (SUD) is a major health issue in Indonesia, where several barriers to treatment exist, including inaccessibility to treatment services, stigma, and criminalization of drug issues. Peer involvement and the use of telemedicine to deliver psychotherapy are promising approaches to overcome these barriers. Objective: This study aims (1) to describe the development of a new group psychotherapy coprovided by a health care worker and a peer and (2) to evaluate the acceptability, practicality, and preliminary outcomes of the program delivered via videoconferencing in Indonesia. Methods: Building upon an established relapse prevention therapy in Japan, we developed a 3-month weekly group therapy module in the Indonesian language. Adjustments were made via focus group discussions with local stakeholders in terms of substance types, understandability, inclusive language, and cultural relevance. A pilot study was conducted to test the new module provided by a peer and a psychiatrist via videoconferencing, termed tele-Indonesia Drug Addiction Relapse Prevention Program (tele-Indo-DARPP), with a pre- and postcontrolled design. We analyzed data from semistructured feedback interviews and outcome measurements, including the number of days using substances and quality of life, and compared the intervention (tele-Indo-DARPP added to treatment as usual [TAU]) and control (TAU only) arms. Results: In total, 8 people diagnosed with SUD participated in the pilot study with a mean age of 37 (SD 12.8) years. All were men, and 7 (88%) used sedatives as the primary substance. Collectively, they attended 44 of the 48 tele-Indo-DARPP sessions. A total of 3 out of 4 (75%) preferred telemedicine rather than in-person therapy. Positive acceptability and practicality were shown from qualitative feedback, in which the participants who joined the tele-Indo-DARPP reported that they liked the convenience of joining from home and that they were able to open up about personal matters, received helpful advice from peers, and received support from other participants. Providers reported that they feel the module was provider-friendly, and the session was convenient to join without diminishing rapport-building. Meanwhile, troubles with the internet connection and difficulty in comprehending some terminology in the workbook were reported. The intervention arm showed better improvements in psychological health and anxiety symptoms. Conclusions: Group psychotherapy via videoconferencing coprovided by health care workers and peers was acceptable and practical for participants with SUD and service providers in this study. A large-scale study is warranted to examine the effectiveness of the newly developed module in Indonesia. %M 38888959 %R 10.2196/50452 %U https://formative.jmir.org/2024/1/e50452 %U https://doi.org/10.2196/50452 %U http://www.ncbi.nlm.nih.gov/pubmed/38888959 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49010 %T Web-Based Forums for People Experiencing Substance Use or Gambling Disorders: Scoping Review %A Peart,Annette %A Horn,Freya %A Petukhova,Rachel %A Barnett,Anthony %A Lubman,Dan I %+ Eastern Health Clinical School, Monash University, Level 2, 110 Church St, Richmond, Victoria, 3121, Australia, 61 3 8413 8413, annette.peart@monash.edu %K web-based forums %K peer support %K substance use %K gambling %K scoping %K review method %K review methodology %K forum %K forums %K substance abuse %K addiction %K addictive %K addictions %K peer-based %K peer support %D 2024 %7 17.6.2024 %9 Review %J JMIR Ment Health %G English %X Background: For people experiencing substance use or gambling disorders, web-based peer-supported forums are a space where they can share their experiences, gather around a collective goal, and find mutual support. Web-based peer support can help to overcome barriers to attending face-to-face meetings by enabling people experiencing addiction to seek support beyond their physical location and with the benefit of anonymity if desired. Understanding who participates in web-based peer-supported forums (and how), and the principles underpinning forums, can also assist those interested in designing or implementing similar platforms. Objective: This study aims to review the literature on how people experiencing substance use or gambling disorders, and their family, friends, and supporters, use and participate in web-based peer-supported forums. Specifically, we asked the following research questions: (1) What are the characteristics of people who use web-based peer-supported substance use or gambling-focused forums? (2) How do people participate in web-based peer-supported forums? (3) What are the key principles reportedly underpinning the web-based peer-supported forums? (4) What are the reported outcomes of web-based peer-supported forums? Methods: Inclusion criteria for our scoping review were peer-reviewed primary studies reporting on web-based addiction forums for adults and available in English. A primary search of 10 databases occurred in June 2021, with 2 subsequent citation searches of included studies in September 2022 and February 2024. Results: Of the 14 included studies, the majority of web-based peer-supported forums reported were aimed specifically for, or largely used by, people experiencing alcohol problems. Results from the 9 studies that did report demographic data suggest forum users were typically women, aged between 40 years and early 50 years. Participation in web-based peer-supported forums was reported quantitatively and qualitatively. The forums reportedly were underpinned by a range of key principles, mostly mutual help approaches and recovery identity formation. Only 3 included studies reported on outcomes for forum users. Conclusions: Web-based peer-supported forums are used by people experiencing addiction in a number of ways, to share information and experiences, and give and receive support. Seeking web-based support offers an alternative approach to traditional face-to-face support options, and may reduce some barriers to engaging in peer support. %M 38885012 %R 10.2196/49010 %U https://mental.jmir.org/2024/1/e49010 %U https://doi.org/10.2196/49010 %U http://www.ncbi.nlm.nih.gov/pubmed/38885012 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53049 %T Care Integration for Hepatitis C Virus Treatment Through Facilitated Telemedicine Within Opioid Treatment Programs: Qualitative Study %A Dickerson,Suzanne S %A George,Saliyah J %A Ventuneac,Ana %A Dharia,Arpan %A Talal,Andrew H %+ Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, UB-CTRC, Suite 6090, 875 Ellicot Street, Buffalo, NY, 14203, United States, 1 716 829 5354, ahtalal@buffalo.edu %K hepatitis C virus %K integrated treatment %K facilitated telemedicine %K substance users %K people with opioid use disorder %K opioid %K opioids %K telemedicine %K telehealth %K eHealth %K e-health %K ICT %K substance use %K substance abuse %K HCV %K hepatitis %K liver %K interview %K interviews %K qualitative %K hermeneutic %K phenomenological %K implementation %K integration %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K addict %K addiction %K addictions %K addicts %K hepatic %D 2024 %7 12.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine has the potential to remove geographic and temporal obstacles to health care access. Whether and how telemedicine can increase health care access for underserved populations remains an open question. To address this issue, we integrated facilitated telemedicine encounters for the management of hepatitis C virus (HCV), a highly prevalent condition among people with opioid use disorder (OUD), into opioid treatment programs (OTPs). In New York State, OTPs are methadone-dispensing centers that provide patient-centered, evidence-based treatment for OUD. We investigated the integration and impact of facilitated telemedicine into OTP workflows in these settings. Objective: This study aims to understand OTP staff experiences with integrating facilitated telemedicine for HCV treatment into OTPs, including best practices and lessons learned. Methods: We conducted semistructured interviews with 45 OTP staff members (13 clinical, 12 administrative, 6 physicians, and 14 support staff members) at least one year after the implementation of facilitated telemedicine for HCV management. We used hermeneutic phenomenological analysis to understand OTP staff experiences. Results: We identified 4 overarching themes illustrating the successful integration of facilitated telemedicine for HCV care into OTPs. First, integration requires an understanding of the challenges, goals, and values of the OTP. As OTP staff learned about new, highly effective HCV therapies, they valued an HCV cure as a “win” for their patients and were excited about the potential to eliminate a highly prevalent infectious disease. Second, the integration of facilitated telemedicine into OTPs fosters social support and reinforces relationships between patients and OTP staff. OTP staff appreciated the ability to have “eyes on” patients during telemedicine encounters to assess body language, a necessary component of OUD management. Third, participants described high levels of interprofessional collaboration as a care team that included the blurring of lines between disciplines working toward a common goal of improving patient care. Study case managers were integrated into OTP workflows and established communication channels to improve patient outcomes. Fourth, administrators endorsed the sustained and future expansion of facilitated telemedicine to address comorbidities. Conclusions: OTP staff were highly enthusiastic about facilitated telemedicine for an underserved population. They described high levels of collaboration and integration comparable to relevant integrative frameworks. When situated within OTPs, facilitated telemedicine is a high-value application of telemedicine that provides support for underserved populations necessary for high-quality health care. These experiences support sustaining and scaling facilitated telemedicine in comparable settings and evaluating its ability to address other comorbidities. Trial Registration: ClinicalTrials.gov NCT02933970; https://clinicaltrials.gov/study/NCT02933970 %M 38865703 %R 10.2196/53049 %U https://www.jmir.org/2024/1/e53049 %U https://doi.org/10.2196/53049 %U http://www.ncbi.nlm.nih.gov/pubmed/38865703 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51323 %T Data-Driven Identification of Potentially Successful Intervention Implementations Using 5 Years of Opioid Prescribing Data: Retrospective Database Study %A Hopcroft,Lisa EM %A Curtis,Helen J %A Croker,Richard %A Pretis,Felix %A Inglesby,Peter %A Evans,David %A Bacon,Sebastian %A Goldacre,Ben %A Walker,Alex J %A MacKenna,Brian %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 01865289313, alex.walker@phc.ox.ac.uk %K electronic health records %K primary care %K general practice %K opioid analgesics %K data science %K implementation science %K data-driven %K identification %K intervention %K implementations %K proof of concept %K opioid %K unbiased %K prescribing data %K analysis tool %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: We have previously demonstrated that opioid prescribing increased by 127% between 1998 and 2016. New policies aimed at tackling this increasing trend have been recommended by public health bodies, and there is some evidence that progress is being made. Objective: We sought to extend our previous work and develop a data-driven approach to identify general practices and clinical commissioning groups (CCGs) whose prescribing data suggest that interventions to reduce the prescribing of opioids may have been successfully implemented. Methods: We analyzed 5 years of prescribing data (December 2014 to November 2019) for 3 opioid prescribing measures—total opioid prescribing as oral morphine equivalent per 1000 registered population, the number of high-dose opioids prescribed per 1000 registered population, and the number of high-dose opioids as a percentage of total opioids prescribed. Using a data-driven approach, we applied a modified version of our change detection Python library to identify reductions in these measures over time, which may be consistent with the successful implementation of an intervention to reduce opioid prescribing. This analysis was carried out for general practices and CCGs, and organizations were ranked according to the change in prescribing rate. Results: We identified a reduction in total opioid prescribing in 94 (49.2%) out of 191 CCGs, with a median reduction of 15.1 (IQR 11.8-18.7; range 9.0-32.8) in total oral morphine equivalence per 1000 patients. We present data for the 3 CCGs and practices demonstrating the biggest reduction in opioid prescribing for each of the 3 opioid prescribing measures. We observed a 40% proportional drop (8.9% absolute reduction) in the regular prescribing of high-dose opioids (measured as a percentage of regular opioids) in the highest-ranked CCG (North Tyneside); a 99% drop in this same measure was found in several practices (44%-95% absolute reduction). Decile plots demonstrate that CCGs exhibiting large reductions in opioid prescribing do so via slow and gradual reductions over a long period of time (typically over a period of 2 years); in contrast, practices exhibiting large reductions do so rapidly over a much shorter period of time. Conclusions: By applying 1 of our existing analysis tools to a national data set, we were able to identify rapid and maintained changes in opioid prescribing within practices and CCGs and rank organizations by the magnitude of reduction. Highly ranked organizations are candidates for further qualitative research into intervention design and implementation. %M 38838327 %R 10.2196/51323 %U https://publichealth.jmir.org/2024/1/e51323 %U https://doi.org/10.2196/51323 %U http://www.ncbi.nlm.nih.gov/pubmed/38838327 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e53625 %T A Machine Learning Application to Classify Patients at Differing Levels of Risk of Opioid Use Disorder: Clinician-Based Validation Study %A Eguale,Tewodros %A Bastardot,François %A Song,Wenyu %A Motta-Calderon,Daniel %A Elsobky,Yasmin %A Rui,Angela %A Marceau,Marlika %A Davis,Clark %A Ganesan,Sandya %A Alsubai,Ava %A Matthews,Michele %A Volk,Lynn A %A Bates,David W %A Rozenblum,Ronen %K opioid-related disorders %K opioid use disorder %K machine learning %K artificial intelligence %K electronic health record %K clinical decision support %K model validation %K patient medication safety %K medication safety %K clinical decision %K decision making %K decision support %K patient safety %K opioid use %K drug use %K opioid safety %K medication %K OUD %K EHR %K AI %D 2024 %7 4.6.2024 %9 %J JMIR Med Inform %G English %X Background: Despite restrictive opioid management guidelines, opioid use disorder (OUD) remains a major public health concern. Machine learning (ML) offers a promising avenue for identifying and alerting clinicians about OUD, thus supporting better clinical decision-making regarding treatment. Objective: This study aimed to assess the clinical validity of an ML application designed to identify and alert clinicians of different levels of OUD risk by comparing it to a structured review of medical records by clinicians. Methods: The ML application generated OUD risk alerts on outpatient data for 649,504 patients from 2 medical centers between 2010 and 2013. A random sample of 60 patients was selected from 3 OUD risk level categories (n=180). An OUD risk classification scheme and standardized data extraction tool were developed to evaluate the validity of the alerts. Clinicians independently conducted a systematic and structured review of medical records and reached a consensus on a patient’s OUD risk level, which was then compared to the ML application’s risk assignments. Results: A total of 78,587 patients without cancer with at least 1 opioid prescription were identified as follows: not high risk (n=50,405, 64.1%), high risk (n=16,636, 21.2%), and suspected OUD or OUD (n=11,546, 14.7%). The sample of 180 patients was representative of the total population in terms of age, sex, and race. The interrater reliability between the ML application and clinicians had a weighted kappa coefficient of 0.62 (95% CI 0.53-0.71), indicating good agreement. Combining the high risk and suspected OUD or OUD categories and using the review of medical records as a gold standard, the ML application had a corrected sensitivity of 56.6% (95% CI 48.7%-64.5%) and a corrected specificity of 94.2% (95% CI 90.3%-98.1%). The positive and negative predictive values were 93.3% (95% CI 88.2%-96.3%) and 60.0% (95% CI 50.4%-68.9%), respectively. Key themes for disagreements between the ML application and clinician reviews were identified. Conclusions: A systematic comparison was conducted between an ML application and clinicians for identifying OUD risk. The ML application generated clinically valid and useful alerts about patients’ different OUD risk levels. ML applications hold promise for identifying patients at differing levels of OUD risk and will likely complement traditional rule-based approaches to generating alerts about opioid safety issues. %R 10.2196/53625 %U https://medinform.jmir.org/2024/1/e53625 %U https://doi.org/10.2196/53625 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46029 %T Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study %A Law,Graham %A Cooper,Rhiannon %A Pirrie,Melissa %A Ferron,Richard %A McLeod,Brent %A Spaight,Robert %A Siriwardena,A Niroshan %A Agarwal,Gina %A , %+ Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, , Canada, 1 905 525 9140, gina.agarwal@gmail.com %K COVID-19 %K mental health %K overdose %K emergency medical services %K administrative data %K Canada %K the United Kingdom %K ambulance %K sex %K age %K lockdown %K pandemic planning %K emergency service %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic impacted mental health and health care systems worldwide. Objective: This study examined the COVID-19 pandemic’s impact on ambulance attendances for mental health and overdose, comparing similar regions in the United Kingdom and Canada that implemented different public health measures. Methods: An interrupted time series study of ambulance attendances was conducted for mental health and overdose in the United Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulance attendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled the count of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown was initiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age. Results: Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown (United Kingdom: incidence rate ratio [IRR] 1.002, 95% CI 1.002-1.003 for mental health). However, substantial changes were observed at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the study regions of both countries (United Kingdom: IRR 0.573, 95% CI 0.518-0.635 and Canada: IRR 0.743, 95% CI 0.602-0.917), the rate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95% CI 1.031-1.227 and Canada: IRR 0.922, 95% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between study regions. Conclusions: The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differed between the UK and Canada study regions. These results may inform future pandemic planning and further research on the public health measures that may explain observed regional differences. %M 38728683 %R 10.2196/46029 %U https://publichealth.jmir.org/2024/1/e46029 %U https://doi.org/10.2196/46029 %U http://www.ncbi.nlm.nih.gov/pubmed/38728683 %0 Journal Article %@ 2563-6316 %I %V 5 %N %P e48519 %T Detecting Substance Use Disorder Using Social Media Data and the Dark Web: Time- and Knowledge-Aware Study %A Lokala,Usha %A Phukan,Orchid Chetia %A Dastidar,Triyasha Ghosh %A Lamy,Francois %A Daniulaityte,Raminta %A Sheth,Amit %K opioid %K substance use %K substance use disorder %K social media %K US %K opioid crisis %K mental health %K substance misuse %K crypto %K dark web %K users %K user perception %K fentanyl %K synthetic opioids %K United States %D 2024 %7 1.5.2024 %9 %J JMIRx Med %G English %X Background: Opioid and substance misuse has become a widespread problem in the United States, leading to the “opioid crisis.” The relationship between substance misuse and mental health has been extensively studied, with one possible relationship being that substance misuse causes poor mental health. However, the lack of evidence on the relationship has resulted in opioids being largely inaccessible through legal means. Objectives: This study aims to analyze social media posts related to substance use and opioids being sold through cryptomarket listings. The study aims to use state-of-the-art deep learning models to generate sentiment and emotion from social media posts to understand users’ perceptions of social media. The study also aims to investigate questions such as which synthetic opioids people are optimistic, neutral, or negative about; what kind of drugs induced fear and sorrow; what kind of drugs people love or are thankful about; which drugs people think negatively about; and which opioids cause little to no sentimental reaction. Methods: The study used the drug abuse ontology and state-of-the-art deep learning models, including knowledge-aware Bidirectional Encoder Representations From Transformers–based models, to generate sentiment and emotion from social media posts related to substance use and opioids being sold through cryptomarket listings. The study crawled cryptomarket data and extracted posts for fentanyl, fentanyl analogs, and other novel synthetic opioids. The study performed topic analysis associated with the generated sentiments and emotions to understand which topics correlate with people’s responses to various drugs. Additionally, the study analyzed time-aware neural models built on these features while considering historical sentiment and emotional activity of posts related to a drug. Results: The study found that the most effective model performed well (statistically significant, with a macro–F1-score of 82.12 and recall of 83.58) in identifying substance use disorder. The study also found that there were varying levels of sentiment and emotion associated with different synthetic opioids, with some drugs eliciting more positive or negative responses than others. The study identified topics that correlated with people’s responses to various drugs, such as pain relief, addiction, and withdrawal symptoms. Conclusions: The study provides insight into users’ perceptions of synthetic opioids based on sentiment and emotion expressed in social media posts. The study’s findings can be used to inform interventions and policies aimed at reducing substance misuse and addressing the opioid crisis. The study demonstrates the potential of deep learning models for analyzing social media data to gain insights into public health issues. %R 10.2196/48519 %U https://xmed.jmir.org/2024/1/e48519 %U https://doi.org/10.2196/48519 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53665 %T Evaluation of a Pilot Program to Prevent the Misuse of Prescribed Opioids Among Health Care Workers: Repeated Measures Survey Study %A Hebard,Stephen %A Weaver,GracieLee %A Hansen,William B %A Ruppert,Scarlett %+ Department of Public Health Education, University of North Carolina Greensboro, PO BOX 26170, Greensboro, NC, 27402-6170, United States, 1 336 334 5000, gmweaver@uncg.edu %K health care workers %K opioid misuse %K pain management %K prescription opioids %K prevention %K substance abuse %K substance use %K workers %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Overprescription of opioids has led to increased misuse of opioids, resulting in higher rates of overdose. The workplace can play a vital role in an individual’s intentions to misuse prescription opioids with injured workers being prescribed opioids, at a rate 3 times the national average. For example, health care workers are at risk for injuries, opioid dispensing, and diversion. Intervening within a context that may contribute to risks for opioid misuse while targeting individual psychosocial factors may be a useful complement to interventions at policy and prescribing levels. Objective: This pilot study assessed the effects of a mobile-friendly opioid misuse intervention prototype tailored for health care workers using the preparation phase of a multiphase optimization strategy design. Methods: A total of 33 health care practitioners participated in the pilot intervention, which included 10 brief web-based lessons aimed at impacting psychosocial measures that underlie opioid misuse. The lesson topics included: addiction beliefs, addiction control, Centers for Disease Control and Prevention guidelines and recommendations, beliefs about patient-provider relationships and communication, control in communicating with providers, beliefs about self-monitoring pain and side effects, control in self-monitoring pain and side effects, diversion and disposal beliefs, diversion and disposal control, and a conclusion lesson. Using a treatment-only design, pretest and posttest surveys were collected. A general linear repeated measures ANOVA was used to assess mean differences from pretest to posttest. Descriptive statistics were used to assess participant feedback about the intervention. Results: After completing the intervention, participants showed significant mean changes with increases in knowledge of opioids (+0.459; P<.001), less favorable attitudes toward opioids (–1.081; P=.001), more positive beliefs about communication with providers (+0.205; P=.01), more positive beliefs about pain management control (+0.969; P<.001), and increased intentions to avoid opioid use (+0.212; P=.03). Of the 33 practitioners who completed the program, most felt positive about the information presented, and almost 70% (23/33) agreed or strongly agreed that other workers in the industry should complete a program like this. Conclusions: While attempts to address the opioid crisis have been made through public health policies and prescribing initiatives, opioid misuse continues to rise. Certain industries place workers at greater risk for injury and opioid dispensing, making interventions that target workers in these industries of particular importance. Results from this pilot study show positive impacts on knowledge, attitudes, and beliefs about communicating with providers and pain management control, as well as intentions to avoid opioid misuse. However, the dropout rate and small sample size are severe limitations, and the results lack generalizability. Results will be used to inform program revisions and future optimization trials, with the intention of providing insight for future intervention development and evaluation of mobile-friendly eHealth interventions for employees. %M 38607664 %R 10.2196/53665 %U https://formative.jmir.org/2024/1/e53665 %U https://doi.org/10.2196/53665 %U http://www.ncbi.nlm.nih.gov/pubmed/38607664 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49751 %T Users' Acceptability and Perceived Efficacy of mHealth for Opioid Use Disorder: Scoping Review %A Lyzwinski,Lynnette Nathalie %A Elgendi,Mohamed %A Menon,Carlo %+ Menrva Research Group, School of Mechatronics Systems Engineering and Engineering Science, Simon Fraser University, 250-13450 102 Avenue, Metro Vancouver, Vancouver, BC, V3T 0A3, Canada, 1 778 302 1151, lnl2@sfu.ca %K acceptability %K addict %K addiction %K addictions %K app %K app-based %K application %K applications %K apps %K barrier %K barriers %K challenge %K challenges %K messaging %K mHealth %K mobile health %K monitoring %K opioid %K opioids %K overdose %K overdosing %K pharmacology %K review methodology %K review methods %K scoping %K sensor %K sensors %K SMS %K substance abuse %K substance use %K text message %K wearable technology %K wearable %K wearables %D 2024 %7 11.4.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The opioid crisis continues to pose significant challenges to global public health, necessitating the development of novel interventions to support individuals in managing their substance use and preventing overdose-related deaths. Mobile health (mHealth), as a promising platform for addressing opioid use disorder, requires a comprehensive understanding of user perspectives to minimize barriers to care and optimize the benefits of mHealth interventions. Objective: This study aims to synthesize qualitative insights into opioid users’ acceptability and perceived efficacy of mHealth and wearable technologies for opioid use disorder. Methods: A scoping review of PubMed (MEDLINE) and Google Scholar databases was conducted to identify research on opioid user perspectives concerning mHealth-assisted interventions, including wearable sensors, SMS text messaging, and app-based technology. Results: Overall, users demonstrate a high willingness to engage with mHealth interventions to prevent overdose-related deaths and manage opioid use. Users perceive mHealth as an opportunity to access care and desire the involvement of trusted health care professionals in these technologies. User comfort with wearing opioid sensors emerged as a significant factor. Personally tailored content, social support, and encouragement are preferred by users. Privacy concerns and limited access to technology pose barriers to care. Conclusions: To maximize benefits and minimize risks for users, it is crucial to implement robust privacy measures, provide comprehensive user training, integrate behavior change techniques, offer professional and peer support, deliver tailored messages, incorporate behavior change theories, assess readiness for change, design stigma-reducing apps, use visual elements, and conduct user-focused research for effective opioid management in mHealth interventions. mHealth demonstrates considerable potential as a tool for addressing opioid use disorder and preventing overdose-related deaths, given the high acceptability and perceived benefits reported by users. %M 38602751 %R 10.2196/49751 %U https://mhealth.jmir.org/2024/1/e49751 %U https://doi.org/10.2196/49751 %U http://www.ncbi.nlm.nih.gov/pubmed/38602751 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49527 %T Estimated Number of Injection-Involved Overdose Deaths in US States From 2000 to 2020: Secondary Analysis of Surveillance Data %A Hall,Eric William %A Sullivan,Patrick Sean %A Bradley,Heather %+ OHSU-PSU School of Public Health, Oregon Health and Science University, 1810 SW 5th Avenue, Suite 510, Portland, OR, 97201, United States, 1 503 494 4966, halleri@ohsu.edu %K death rate %K death %K drug abuse %K drugs %K injection drug use %K injection %K mortality %K National Vital Statistics System %K overdose death rate %K overdose %K state %K substance abuse %K Treatment Episode Dataset-Admission %K treatment %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the United States, both drug overdose mortality and injection-involved drug overdose mortality have increased nationally over the past 25 years. Despite documented geographic differences in overdose mortality and substances implicated in overdose mortality trends, injection-involved overdose mortality has not been summarized at a subnational level. Objective: We aimed to estimate the annual number of injection-involved overdose deaths in each US state from 2000 to 2020. Methods: We conducted a stratified analysis that used data from drug treatment admissions (Treatment Episodes Data Set–Admissions; TEDS-A) and the National Vital Statistics System (NVSS) to estimate state-specific percentages of reported drug overdose deaths that were injection-involved from 2000 to 2020. TEDS-A collects data on the route of administration and the type of substance used upon treatment admission. We used these data to calculate the percentage of reported injections for each drug type by demographic group (race or ethnicity, sex, and age group), year, and state. Additionally, using NVSS mortality data, the annual number of overdose deaths involving selected drug types was identified by the following specific multiple-cause-of-death codes: heroin or synthetic opioids other than methadone (T40.1, T40.4), natural or semisynthetic opioids and methadone (T40.2, T40.3), cocaine (T40.5), psychostimulants with abuse potential (T43.6), sedatives (T42.3, T42.4), and others (T36-T59.0). We used the probabilities of injection with the annual number of overdose deaths, by year, primary substance, and demographic groups to estimate the number of overdose deaths that were injection-involved. Results: In 2020, there were 91,071 overdose deaths among adults recorded in the United States, and 93.1% (84,753/91,071) occurred in the 46 jurisdictions that reported data to TEDS-A. Slightly less than half (38,253/84,753, 45.1%; 95% CI 41.1%-49.8%) of those overdose deaths were estimated to be injection-involved, translating to 38,253 (95% CI 34,839-42,181) injection-involved overdose deaths in 2020. There was large variation among states in the estimated injection-involved overdose death rate (median 14.72, range 5.45-31.77 per 100,000 people). The national injection-involved overdose death rate increased by 323% (95% CI 255%-391%) from 2010 (3.78, 95% CI 3.33-4.31) to 2020 (15.97, 95% CI 14.55-17.61). States in which the estimated injection-involved overdose death rate increased faster than the national average were disproportionately concentrated in the Northeast region. Conclusions: Although overdose mortality and injection-involved overdose mortality have increased dramatically across the country, these trends have been more pronounced in some regions. A better understanding of state-level trends in injection-involved mortality can inform the prioritization of public health strategies that aim to reduce overdose mortality and prevent downstream consequences of injection drug use. %M 38578676 %R 10.2196/49527 %U https://publichealth.jmir.org/2024/1/e49527 %U https://doi.org/10.2196/49527 %U http://www.ncbi.nlm.nih.gov/pubmed/38578676 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e48135 %T Using Project Extension for Community Healthcare Outcomes to Enhance Substance Use Disorder Care in Primary Care: Mixed Methods Study %A Koester,MacKenzie %A Motz,Rosemary %A Porto,Ariel %A Reyes Nieves,Nikita %A Ashley,Karen %+ Weitzman Institute, Moses Weitzman Health System, 1575 I Street Northwest, Suite 300, Washington, DC, 20005, United States, 1 8603476971, koestem@mwhs1.com %K continuing medical education %K telementoring %K substance use disorder treatment %K substance use disorder %K SUD %K primary care %K Extension for Community Healthcare Outcomes %K Project ECHO %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Substance use and overdose deaths make up a substantial portion of injury-related deaths in the United States, with the state of Ohio leading the nation in rates of diagnosed substance use disorder (SUD). Ohio’s growing epidemic has indicated a need to improve SUD care in a primary care setting through the engagement of multidisciplinary providers and the use of a comprehensive approach to care. Objective: The purpose of this study was to assess the ability of the Weitzman Extension for Community Healthcare Outcomes (ECHO): Comprehensive Substance Use Disorder Care program to both address and meet 7 series learning objectives and address substances by analyzing (1) the frequency of exposure to the learning objective topics and substance types during case discussions and (2) participants’ change in knowledge, self-efficacy, attitudes, and skills related to the treatment of SUDs pre- to postseries. The 7 series learning objective themes included harm reduction, team-based care, behavioral techniques, medication-assisted treatment, trauma-informed care, co-occurring conditions, and social determinants of health. Methods: We used a mixed methods approach using a conceptual content analysis based on series learning objectives and substances and a 2-tailed paired-samples t test of participants’ self-reported learner outcomes. The content analysis gauged the frequency and dose of learning objective themes and illicit and nonillicit substances mentioned in participant case presentations and discussions, and the paired-samples t test compared participants’ knowledge, self-efficacy, attitudes, and skills associated with learning objectives and medication management of substances from pre- to postseries. Results: The results of the content analysis indicated that 3 learning objective themes—team-based care, harm reduction, and social determinants of health—resulted in the highest frequencies and dose, appearing in 100% (n=22) of case presentations and discussions. Alcohol had the highest frequency and dose among the illicit and nonillicit substances, appearing in 81% (n=18) of case presentations and discussions. The results of the paired-samples t test indicated statistically significant increases in knowledge domain statements related to polysubstance use (P=.02), understanding the approach other disciplines use in SUD care (P=.02), and medication management strategies for nicotine (P=.03) and opioid use disorder (P=.003). Statistically significant increases were observed for 2 self-efficacy domain statements regarding medication management for nicotine (P=.002) and alcohol use disorder (P=.02). Further, 1 statistically significant increase in the skill domain was observed regarding using the stages of change theory in interventions (P=.03). Conclusions: These findings indicate that the ECHO program’s content aligned with its stated learning objectives; met its learning objectives for the 3 themes where significant improvements were measured; and met its intent to address multiple substances in case presentations and discussions. These results demonstrate that Project ECHO is a potential tool to educate multidisciplinary providers in a comprehensive approach to SUD care. %M 38557477 %R 10.2196/48135 %U https://mededu.jmir.org/2024/1/e48135 %U https://doi.org/10.2196/48135 %U http://www.ncbi.nlm.nih.gov/pubmed/38557477 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48068 %T Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study %A King Jr,Van Lewis %A Siegel,Gregg %A Priesmeyer,Henry Richard %A Siegel,Leslie H %A Potter,Jennifer S %+ Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center San Antonio, 5109 Medical Drive, San Antonio, TX, 78229, United States, 1 210 450 8058, kingvl@uthscsa.edu %K opioid use disorder %K digital health %K behavioral medicine %K KIOS %K mHealth %K substance use disorder %K substance use treatment %K self-management %K opioid misuse %K substance use %K social support %K KIOS app %K KIOS application %K software %K patient-centered %K opioid %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient’s recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers. Objective: This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs. Methods: We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual’s patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual’s changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes. Results: In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use. Conclusions: KIOS tracks key clinical variables and generates advice specifically relevant to the patient’s current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse–funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted. %M 38557501 %R 10.2196/48068 %U https://formative.jmir.org/2024/1/e48068 %U https://doi.org/10.2196/48068 %U http://www.ncbi.nlm.nih.gov/pubmed/38557501 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57280 %T The Feasibility of Using the National PulsePoint Cardiopulmonary Resuscitation Responder Network to Facilitate Overdose Education and Naloxone Distribution: Protocol for a Randomized Controlled Trial %A Agley,Jon %A Henderson,Cris %A Seo,Dong-Chul %A Parker,Maria %A Golzarri-Arroyo,Lilian %A Dickinson,Stephanie %A Tidd,David %+ Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St., Bloomington, IN, 47405, United States, 1 812 855 3123, jagley@indiana.edu %K naloxone %K PulsePoint %K randomized controlled trial %K RCT %K first responder %K overdose %K community engagement %K citizen mobilization %K opioids %K Narcan %K mobile phone %D 2024 %7 29.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of naloxone, an opioid antagonist, is a critical component of the US response to fatal opioid-involved overdoses. The importance and utility of naloxone in preventing fatal overdoses have been widely declaimed by medical associations and government officials and are supported by strong research evidence. Still, there are gaps in the current US national strategy because many opioid-involved overdose fatalities have no evidence of naloxone administration. Improving the likelihood that naloxone will be used to prevent fatal overdoses is predicated on facilitating an environment wherein naloxone is available near each overdose and can be accessed by someone who is willing and able to use it. How to accomplish this on a national scale has been unclear. However, there exists a national network 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 13 %N %P e54342 %T Efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT) in Individuals With Chronic Pain and Opioid Use Disorder: Protocol for a Randomized Clinical Trial of a Digital Cognitive Behavioral Treatment %A MacLean,R Ross %A Ankawi,Brett %A Driscoll,Mary A %A Gordon,Melissa A %A Frankforter,Tami L %A Nich,Charla %A Szollosy,Sara K %A Loya,Jennifer M %A Brito,Larissa %A Ribeiro,Margaridha I P %A Edmond,Sara N %A Becker,William C %A Martino,Steve %A Sofuoglu,Mehmet %A Heapy,Alicia A %+ VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, United States, 1 2039325711, ross.maclean@yale.edu %K chronic pain %K digital treatment %K medications for opioid use disorder %K methadone %K opioid use disorder %D 2024 %7 20.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is common among individuals with opioid use disorder (OUD) who are maintained on medications for OUD (MOUD; eg, buprenorphine or methadone). Chronic pain is associated with worse retention and higher levels of substance use. Treatment of individuals with chronic pain receiving MOUD can be challenging due to their increased clinical complexity. Given the acute and growing nature of the opioid crisis, MOUD is increasingly offered in a wide range of settings, where high-quality, clinician-delivered, empirically validated behavioral treatment for chronic pain may not be available. Therefore, digital treatments that support patient self-management of chronic pain and OUD have the potential for wider implementation to fill this gap. Objective: This study aims to evaluate the efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT), an interactive digital treatment program with asynchronous coach feedback, compared to treatment as usual (TAU) in individuals with chronic pain and OUD receiving MOUD. Methods: Adult participants (n=160) receiving MOUD and reporting bothersome or high-impact chronic pain will be recruited from outpatient opioid treatment programs in Connecticut (United States) and randomized 1:1 to either IMPACT+TAU or TAU only. Participants randomized to IMPACT+TAU will complete an interactive digital treatment that includes 9 modules promoting training in pain and addiction coping skills and a progressive walking program. The program is augmented with a weekly personalized voice message from a trained coach based on daily participant-reported pain intensity and interference, craving to use opioids, sleep quality, daily steps, pain self-efficacy, MOUD adherence, and engagement with IMPACT collected through digital surveys. Outcomes will be assessed at 3, 6, and 9 months post randomization. The primary outcome is MOUD retention at 3 months post randomization (ie, post treatment). Secondary outcomes include pain interference, physical functioning, MOUD adherence, substance use, craving, pain intensity, sleep disturbance, pain catastrophizing, and pain self-efficacy. Semistructured qualitative interviews with study participants (n=34) randomized to IMPACT (completers and noncompleters) will be conducted to evaluate the usability and quality of the program and its outcomes. Results: The study has received institutional review board approval and began recruitment at 1 site in July 2022. Recruitment at a second site started in January 2023, with a third and final site anticipated to begin recruitment in January 2024. Data collection is expected to continue through June 2025. Conclusions: Establishing efficacy for a digital treatment for addiction and chronic pain that can be integrated into MOUD clinics will provide options for individuals with OUD, which reduce barriers to behavioral treatment. Participant feedback on the intervention will inform updates or modifications to improve engagement and efficacy. Trial Registration: ClinicalTrials.gov NCT05204576; https://clinicaltrials.gov/ct2/show/NCT05204576 International Registered Report Identifier (IRRID): DERR1-10.2196/54342 %M 38506917 %R 10.2196/54342 %U https://www.researchprotocols.org/2024/1/e54342 %U https://doi.org/10.2196/54342 %U http://www.ncbi.nlm.nih.gov/pubmed/38506917 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54077 %T Implementation Documentation and Process Assessment of the PharmNet Intervention: Observational Report %A Eldridge,Lori Ann %A Meyerson,Beth E %A Agley,Jon %+ Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E 9th Street, Bloomington, IN, 47405, United States, 1 812 855 3123, jagley@indiana.edu %K naloxone %K Narcan %K pharmacy %K harm reduction %K PharmNet %K overdose %K opioids %K implementation %K pragmatic trial %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of overdose deaths in the United States involving opioids continues to exceed 100,000 per year. This has precipitated ongoing declarations of a public health emergency. Harm reduction approaches, such as promoting awareness of, ensuring access to, and fostering willingness to use naloxone to reverse opioid overdose, are a key component of a larger national strategy to address the crisis. In addition, overdose reversal with naloxone directly and immediately saves lives. Because of pharmacies’ ubiquity and pharmacists’ extensive clinical training, community pharmacies are well-positioned, in principle, to facilitate naloxone access and education. Objective: In 2022, a single-site pilot study of PharmNet, a community pharmacy intervention incorporating naloxone distribution, awareness building, and referral, showed promising outcomes for both naloxone and resource distribution in the community. As a next step, this study was intended to be a pilot randomized controlled trial of PharmNet in 7 pharmacies. However, due to circumstances outside of the study team’s control, data collection was unable to be fully completed as planned. In keeping with open research standards, we transparently report all available data from the study and discuss trial barriers and processes. We do so both to provide insights that may inform similar studies and to avoid the “file-drawer” (publication bias) problem, which can skew the aggregated scholarly literature through nonpublication of registered trial results or selective publication of findings affirming authors’ hypotheses. Methods: This paper reports an in-depth implementation study assessment, provides the available observational data, and discusses implementation considerations for similar studies in independent (eg, nonchain) community pharmacies. Results: Retrospective assessment of study outcomes and fidelity data provided for robust discussion around how resource differences in independent community pharmacies (vs well-resourced chain pharmacies), as well as high demands on staff, can affect intervention implementation, even when leadership is highly supportive. Conclusions: Community pharmacies, particularly independent community pharmacies, may require more support than anticipated to be successful when implementing a new intervention into practice, even if it might affect estimates of real-world effectiveness. Further implementation science research is needed specific to independent community pharmacies. All study elements are outlined in the International Registered Report Identifier (IRRID) PRR1-10.2196/42373. Although this paper reports results associated with that registration, results and conclusions should not be given the weight assigned to findings from a preregistered study. International Registered Report Identifier (IRRID): RR2-10.2196/42373 %M 38498037 %R 10.2196/54077 %U https://formative.jmir.org/2024/1/e54077 %U https://doi.org/10.2196/54077 %U http://www.ncbi.nlm.nih.gov/pubmed/38498037 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54953 %T Benefits, Harms, and Stakeholder Perspectives Regarding Opioid Therapy for Pain in Individuals With Metastatic Cancer: Protocol for a Descriptive Cohort Study %A Jones,Katie Fitzgerald %A White,Gretchen %A Bennett,Antonia %A Bulls,Hailey %A Escott,Paula %A Orris,Sarah %A Escott,Elizabeth %A Fischer,Stacy %A Hamm,Megan %A Krishnamurti,Tamar %A Wong,Risa %A LeBlanc,Thomas W %A Liebschutz,Jane %A Meghani,Salimah %A Smith,Cardinale %A Temel,Jennifer %A Ritchie,Christine %A Merlin,Jessica S %+ New England Geriatrics Research, Education, and Clinical Center (GRECC), 159 Huntington Ave, Jamaica Plain, MA, 02130, United States, 1 617 232 9500, katie.jones4@va.gov %K cancer %K cancer-related pain %K neoplasm-related pain %K opioid analgesics %K opioids %K pain %D 2024 %7 13.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Opioids are a key component of pain management among patients with metastatic cancer pain. However, the evidence base available to guide opioid-related decision-making in individuals with advanced cancer is limited. Patients with advanced cancer or cancer that is unlikely to be cured frequently experience pain. Opioids are a key component of pain management among patients with metastatic cancer pain. Many individuals with advanced cancer are now living long enough to experience opioid-related harm. Emerging evidence from chronic noncancer pain literature suggests that longer-term opioid therapy may have limited benefits for pain and function, and opioid-related harms are also a major concern. However, whether these benefits and harms of opioids apply to patients with cancer-related pain is unknown. Objective: This manuscript outlines the protocol for the “Opioid Therapy for Pain in Individuals With Metastatic Cancer: The Benefits, Harms, and Stakeholder Perspectives (BEST) Study.” The study aims to better understand opioid decision-making in patients with advanced cancer, along with opioid benefits and harms, through prospective examination of patients’ pain experiences and opioid side effects and understanding the decision-making by patients, care partners, and clinicians. Methods: This is a multicenter, prospective cohort study that aims to enroll 630 patients with advanced cancer, 20 care partners, and 20 clinicians (670 total participants). Patient participants must have an advanced solid cancer diagnosis, defined by the American Cancer Society as cancer that is unlikely to be cured. We will recruit patient participants within 12 weeks after diagnosis so that we can understand opioid benefits, harms, and perspectives on opioid decision-making throughout the course of their advanced cancer (up to 2 years). We will also specifically elicit information regarding long-term opioid use (ie, opioids for ≥90 consecutive days) and exclude patients on long-term opioid therapy before an advanced cancer diagnosis. Lived-experience perspectives related to opioid use in those with advanced cancer will be captured by qualitative interviews with a subset of patients, clinicians, and care partners. Our data collection will be grounded in a behavioral decision research approach that will allow us to develop future interventions to inform opioid-related decision-making for patients with metastatic cancer. Results: Data collection began in October 2022 and is anticipated to end by November 2024. Conclusions: Upon successful execution of our study protocol, we anticipate the development of a comprehensive evidence base on opioid therapy in individuals with advanced cancer guided by the behavioral decision research framework. The information gained from this study will be used to guide interventions to facilitate opioid decisions among patients, clinicians, and care partners. Given the limited evidence base about opioid therapy in people with cancer, we envision this study will have significant real-world implications for cancer-related pain management and opioid-related clinical decision-making. International Registered Report Identifier (IRRID): DERR1-10.2196/54953 %M 38478905 %R 10.2196/54953 %U https://www.researchprotocols.org/2024/1/e54953 %U https://doi.org/10.2196/54953 %U http://www.ncbi.nlm.nih.gov/pubmed/38478905 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49759 %T Architecture and Development Framework for a Web-Based Risk Assessment and Management Platform Developed on WordPress to Address Opioid Overdose %A Kazemi,Alireza %A Boyd,Marisha %A Choi,Fiona %A Tai,Andy Man Yeung %A Tsang,Vivian WL %A To,Tam %A Kim,Jane %A Jang,Kerry %A Shams,Farhud %A Schreiter,Stefanie %A Cabanis,Maurice %A Krausz,Reinhard Michael %+ Institute of Mental Health, Department of Psychiatry, University of British Columbia, 4th Floor, Room 430, David Strangway Building, 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada, 1 236 888 8330, alireza.kazemi@ubc.ca %K software designs %K risks management %K risk assessments %K opioid overdose %K crisis intervention %K substance related disorders %D 2024 %7 11.3.2024 %9 Viewpoint %J JMIR Form Res %G English %X The number of overdose-related fatalities continues to reach historic levels across Canada, despite ongoing efforts by authorities. To reduce mortality, a clinical trajectory ranging from preventative measures to crisis intervention, skill training to treatment, and risk assessment to risk management needs to be supported. The web-based Risk Assessment and Management Platform (RAMP) was developed to realize this concept and to empower people who use drugs through an integrated tool that allows them to better understand and manage their risk of overdose. This paper outlines the architecture and development of RAMP, which is built on the WordPress platform. WordPress components are mapped onto a 3-tier architecture that consists of presentation, application, and database layers. The architecture facilitates the development of a modular software that includes several features that are independent in functionality but interact with each other in an integrated platform. The relatively low coupling and high coherence of the features may reduce the cost of maintenance and increase flexibility of future developments. RAMP’s architecture comprises a user interface, conceptual framework, and backend layers. The RAMP front end effectively uses some of the WordPress’ features such as HTML5, CSS, and JavaScript to create a mobile, friendly, and scalable user interface. The RAMP backend uses several standard and custom WordPress plug-ins to support risk assessment and monitoring, with the goal of mitigating the impacts and eliminating risks together. A rule-based decision support system has been hard-coded to suggest relevant modules and goals to complement each user’s lifestyle and goals based on their risk assessment. Finally, the backend uses the MySQL database management system and communicates with the RAMP framework layer via the data access layer to facilitate a timely and secure handling of information. Overall, RAMP is a modular system developed to identify and manage the risk of opioid overdose in the population of people who use drugs. Its modular design uses the WordPress architecture to efficiently communicate between layers and provide a base for external plug-ins. There is potential for the current system to adopt and address other related fields such as suicide, anxiety, and trauma. Broader implementation will support this concept and lead to the next level of functionality. %M 38466977 %R 10.2196/49759 %U https://formative.jmir.org/2024/1/e49759 %U https://doi.org/10.2196/49759 %U http://www.ncbi.nlm.nih.gov/pubmed/38466977 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52882 %T Decreasing Opioid Addiction and Diversion Using Behavioral Economics Applied Through a Digital Engagement Solution: Protocol for a Randomized Controlled Trial %A Rizvi,Rubina Fatima %A Schoephoerster,Jamee Ann %A Desphande,Sagar Satish %A Usher,Michael %A Oien,Andy Elaine %A Peters,Maya Marie %A Loth,Matthew Scott %A Bahr,Matthew William %A Ventz,Steffen %A Koopmeiners,Joseph Stephen %A Melton,Genevieve B %+ Division of Computational Health Sciences, Department of Surgery, University of Minnesota, 11-132 Phillips-Wangensteen Building, 516 Delaware Street Southeast, Minneapolis, MN, 55455, United States, 1 612 626 1999, gmelton@umn.edu %K opioid abuse %K opioid naïve patients %K opioid addiction %K behavioral economics %K nudges %K MyChart %K personal health record %K post-operative care %K opioid %K opioid use %K randomized controlled trial %K RCT %K behavioral economics %K digital engagement %K health crisis %K overdose %K acute pain %K pain %K tool %K tools %K phone app %K website %K application %D 2024 %7 8.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite strong and growing interest in ending the ongoing opioid health crisis, there has been limited success in reducing the prevalence of opioid addiction and the number of deaths associated with opioid overdoses. Further, 1 explanation for this is that existing interventions target those who are opiate-dependent but do not prevent opioid-naïve patients from becoming addicted. Objective: Leveraging behavioral economics at the patient level could help patients successfully use, discontinue, and dispose of their opioid medications in an acute pain setting. The primary goal of this project is to evaluate the effect of the 3 versions of the Opioid Management for You (OPY) tool on measures of opioid use relative to the standard of care by leveraging a pragmatic randomized controlled trial (RCT). Methods: A team of researchers from the Center for Learning Health System Sciences (CLHSS) at the University of Minnesota partnered with M Health Fairview to design, build, and test the 3 versions of the OPY tool: social influence, precommitment, and testimonial version. The tool is being built using the Epic Care Companion (Epic Inc) platform and interacts with the patient through their existing MyChart (Epic Systems Corporation) personal health record account, and Epic patient portal, accessed through a phone app or the MyChart website. We have demonstrated feasibility with pilot data of the social influence version of the OPY app by targeting our pilot to a specific cohort of patients undergoing upper-extremity procedures. This study will use a group sequential RCT design to test the impact of this important health system initiative. Patients who meet OPY inclusion criteria will be stratified into low, intermediate, and high risk of opiate use based on their type of surgery. Results: This study is being funded and supported by the CLHSS Rapid Prospective Evaluation and Digital Technology Innovation Programs, and M Health Fairview. Support and coordination provided by CLHSS include the structure of engagement, survey development, data collection, statistical analysis, and dissemination. The project was initially started in August 2022. The pilot was launched in February 2023 and is still running, with the data last counted in August 2023. The actual RCT is planned to start by early 2024. Conclusions: Through this RCT, we will test our hypothesis that patient opioid use and diverted prescription opioid availability can both be improved by information delivery applied through a behavioral economics lens via sending nudges directly to the opioid users through their personal health record. Trial Registration: ClinicalTrials.gov NCT06124079; https://clinicaltrials.gov/study/NCT06124079 International Registered Report Identifier (IRRID): PRR1-10.2196/52882 %M 38457203 %R 10.2196/52882 %U https://www.researchprotocols.org/2024/1/e52882 %U https://doi.org/10.2196/52882 %U http://www.ncbi.nlm.nih.gov/pubmed/38457203 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44726 %T Identification of Myths and Misinformation About Treatment for Opioid Use Disorder on Social Media: Infodemiology Study %A ElSherief,Mai %A Sumner,Steven %A Krishnasamy,Vikram %A Jones,Christopher %A Law,Royal %A Kacha-Ochana,Akadia %A Schieber,Lyna %A De Choudhury,Munmun %+ Khoury College of Computer Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, United States, 1 (617) 373 2462, m.elsherif@northeastern.edu %K addiction treatment %K machine learning %K misinformation %K natural language processing %K opioid use disorder %K social media %K substance use %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health misinformation and myths about treatment for opioid use disorder (OUD) are present on social media and contribute to challenges in preventing drug overdose deaths. However, no systematic, quantitative methodology exists to identify what types of misinformation are being shared and discussed. Objective: We developed a multistage analytic pipeline to assess social media posts from Twitter (subsequently rebranded as X), YouTube, Reddit, and Drugs-Forum for the presence of health misinformation about treatment for OUD. Methods: Our approach first used document embeddings to identify potential new statements of misinformation from known myths. These statements were grouped into themes using hierarchical agglomerative clustering, and public health experts then reviewed the results for misinformation. Results: We collected a total of 19,953,599 posts discussing opioid-related content across the aforementioned platforms. Our multistage analytic pipeline identified 7 main clusters or discussion themes. Among a high-yield data set of posts (n=303) for further public health expert review, these included discussion about potential treatments for OUD (90/303, 29.8%), the nature of addiction (68/303, 22.5%), pharmacologic properties of substances (52/303, 16.9%), injection drug use (36/303, 11.9%), pain and opioids (28/303, 9.3%), physical dependence of medications (22/303, 7.2%), and tramadol use (7/303, 2.3%). A public health expert review of the content within each cluster identified the presence of misinformation and myths beyond those used as seed myths to initialize the algorithm. Conclusions: Identifying and addressing misinformation through appropriate communication strategies could be an increasingly important component of preventing overdose deaths. To further this goal, we developed and tested an approach to aid in the identification of myths and misinformation about OUD from large-scale social media content. %M 38393772 %R 10.2196/44726 %U https://formative.jmir.org/2024/1/e44726 %U https://doi.org/10.2196/44726 %U http://www.ncbi.nlm.nih.gov/pubmed/38393772 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47130 %T Impact of the Narcotics Information Management System on Opioid Use Among Outpatients With Musculoskeletal and Connective Tissue Disorders: Quasi-Experimental Study Using Interrupted Time Series %A Lee,Iyn-Hyang %A Kim,So Young %A Park,Susin %A Ryu,Jae Gon %A Je,Nam Kyung %+ College of Pharmacy, Pusan National University, 2 Busandaehak-ro, 63 Beon-gil, Geumjeong-gu, Busan, 46241, Republic of Korea, 82 +82515102802, jenk@pusan.ac.kr %K addiction %K chronic noncancer pain %K monitoring %K mortality rate %K Narcotics Information Management System %K narcotics %K NIMS %K opioid misuse %K opioid prescription %K opioid %K overdose %K prevention %K terminal pain %K time series %K web-based system %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Opioids have traditionally been used to manage acute or terminal pain. However, their prolonged use has the potential for abuse, misuse, and addiction. South Korea introduced a new health care IT system named the Narcotics Information Management System (NIMS) with the objective of managing all aspects of opioid use, including manufacturing, distribution, sales, disposal, etc. Objective: This study aimed to assess the impact of NIMS on opioid use. Methods: We conducted an analysis using national claims data from 45,582 patients diagnosed with musculoskeletal and connective tissue disorders between 2016 and 2020. Our approach included using an interrupted time-series analysis and constructing segmented regression models. Within these models, we considered the primary intervention to be the implementation of NIMS, while we treated the COVID-19 outbreak as the secondary event. To comprehensively assess inappropriate opioid use, we examined 4 key indicators, as established in previous studies: (1) the proportion of patients on high-dose opioid treatment, (2) the proportion of patients receiving opioid prescriptions from multiple providers, (3) the overlap rate of opioid prescriptions per patient, and (4) the naloxone use rate among opioid users. Results: During the study period, there was a general trend of increasing opioid use. After the implementation of NIMS, significant increases were observed in the trend of the proportion of patients on high-dose opioid treatment (coefficient=0.0271; P=.01) and in the level of the proportion of patients receiving opioid prescriptions from multiple providers (coefficient=0.6252; P=.004). An abrupt decline was seen in the level of the naloxone use rate among opioid users (coefficient=–0.2968; P=.04). While these changes were statistically significant, their clinical significance appears to be minor. No significant changes were observed after both the implementation of NIMS and the COVID-19 outbreak. Conclusions: This study suggests that, in its current form, the NIMS may not have brought significant improvements to the identified indicators of opioid overuse and misuse. Additionally, the COVID-19 outbreak exhibited no significant influence on opioid use patterns. The absence of real-time monitoring feature within the NIMS could be a key contributing factor. Further exploration and enhancements are needed to maximize the NIMS’ impact on curbing inappropriate opioid use. %M 38381481 %R 10.2196/47130 %U https://publichealth.jmir.org/2024/1/e47130 %U https://doi.org/10.2196/47130 %U http://www.ncbi.nlm.nih.gov/pubmed/38381481 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50399 %T Feasibility, Acceptability, and Potential Efficacy of a Self-Guided Internet-Delivered Dialectical Behavior Therapy Intervention for Substance Use Disorders: Randomized Controlled Trial %A Daros,Alexander R %A Guimond,Timothy H %A Yager,Christina %A Palermo,Emma H %A Wilks,Chelsey R %A Quilty,Lena C %+ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J1H1, Canada, 1 5192533000 ext 2236, daros.alexander@gmail.com %K depression %K anxiety %K emotion dysregulation %K digital interventions %K dialectical behavior therapy %K substance use disorder %K alcohol use disorder %K randomized controlled trial %K eHealth %K mobile phone %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: People with alcohol and substance use disorders (SUDs) often have underlying difficulties in regulating emotions. Although dialectical behavioral therapy is effective for SUDs, it is often difficult to access. Self-guided, internet-delivered dialectical behavioral therapy (iDBT) allows for expanded availability, but few studies have rigorously evaluated it in individuals with SUDs. Objective: This study examines the feasibility, acceptability, and potential efficacy of an iDBT intervention in treatment-seeking adults with SUDs. We hypothesized that iDBT would be feasible, credible, acceptable, and engaging to people with SUDs. We also hypothesized that the immediate versus delayed iDBT group would show comparatively greater improvements and that both groups would show significant improvements over time. Methods: A 12-week, single-blinded, parallel-arm, randomized controlled trial was implemented, with assessments at baseline and at 4 (acute), 8, and 12 weeks (follow-up). A total of 72 community adults aged 18 to 64 years were randomized. The immediate group (n=38) received access to iDBT at baseline, and the delayed group (n=34) received access after 4 weeks. The intervention (Pocket Skills 2.0) was a self-guided iDBT via a website, with immediate access to all content, additional text and email reminders, and additional support meetings as requested. Our primary outcome was substance dependence, with secondary outcomes pertaining to feasibility, clinical outcomes, functional disability, and emotion dysregulation, among other measures. All outcomes were assessed using self-report questionnaires. Results: iDBT was perceived as a credible and acceptable treatment. In terms of feasibility, 94% (68/72) of the participants started iDBT, 13% (9/68) were early dropouts, 35% (24/68) used it for the recommended 8 days in the first month, and 50% (34/68) were still active 4 weeks later. On average, the participants used iDBT for 2 hours and 24 minutes across 10 separate days. In the acute period, no greater benefit was found for the immediate group on substance dependence, although we did find lower depression (b=−2.46; P=.02) and anxiety (b=−2.22; P=.02). At follow-up, there were greater benefits in terms of reduced alcohol (b=−2.00; P=.02) and nonalcoholic substance (b=−3.74; P=.01) consumption in the immediate access group. Both groups demonstrated improvements in substance dependence in the acute (b=−1.73; P<.001) and follow-up period (b=−2.09; P<.001). At follow-up, both groups reported reduced depression, anxiety, suicidal behaviors, emotional dysregulation, and functional disability. Conclusions: iDBT is a feasible and acceptable intervention for patients with SUDs, although methods for improving engagement are warranted. Although results did not support efficacy for the primary outcome at 4 weeks, findings support reductions in substance dependence and other mental health concerns at 12 weeks. Notwithstanding the limitations of this study, the results suggest the potential value of iDBT in the treatment of SUDs and other mental health conditions. Trial Registration: ClinicalTrials.gov NCT05094440; https://clinicaltrials.gov/show/NCT05094440 %M 38227362 %R 10.2196/50399 %U https://mental.jmir.org/2024/1/e50399 %U https://doi.org/10.2196/50399 %U http://www.ncbi.nlm.nih.gov/pubmed/38227362 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53366 %T Developing a Framework to Infer Opioid Use Disorder Severity From Clinical Notes to Inform Natural Language Processing Methods: Characterization Study %A Poulsen,Melissa N %A Freda,Philip J %A Troiani,Vanessa %A Mowery,Danielle L %+ Department of Population Health Sciences, Geisinger, 100 North Academy Avenue, Danville, PA, 17822, United States, 1 5702149322, mpoulsen@geisinger.edu %K annotation %K clinical notes %K natural language processing %K opioid related disorders %K opioid use disorder %K substance use disorders %K adult %K adults %K opioid %K annotation schema %K severity score %K substance misuse %K mental health %D 2024 %7 15.1.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Information regarding opioid use disorder (OUD) status and severity is important for patient care. Clinical notes provide valuable information for detecting and characterizing problematic opioid use, necessitating development of natural language processing (NLP) tools, which in turn requires reliably labeled OUD-relevant text and understanding of documentation patterns. Objective: To inform automated NLP methods, we aimed to develop and evaluate an annotation schema for characterizing OUD and its severity, and to document patterns of OUD-relevant information within clinical notes of heterogeneous patient cohorts. Methods: We developed an annotation schema to characterize OUD severity based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. In total, 2 annotators reviewed clinical notes from key encounters of 100 adult patients with varied evidence of OUD, including patients with and those without chronic pain, with and without medication treatment for OUD, and a control group. We completed annotations at the sentence level. We calculated severity scores based on annotation of note text with 18 classes aligned with criteria for OUD severity and determined positive predictive values for OUD severity. Results: The annotation schema contained 27 classes. We annotated 1436 sentences from 82 patients; notes of 18 patients (11 of whom were controls) contained no relevant information. Interannotator agreement was above 70% for 11 of 15 batches of reviewed notes. Severity scores for control group patients were all 0. Among noncontrol patients, the mean severity score was 5.1 (SD 3.2), indicating moderate OUD, and the positive predictive value for detecting moderate or severe OUD was 0.71. Progress notes and notes from emergency department and outpatient settings contained the most and greatest diversity of information. Substance misuse and psychiatric classes were most prevalent and highly correlated across note types with high co-occurrence across patients. Conclusions: Implementation of the annotation schema demonstrated strong potential for inferring OUD severity based on key information in a small set of clinical notes and highlighting where such information is documented. These advancements will facilitate NLP tool development to improve OUD prevention, diagnosis, and treatment. %M 38224481 %R 10.2196/53366 %U https://mental.jmir.org/2024/1/e53366 %U https://doi.org/10.2196/53366 %U http://www.ncbi.nlm.nih.gov/pubmed/38224481 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49173 %T Experiences and Outcomes of Using e-Prescribing for Opioids: Rapid Scoping Review %A Guilcher,Sara J T %A Cimino,Stephanie R %A Tadrous,Mina %A McCarthy,Lisa M %A Riad,Jessica %A Tricco,Andrea C %A Hagens,Simon %A Lien,Jennifer %A Tharmalingam,Sukirtha %A Gomes,Tara %+ Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S3M2, Canada, 1 4169467020, sara.guilcher@utoronto.ca %K e-prescribing %K opioid prescription %K opioid use %K rapid scoping review %D 2023 %7 28.12.2023 %9 Review %J J Med Internet Res %G English %X Background: e-Prescribing is designed to assist in facilitating safe and appropriate prescriptions for patients. Currently, it is unknown to what extent e-prescribing for opioids influences experiences and outcomes. To address this gap, a rapid scoping review was conducted. Objective: This rapid scoping review aims to (1) explore how e-prescribing has been used clinically; (2) examine the effects of e-prescribing on clinical outcomes, the patient or clinician experience, service delivery, and policy; and (3) identify current gaps in the present literature to inform future studies and recommendations. Methods: A rapid scoping review was conducted following the guidance of the JBI 2020 scoping review methodology and the World Health Organization guide to rapid reviews. A comprehensive literature search was completed by an expert librarian from inception until November 16, 2022. Three databases were electronically searched: MEDLINE (Ovid), Embase (Ovid), and Scopus (Elsevier). The search criteria were as follows: (1) e-prescribing programs targeted to the use or misuse of opioids, including those that were complemented or accompanied by clinically focused initiatives, and (2) a primary research study of experimental, quasi-experimental, observational, qualitative, or mixed methods design. An additional criterion of an ambulatory component of e-prescribing (eg, e-prescribing occurred upon discharge from acute care) was added at the full-text stage. No language limitations or filters were applied. All articles were double screened by trained reviewers. Gray literature was manually searched by a single reviewer. Data were synthesized using a descriptive approach. Results: Upon completing screening, 34 articles met the inclusion criteria: 32 (94%) peer-reviewed studies and 2 (6%) gray literature documents (1 thesis study and 1 report). All 33 studies had a quantitative component, with most highlighting e-prescribing from acute care settings to community settings (n=12, 36%). Only 1 (3%) of the 34 articles provided evidence on e-prescribing in a primary care setting. Minimal prescriber, pharmacist, and clinical population characteristics were reported. The main outcomes identified were related to opioid prescribing rates, alerts (eg, adverse drug events and drug-drug interactions), the quantity and duration of opioid prescriptions, the adoption of e-prescribing technology, attitudes toward e-prescribing, and potential challenges with the implementation of e-prescribing into clinical practice. e-Prescribing, including key features such as alerts and dose order sets, may reduce prescribing errors. Conclusions: This rapid scoping review highlights initial promising results with e-prescribing and opioid therapy management. It is important that future work explores the experience of prescribers, pharmacists, and patients using e-prescribing for opioid therapy management with an emphasis on prescribers in the community and primary care. Developing a common set of quality indicators for e-prescribing of opioids will help build a stronger evidence base. Understanding implementation considerations will be of importance as the technology is integrated into clinical practice and health systems. %M 38153776 %R 10.2196/49173 %U https://www.jmir.org/2023/1/e49173 %U https://doi.org/10.2196/49173 %U http://www.ncbi.nlm.nih.gov/pubmed/38153776 %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 %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45238 %T Adoption of Electronic Health Record Among Substance Use Disorder Treatment Programs: Nationwide Cross-Sectional Survey Study %A Frimpong,Jemima A %A Liu,Xun %A Liu,Lingrui %A Zhang,Ruoqiuyan %+ New York University Abu Dhabi, Social Science Division, Abu Dhabi, 00000, United Arab Emirates, 971 2 628 8732, jafrimpong@nyu.edu %K adoption of technology %K barriers to adoption %K electronic health record %K health information technology %K opioid treatment programs %K substance use disorder %D 2023 %7 14.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health record (EHR) systems have been shown to be associated with improvements in care processes, quality of care, and patient outcomes. EHR also has a crucial role in the delivery of substance use disorder (SUD) treatment and is considered important for addressing SUD crises, including the opioid epidemic. However, little is known about the adoption of EHR in SUD treatment programs or the organizational-level factors associated with the adoption of EHR in SUD treatment. Objective: We examined the adoption of EHR in SUD programs, with a focus on changes in adoption from 2014 to 2017, and identified organizational-level factors associated with EHR adoption. Methods: We used data from the 2014 and 2017 National Drug Abuse Treatment System Surveys. Our analysis included 1027 SUD programs (531 in 2014 and 496 in 2017). We used chi-square and Mann-Whitney U tests for categorical and continuous variables, respectively, to assess changes in EHR adoption, technology use, program, and client characteristics. We also investigated differences in characteristics and barriers to adoption by EHR adoption status (adopted EHR vs had not adopted or were planning to adopt EHR). We then conducted multivariate logistic regressions to examine internal and external factors associated with EHR adoption. Results: The adoption of EHR increased significantly from 57.6% (306/531) in 2014 to 69.2% (343/496) in 2017 (P<.001), showing that nearly one-third (153/496, 30.8%) of SUD programs had not yet adopted an EHR system by 2017. We identified a significant increase in technology use and ownership by a parent company (P=.01 and P<.001) and a decrease in the percentage of uninsured patients in 2017 (P<.001), compared to 2014. Our analysis further showed significant differences by adoption status for three major barriers to adoption: (1) start-up costs, (2) ongoing financial costs, and (3) privacy or security concerns (P<.001). Programs that used computerized scheduling (adjusted odds ratio [AOR] 3.02, 95% CI 2.23-4.09) and billing systems (AOR 2.29, 95% CI 1.62-3.25) were more likely to adopt EHR. Similarly, ownership type, such as private nonprofit (AOR 1.86, 95% CI 1.31-2.65) and public (AOR 2.14, 95% CI 1.27-3.67), or interest in participating in a patient-centered medical home (AOR 1.93, 95% CI 1.29-2.92), were associated with an increased likelihood to adopt EHR. Overall, SUD programs were more likely to adopt an EHR system in 2017 compared to 2014 (AOR 1.44, 95% CI 1.07-1.94). Conclusions: Our findings highlighted that SUD programs may be on track to achieve widespread EHR adoption. However, there is a need for focused strategies, resources, and policies explicitly designed to systematically address barriers and tackle obstacles to expanding the adoption of EHR systems. These efforts must be holistic and address factors at multiple organizational levels. %M 38096006 %R 10.2196/45238 %U https://www.jmir.org/2023/1/e45238 %U https://doi.org/10.2196/45238 %U http://www.ncbi.nlm.nih.gov/pubmed/38096006 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51812 %T Assessing the Impact of a Serious Game (MedSMARxT: Adventures in PharmaCity) in Improving Opioid Safety Awareness Among Adolescents and Parents: Quantitative Study %A Abraham,Olufunmilola %A McCarthy,Tyler James %A Zaborek,Jen %+ Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Room 2515 Rennebohm Hall, 777 Highland Avenue, Madison, WI, 53705, United States, 1 608 263 4498, olufunmilola.abraham@wisc.edu %K adolescent %K opioid %K medication safety %K serious games %K gamification %K health behavior %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The opioid crisis continues to worsen across the United States, affecting people of all demographics. Few evidence-based interventions exist for educating families, particularly those with adolescents, about opioid prescription safety. Serious games have demonstrated impacts in improving medication-related outcomes for various health conditions. The characterizing goal of this serious game is to improve opioid safety knowledge and awareness among adolescents and their families. Objective: This study evaluated the impact of a serious game, MedSMARxT: Adventures in PharmaCity, designed to foster opioid safety awareness among adolescents and their parents. Methods: A national sample of parents and their adolescent children was recruited through Qualtrics research panels, social media, listservs, and snowball sampling. Eligible participants were adolescents aged between 12 and 18 years and their parents. Study participants were required to reside in the United States; speak, read, and understand English; and have access to a computer with a webcam. Parent-child dyads completed pregame and postgame surveys and participated in gameplay for up to 30 minutes. Primary outcome scales have been previously evaluated by the study team. Results: A total of 60 adolescent participants and 68 parent participants met full attention criteria for inclusion in this study. Statistical analysis confirmed that both adolescents’ and parents’ concept scores improved from baseline regarding opioid safety self-efficacy (adolescent: mean 0.35, SD 0.60; P<.001; parent: mean 0.28, SD 0.42; P<.001), perceived knowledge (adolescent: mean 1.08, SD 1.04; P<.001; parent: mean 0.56, SD 0.55; P<.001), behavioral intent (adolescent: mean 0.26, SD 0.39; P<.001; parent: mean 0.25, SD 0.32; P<.001), safe storage (adolescent: mean 0.12, SD 0.27; P<.001; parent: mean 0.03, SD 0.11; P=.03), disposal knowledge (adolescent: mean 0.10, SD 0.27; P=.006; parent: mean 0.07, SD 0.16; P<.001), and knowledge about misuse behavior (adolescent: mean 0.05, SD 0.14; P=.002; parent: mean 0.04, SD 0.10; P<.001). Participant groups, stratified by who completed and who did not complete gameplay, improved their knowledge and awareness, with no significant differences between subgroups. Conclusions: The use of this serious game to improve opioid prescription safety practices among parents and adolescents was supported by the study findings. MedSMARxT: Adventures in PharmaCity is an intervention with the capability of teaching parents and adolescents about safe opioid prescription practices. Further studies and game refinement are needed to demonstrate the effectiveness of a game-based intervention in clinical settings and community pharmacies. %M 38060287 %R 10.2196/51812 %U https://formative.jmir.org/2023/1/e51812 %U https://doi.org/10.2196/51812 %U http://www.ncbi.nlm.nih.gov/pubmed/38060287 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45128 %T User-Guided Enhancements to a Technology-Facilitated Resilience Program to Address Opioid Risks Following Traumatic Injury in Youth: Qualitative Interview Study %A Adams,Zachary W %A Marriott,Brigid R %A Karra,Swathi %A Linhart-Musikant,Elizabeth %A Raymond,Jodi L %A Fischer,Lydia J %A Bixler,Kristina A %A Bell,Teresa M %A Bryan,Eric A %A Hulvershorn,Leslie A %+ Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN, 46202, United States, 1 3172780591, zwadams@iu.edu %K access-to-care %K addiction %K adolescent %K behavior %K health disorder %K opioid use disorder %K opioid %K personalized care %K telehealth %K telemedicine %K trauma %K user %K youth %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth with traumatic injury experience elevated risk for behavioral health disorders, yet posthospital monitoring of patients’ behavioral health is rare. The Telehealth Resilience and Recovery Program (TRRP), a technology-facilitated and stepped access-to-care program initiated in hospitals and designed to be integrated seamlessly into trauma center operations, is a program that can potentially address this treatment gap. However, the TRRP was originally developed to address this gap for mental health recovery but not substance use. Given the high rates of substance and opioid use disorders among youth with traumatic injury, there is a need to monitor substance use and related symptoms alongside other mental health concerns. Objective: This study aimed to use an iterative, user-guided approach to inform substance use adaptations to TRRP content and procedures. Methods: We conducted individual semistructured interviews with adolescents (aged 12-17 years) and young adults (aged 18-25 years) who were recently discharged from trauma centers (n=20) and health care providers from two level 1 trauma centers (n=15). Interviews inquired about reactions to and recommendations for expanding TRRP content, features, and functionality; factors related to TRRP implementation and acceptability; and current strategies for monitoring patients’ postinjury physical and emotional recovery and opioid and substance use. Interview responses were transcribed and analyzed using thematic analysis to guide new TRRP substance use content and procedures. Results: Themes identified in interviews included gaps in care, task automation, user personalization, privacy concerns, and in-person preferences. Based on these results, a multimedia, web-based mobile education app was developed that included 8 discrete interactive education modules and 6 videos on opioid use disorder, and TRRP procedures were adapted to target opioid and other substance use disorder risk. Substance use adaptations included the development of a set of SMS text messaging–delivered questions that monitor both mental health symptoms and substance use and related symptoms (eg, pain and sleep) and the identification of validated mental health and substance use screening tools to monitor patients’ behavioral health in the months after discharge. Conclusions: Patients and health care providers found the TRRP and its expansion to address substance use acceptable. This iterative, user-guided approach yielded novel content and procedures that will be evaluated in a future trial. %M 38032728 %R 10.2196/45128 %U https://formative.jmir.org/2023/1/e45128 %U https://doi.org/10.2196/45128 %U http://www.ncbi.nlm.nih.gov/pubmed/38032728 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45021 %T Internet-Based Inquiries From Users With the Intention to Overdose With Over-the-Counter Drugs: Qualitative Analysis of Yahoo! Chiebukuro %A Kariya,Azusa %A Okada,Hiroshi %A Suzuki,Shota %A Dote,Satoshi %A Nishikawa,Yoshitaka %A Araki,Kazuo %A Takahashi,Yoshimitsu %A Nakayama,Takeo %+ Department of Health Informatics, Graduate School of Medicine & School of Public Health, Kyoto University, Yoshidakonoecho, Sakyo-ku, Kyoto, 606-8501, Japan, 81 75 753 9477, kariya.azusa.57m@st.kyoto-u.ac.jp %K abuse %K consumer-generated media %K CGM %K overdose %K over-the-counter drug %K OTC drug %K question and answer site %K Q and A site %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Public concern with regard to over-the-counter (OTC) drug abuse is growing rapidly across countries. OTC drug abuse has serious effects on the mind and body, such as poisoning symptoms, and often requires specialized treatments. In contrast, there is concern about people who potentially abuse OTC drugs whose symptoms are not serious enough to consult medical institutions or drug addiction rehabilitation centers yet are at high risk of becoming drug dependent in the future. Objective: Consumer-generated media (CGM), which allows users to disseminate information, is being used by people who abuse (and those who are trying to abuse) OTC drugs to obtain information about OTC drug abuse. This study aims to analyze the content of CGM to explore the questions of people who potentially abuse OTC drugs. Methods: The subject of this research was Yahoo! Chiebukuro, the largest question and answer website in Japan. A search was performed using the names of drugs commonly used in OTC drug abuse and the keywords overdose and OD, and the number of questions posted on the content of OTC drug abuse was counted. Furthermore, a thematic analysis was conducted by extracting text data on the most abused antitussive and expectorant drug, BRON. Results: The number of questions about the content of overdose medications containing the keyword BRON has increased sharply as compared with other product names. Furthermore, 467 items of question data that met the eligibility criteria were obtained from 528 items of text data on BRON; 26 codes, 6 categories, and 3 themes were generated from the 578 questions contained in these items. Questions were asked about the effects they would gain from abusing OTC drugs and the information they needed to obtain the effects they sought, as well as about the effects of abuse on their bodies. Moreover, there were questions on how to stop abusing and what is needed when seeking help from a health care provider if they become dependent. It has become clear that people who abuse OTC drugs have difficulty in consulting face-to-face with others, and CGM is used as a means to obtain the necessary information anonymously. Conclusions: On CGM, people who abused or tried to abuse OTC drugs were asking questions about their abuse expectations and anxieties. In addition, when they became dependent, they sought advice to quit their abuse. CGM was used to exchange information about OTC drug abuse, and many questions on anxieties and hesitations were posted. This study suggests that it is necessary to produce and disseminate information on OTC drug abuse, considering the situation of those who abuse or are willing to abuse OTC drugs. Support from pharmacies and drugstores would also be essential to reduce opportunities for OTC drug abuse. %M 37991829 %R 10.2196/45021 %U https://formative.jmir.org/2023/1/e45021 %U https://doi.org/10.2196/45021 %U http://www.ncbi.nlm.nih.gov/pubmed/37991829 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e46912 %T A Video Game Intervention to Prevent Opioid Misuse Among Older Adolescents: Development and Preimplementation Study %A Aneni,Kammarauche %A Fernandes,Claudia-Santi F %A Hoerner,Lily A %A Szapary,Claire %A Pendergrass Boomer,Tyra M %A Fiellin,Lynn E %+ Department of Internal Medicine, Yale University School of Medicine, 2 Church Street South, Suite 515, New Haven, CT, 06519, United States, 1 203 785 2885, lynn.sullivan@yale.edu %K videogames %K serious games %K opioid misuse %K mental health %K adolescents %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Opioid misuse and mental disorders are highly comorbid conditions. The ongoing substance misuse and mental health crises among adolescents in the United States underscores the importance of widely scalable substance misuse preventive interventions that also address mental health risks. Serious video games offer an engaging, widely scalable method for delivering and implementing preventive interventions. However, there are no video game interventions that focus on preventing opioid misuse among older adolescents, and there are limited existing video game interventions that address mental health. Objective: This study aims to develop and conduct a formative evaluation of a video game intervention to prevent opioid misuse and promote mental health among adolescents aged 16-19 years (PlaySmart). We conducted formative work in preparation for a subsequent randomized controlled trial. Methods: We conducted development and formative evaluation of PlaySmart in 3 phases (development, playtesting, and preimplementation) through individual interviews and focus groups with multiple stakeholders (adolescents: n=103; school-based health care providers: n=51; and addiction treatment providers: n=6). PlaySmart content development was informed by the health belief model, the theory of planned behavior, and social cognitive theory. User-centered design principles informed the approach to development and play testing. The Exploration, Preparation, Implementation, and Sustainability framework informed preimplementation activities. Thematic analysis was used to identify themes from interviews and focus groups that informed PlaySmart game content and approaches to future implementation of PlaySmart. Results: We developed a novel video game PlaySmart for older adolescents that addresses the risk and protective factors for opioid misuse and mental health. Nine themes emerged from the focus groups that provided information regarding game content. Playtesting revealed areas of the game that required improvement, which were modified for the final game. Preimplementation focus groups identified potential barriers and facilitators for implementing PlaySmart in school settings. Conclusions: PlaySmart offers a promising digital intervention to address the current opioid and mental health crises among adolescents in a scalable manner. %M 37921851 %R 10.2196/46912 %U https://games.jmir.org/2023/1/e46912 %U https://doi.org/10.2196/46912 %U http://www.ncbi.nlm.nih.gov/pubmed/37921851 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50833 %T An eHealth Prevention Program for Substance Use, Sexual Assault, and Sexual Risk Behaviors for Adolescents in Primary Care: Pilot Feasibility Randomized Controlled Trial of Teen Well Check %A Gilmore,Amanda K %A Fortson,Kennicia %A Mullican,K Nicole %A García-Ramírez,Grisel %A Hutchins,Anna %A Bartlett,Alyssa M %A Gooding,Holly C %A Wallis,Elizabeth %A Levy,Sharon %A Ruggiero,Kenneth J %A Kaysen,Debra %A Danielson,Carla Kmett %A Platner,Robert %A Hartman,April %A Self-Brown,Shannon %+ Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302, United States, agilmore12@gsu.edu %K prevention %K adolescents %K eHealth %K drug use %K sexual assault %K sexual health %D 2023 %7 2.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use, sexual assault, and sexual risk behaviors are common among adolescents and are interrelated. Nearly 1 in 5 adolescents use substances before sexual encounters, placing these young people at risk for both sexual assault and sexual risk behaviors. Primary care visits present a unique opportunity to address multiple health risk behaviors. Objective: Teen Well Check is a web-based integrated prevention program for substance use, sexual assault, and sexual risk behaviors with demonstrated usability and acceptability among patients and providers. The aim of this study was to conduct a pilot randomized controlled trial to assess feasibility. Methods: Adolescents (n=123) aged 14 to 18 years from diverse backgrounds were recruited from primarily Medicaid-serving pediatric primary care clinics. Participants completed a baseline survey; were randomized to receive Teen Well Check or an assessment-only control; and completed 1-, 3-, and 6-month follow-up surveys. Feasibility was assessed in terms of recruitment and retention rates. Preliminary changes from baseline to follow-up periods were examined separately in the Teen Well Check and control conditions. Results: We recruited 123 participants (Teen Well Check: n=61, 49.6%; control: n=62, 50.4%). Of the 61 participants assigned to the Teen Well Check condition, 55 (90%) completed the full program and viewed all intervention content. Of the 123 participants, 105 (85.4%) were retained across at least 1 follow-up period, and there was no difference in follow-up rates between the conditions (χ21=0.6; P=.43). The completion of Teen Well Check took an average of 6.2 (SD 5.8) minutes. Preliminary analyses revealed that there were significant reductions in perceived peer norms (descriptive norms) for substance use before sex across follow-ups among participants in the Teen Well Check condition (P=.001 from baseline to 6 months), whereas there were significant increases among participants in the control condition (P=.003 from baseline to 6 months). In addition, there were nonsignificant reductions in substance misuse risk from baseline to the 6-month follow-up among participants in the Teen Well Check condition (P=.16). Conclusions: These findings support the feasibility of Teen Well Check delivery within pediatric primary care clinics. A randomized clinical trial is needed to assess efficacy. Trial Registration: ClinicalTrials.gov NCT3489434; https://www.clinicaltrials.gov/study/NCT03489434 %M 37917146 %R 10.2196/50833 %U https://formative.jmir.org/2023/1/e50833 %U https://doi.org/10.2196/50833 %U http://www.ncbi.nlm.nih.gov/pubmed/37917146 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50013 %T Understanding Public Perceptions and Discussions on Opioids Through Twitter: Cross-Sectional Infodemiology Study %A Carabot,Federico %A Fraile-Martínez,Oscar %A Donat-Vargas,Carolina %A Santoma,Javier %A Garcia-Montero,Cielo %A Pinto da Costa,Mariana %A Molina-Ruiz,Rosa M %A Ortega,Miguel A %A Alvarez-Mon,Melchor %A Alvarez-Mon,Miguel Angel %+ Department of Medicine and Medical Specialities, University of Alcala, Campus Universitario – C/ 19, Av de Madrid, Km 33,600, Alcala de Henares, 28871, Spain, 34 622816335, fcarabot@gmail.com %K awareness %K epidemic %K fentanyl %K health communication %K infodemiology %K machine learning %K opioids %K recreational use %K social media listening %K Twitter %K user %D 2023 %7 31.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Opioids are used for the treatment of refractory pain, but their inappropriate use has detrimental consequences for health. Understanding the current experiences and perceptions of patients in a spontaneous and colloquial environment regarding the key drugs involved in the opioid crisis is of utmost significance. Objective: The study aims to analyze Twitter content related to opioids, with objectives including characterizing users participating in these conversations, identifying prevalent topics and gauging public perception, assessing opinions on drug efficacy and tolerability, and detecting discussions related to drug dispensing, prescription, or acquisition. Methods: In this cross-sectional study, we gathered public tweets concerning major opioids posted in English or Spanish between January 1, 2019, and December 31, 2020. A total of 256,218 tweets were collected. Approximately 27% (69,222/256,218) were excluded. Subsequently, 7000 tweets were subjected to manual analysis based on a codebook developed by the researchers. The remaining databases underwent analysis using machine learning classifiers. In the codebook, the type of user was the initial classification domain. We differentiated between patients, family members and friends, health care professionals, and institutions. Next, a distinction was made between medical and nonmedical content. If it was medical in nature, we classified it according to whether it referred to the drug’s efficacy or adverse effects. In nonmedical content tweets, we analyzed whether the content referred to management issues (eg, pharmacy dispensation, medical appointment prescriptions, commercial advertisements, or legal aspects) or the trivialization of the drug. Results: Among the entire array of scrutinized pharmaceuticals, fentanyl emerged as the predominant subject, featuring in 27% (39,997/148,335 posts) of the tweets. Concerning user categorization, roughly 70% (101,259/148,335) were classified as patients. Nevertheless, tweets posted by health care professionals obtained the highest number of retweets (37/16,956, 0.2% of their posts received over 100 retweets). We found statistically significant differences in the distribution concerning efficacy and side effects among distinct drug categories (P<.001). Nearly 60% (84,401/148,335) of the posts were devoted to nonmedical subjects. Within this category, legal facets and recreational use surfaced as the most prevalent themes, while in the medical discourse, efficacy constituted the most frequent topic, with over 90% (45,621/48,777) of instances characterizing it as poor or null. The opioid with the greatest proportion of tweets concerning legal considerations was fentanyl. Furthermore, fentanyl was the drug most frequently offered for sale on Twitter, while methadone generated the most tweets about pharmacy delivery. Conclusions: The opioid crisis is present on social media, where tweets discuss legal and recreational use. Opioid users are the most active participants, prioritizing medication efficacy over side effects. Surprisingly, health care professionals generate the most engagement, indicating their positive reception. Authorities must monitor web-based opioid discussions to detect illicit acquisitions and recreational use. %M 37906234 %R 10.2196/50013 %U https://www.jmir.org/2023/1/e50013 %U https://doi.org/10.2196/50013 %U http://www.ncbi.nlm.nih.gov/pubmed/37906234 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 8 %N %P e51754 %T A Radar-Based Opioid Overdose Detection Device for Public Restrooms: Design, Development, and Evaluation Study %A Oreskovic,Jessica %A Kaufman,Jaycee %A Thommandram,Anirudh %A Fossat,Yan %+ Klick Labs, Klick Inc, 175 Bloor Street East, North Tower #300, 3rd Floor, Toronto, ON, M4W3R8, Canada, 1 416 214 4977, joreskovic@klick.com %K 60 GHz radar %K opioid overdose %K overdose detection %K overdose prevention %K respiratory depression %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: The opioid epidemic is a growing crisis worldwide. While many interventions have been put in place to try to protect people from opioid overdoses, they typically rely on the person to take initiative in protecting themselves, requiring forethought, preparation, and action. Respiratory depression or arrest is the mechanism by which opioid overdoses become fatal, but it can be reversed with the timely administration of naloxone. Objective: In this study, we described the development and validation of an opioid overdose detection radar (ODR), specifically designed for use in public restroom stalls. In-laboratory testing was conducted to validate the noncontact, privacy-preserving device against a respiration belt and to determine the accuracy and reliability of the device. Methods: We used an ODR system with a high-frequency pulsed coherent radar sensor and a Raspberry Pi (Raspberry Pi Ltd), combining advanced technology with a compact and cost-effective setup to monitor respiration and detect opioid overdoses. To determine the optimal position for the ODR within the confined space of a restroom stall, iterative testing was conducted, considering the radar’s bounded capture area and the limitations imposed by the stall’s dimensions and layout. By adjusting the orientation of the ODR, we were able to identify the most effective placement where the device reliably tracked respiration in a number of expected positions. Experiments used a mock restroom stall setup that adhered to building code regulations, creating a controlled environment while maintaining the authenticity of a public restroom stall. By simulating different body positions commonly associated with opioid overdoses, the ODR’s ability to accurately track respiration in various scenarios was assessed. To determine the accuracy of the ODR, testing was performed using a respiration belt as a reference. The radar measurements were compared with those obtained from the belt in experiments where participants were seated upright and slumped over. Results: The results demonstrated favorable agreement between the radar and belt measurements, with an overall mean error in respiration cycle duration of 0.0072 (SD 0.54) seconds for all recorded respiration cycles (N=204). During the simulated overdose experiments where participants were slumped over, the ODR successfully tracked respiration with a mean period difference of 0.0091 (SD 0.62) seconds compared with the reference data. Conclusions: The findings suggest that the ODR has the potential to detect significant deviations in respiration patterns that may indicate an opioid overdose event. The success of the ODR in these experiments indicates the device should be further developed and implemented to enhance safety and emergency response measures in public restrooms. However, additional validation is required for unhealthy opioid-influenced respiratory patterns to guarantee the ODR’s effectiveness in real-world overdose situations. %M 38875668 %R 10.2196/51754 %U https://biomedeng.jmir.org/2023/1/e51754 %U https://doi.org/10.2196/51754 %U http://www.ncbi.nlm.nih.gov/pubmed/38875668 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47186 %T Developing a Theoretically Informed Implementation Model for Telemedicine-Delivered Medication for Opioid Use Disorder: Qualitative Study With Key Informants %A Tay Wee Teck,Joseph %A Gittins,Rosalind %A Zlatkute,Giedre %A Oteo Pérez,Alberto %A Galea-Singer,Susanna %A Baldacchino,Alexander %+ Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, United Kingdom, 44 07983344674, jbtwt1@st-andrews.ac.uk %K telemedicine %K medication for opioid use disorder %K implementation model %K telebuprenorphine %K opioid use disorder %K mobile phone %D 2023 %7 18.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Telemedicine-delivered medication for opioid use disorder (TMOUD) has become more prevalent during the COVID-19 pandemic, particularly in North America. This is considered a positive development as TMOUD has the potential to increase access to evidence-based treatment for a population heavily affected by the opioid crisis and consequent rising mortality and morbidity rates in relation to opioid use disorder. Despite the increase in the use of TMOUD, there are no established service- and process-focused models to guide the implementation of this intervention. Objective: This study aims to develop a process- and service-focused implementation model in collaboration with key stakeholders and bring together peer-reviewed literature, practice-based knowledge, and expert opinions. Methods: The simple rules for evidence translation in complex systems framework was applied to guide the development of a 6-step qualitative study. The steps were definition of the scope and objectives of the model, identification of evidence, stakeholder engagement, draft model development, key informant consultation, and final model specification. Results: The final specification for the TMOUD implementation model incorporated key strategic priorities, service delivery prerequisites, service design elements, stakeholder identification and engagement, key process domains, and iterative cycles of evaluation and improvement. Conclusions: Through stakeholder engagement and key informant consultation, we produced a process- and service-focused TMOUD implementation model. The model is modifiable to different contexts and settings while also in keeping with the current evidence base and national and international standards of high-quality opioid use disorder care. %M 37851506 %R 10.2196/47186 %U https://mental.jmir.org/2023/1/e47186 %U https://doi.org/10.2196/47186 %U http://www.ncbi.nlm.nih.gov/pubmed/37851506 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 6 %N %P e50116 %T A Mobile App for Postoperative Pain Management Among Older Veterans Undergoing Total Knee Arthroplasty: Mixed Methods Feasibility and Acceptability Pilot Study %A Morgan,Jessica Kelley %A Rawlins,Caitlin R %A Walther,Steven K %A Harvey,Andrew %A O'Donnell,Annmarie %A Greene,Marla %A Schmidt,Troy G %+ Continuous Precision Medicine, 800 Park Offices Drive, Suite 3718, Research Triangle Park, NC, 27709-3547, United States, 1 9196185405, jmorgan@cpmed.io %K mobile app %K pain management %K opioids %K older adults %K veterans %K mobile phone %D 2023 %7 18.10.2023 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Prescription opioid misuse risk is disproportionate among veterans; military veterans wounded in combat misuse prescription opioids at an even higher rate (46.2%). Opioid misuse is costly in terms of morbidity, mortality, and humanitarian and economic burden and costs the Civilian Health and Medical Program of the Department of Veterans Affairs more than US $1.13 billion annually. Preventing opioid misuse at the time of prescription is a critical component in the response to the opioid crisis. The CPMRx mobile app has been shown to decrease the odds of opioid misuse during the postoperative period. Objective: The overarching purpose of this feasibility pilot study was to explore whether deploying a mobile app (CPMRx) to track postoperative pain and medication use is feasible in a Department of Veterans Affairs medical center. In support of this goal, we had four complementary specific aims: (1) determine the technological and logistical feasibility of the mobile app, (2) assess the acceptability of the mobile app to participants, (3) measure demand for and engagement with the mobile app, and (4) explore the potential use of the mobile app to patients and providers. Methods: Participants (N=10) were veterans undergoing total knee arthroplasty within the Veterans Health Administration provided with the CPMRx app to self-manage their pain during their 7-day at-home recovery following surgery. CPMRx uses scientifically validated tools to help clinicians understand how a patient can use the least amount of medication while getting the most benefit. The suite of software includes a mobile app for patients that includes a behavioral health intervention and a clinical decision support tool for health care providers that provides feedback about pain and medication use trends. Patients filled out paper questionnaires regarding acceptability at their postoperative follow-up appointment. Results: Overall, quantitative measures of acceptability were high. The average rating for the amount of time required to use the app was 4.9 of 5 (5=“very little”), and the average rating for ease of use was 4.4 of 5 (5=“very easy”). Open-ended questions also revealed that most participants found ease of use to be high. Demand and engagement were high as well with a mean number of mobile app entries of 34.1 (SD 20.1) during the postoperative period. There were no reported technological or logistical issues with the mobile app. Participants took an average of 25.13 (SD 14.37) opioid tablets to manage their postoperative pain. Conclusions: Results of this study revealed that the use of a mobile app for pain and medication management during postoperative recovery was both feasible and acceptable in older veterans undergoing total knee arthroplasty within the Veterans Health Administration. The wide variation in opioid consumption across participants revealed the potential use of the mobile app to provide actionable insights to clinicians if adopted more widely. %M 37851497 %R 10.2196/50116 %U https://periop.jmir.org/2023/1/e50116 %U https://doi.org/10.2196/50116 %U http://www.ncbi.nlm.nih.gov/pubmed/37851497 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51825 %T Determining the Impact of Opioid Policy on Substance Use and Mental Health–Related Harms: Protocol for a Data Linkage Study %A Xia,Ting %A Picco,Louisa %A Lalic,Samanta %A Buchbinder,Rachelle %A Bell,J Simon %A Andrew,Nadine E %A Lubman,Dan I %A Pearce,Christopher %A Nielsen,Suzanne %+ Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Australia, 61 0399030770, ting.xia@monash.edu %K data linkage %K drug policy %K general practice %K opioid %K primary care %D 2023 %7 17.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Increasing harms related to prescription opioids over the past decade have led to the introduction of a range of key national and state policy initiatives across Australia. These include introducing a mandatory real-time prescription drug–monitoring program in the state of Victoria from April 2020 and a series of changes to subsidies for opioids on the Pharmaceutical Benefit Scheme from June 2020. Together, these changes aim to influence opioid supply and reduce harms related to prescription opioids, yet few studies have specifically explored how these policies have influenced opioid prescribing and related harms in Australia. Objective: The aim of this study is to examine the impact of a range of opioid-related policies on hospital admissions and emergency department (ED) presentations in Victoria, Australia. In particular, the study aims to understand the effect of various opioid policies and opioid-prescribing changes on (1) the number and rates of ED presentations and hospital admissions attributed to substance use (ie, opioid and nonopioid related) or mental ill-health (eg, suicide, self-harm, anxiety, and depression), (2) the association between differing opioid dose trajectories and the likelihood of ED presentations and hospital admissions related to substance use and mental ill-health, and (3) whether changes in an individual’s opioid prescribing change the risk related to ED presentations and hospital admissions related to substance use and mental ill-health. Methods: We will conduct a population-level linked data study. General practice health records obtained from the Population Level Analysis and Reporting platform are linked with person-level data from 3 large hospital networks in Victoria, Australia. Interrupted time series analysis will be used to examine the impact of opioid policies on a range of harms, including the rates of presentations related to substance use (opioid and nonopioid) and mental ill-health among the primary care cohort. Group-based trajectory modeling and a case-crossover design will be used to further explore the impact of changes in opioid dosage and other covariates on opioid and nonopioid poisonings and mental ill-health–related presentations at the patient level. Results: Given that this paper serves as a protocol, there are currently no results available. The deidentified primary health data were sourced from electronic medical records of approximately 4,717,000 patients from 542 consenting general practices over a 6-year period (2017-2022). The submission of results for publication is planned for early 2024. Conclusions: This study will add to the limited evidence base to help understand the impact of opioid policies in Australia, including whether intended or unintended outcomes are occurring as a result. Trial Registration: EU PAS Register EUPAS104005; https://www.encepp.eu/encepp/viewResource.htm?id=104006 International Registered Report Identifier (IRRID): DERR1-10.2196/51825 %M 37847553 %R 10.2196/51825 %U https://www.researchprotocols.org/2023/1/e51825 %U https://doi.org/10.2196/51825 %U http://www.ncbi.nlm.nih.gov/pubmed/37847553 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46747 %T Initiation Patterns and Transitions Among Adults Using Stimulant Drugs: Latent Transition Analysis %A Black,Joshua C %A Burkett,Hannah L %A Rockhill,Karilynn M %A Olson,Richard %A Dart,Richard C %A Iwanicki,Janetta %+ Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, 777 Bannock St, Denver, CO, 80204-4531, United States, 1 3033891652, joshua.black@rmpds.org %K stimulant misuse %K high dimensional analysis %K latent transition analysis %K general population %K stimulant drug %K drug misuse %K overdose %K behavioral trajectory %K drug overdose %K stimulant initiation %K drugs %K substance abuse %K analysis %D 2023 %7 5.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The fourth wave of the drug overdose epidemic in the United States includes increasing rates of stimulant-involved overdose. Recent studies of transitions leading to stimulant misuse have shown complex patterns that are not universally applicable because they have isolated individual populations or individual behaviors. A comprehensive analysis of transitions between behaviors and the associations with present-day problematic drug use has not been conducted. Objective: This study aims to determine whether adults from the general population who use stimulants initiate use through a heterogeneous combination of behaviors and quantify the association between these typologies with present-day problematic drug use. Methods: Individuals who have reported use of any stimulant in their lifetime were recruited from the 2021 Survey of Nonmedical Use of Prescription Drugs Program, a nationally representative web-based survey on drug use, to participate in a rapid follow-up survey about their past stimulant use. Individuals were asked which stimulants they used, the reasons for use, the routes of administration, and the sources of the stimulant. For each stimulant-related behavior, they were asked at what age, between 6 and 30 years, they initiated each behavior in a 6-year time window. A latent transition analysis was used to characterize heterogeneity in initiation typologies. Mutually exclusive pathways of initiation were identified manually by the researchers. The association of these pathways with present-day problematic drug use was calculated using logistic regression adjusted by the current age of the respondent. Results: From a total of 1329 participants, 740 (55.7%) reported lifetime prescription stimulant use and 1077 (81%) reported lifetime illicit stimulant use. Three typologies were identified. The first typology was characterized by illicit stimulant initiation to get high, usually via oral or snorting routes and acquisition from friends or family or a dealer (illicit experimentation). The second typology was characterized by low, but approximately equal probabilities of initiating 1-2 new behaviors in a time window, but no singular set of behaviors characterized the typology (conservative initiation). The third was characterized by a high probability of initiating many diverse combinations of behaviors (nondiscriminatory experimentation). The choice of drug initiated was not a strong differentiator. Categorization of pathways showed those who were only in an illicit experimentation status (reference) had the lowest odds of having severe present-day problematic drug use. Odds were higher for a conservative initiation-only status (odds ratio [OR] 1.84, 95% CI 1.14-2.94), which is higher still for those moving from illicit experimentation to conservative initiation (OR 3.50, 95% CI 2.13-5.74), and highest for a nondiscriminatory experimentation status (OR 5.45, 95% CI 3.39-8.77). Conclusions: Initiation of stimulant-related use behaviors occurred across many time windows, indicating that multiple intervention opportunities are presented. Screening should be continued throughout adulthood to address unhealthy drug use before developing into full substance use disorders. %M 37796607 %R 10.2196/46747 %U https://www.jmir.org/2023/1/e46747 %U https://doi.org/10.2196/46747 %U http://www.ncbi.nlm.nih.gov/pubmed/37796607 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e48189 %T Corpus-Based Discourse Analysis of a Reddit Community of Users of Crystal Methamphetamine: Mixed Methods Study %A Lustig,Andrew %A Brookes,Gavin %+ Department of Linguistics and English Language, Lancaster University, County South, Bailrigg, Lancaster, LA1 4YL, United Kingdom, 44 1524 593045, g.brookes@lancaster.ac.uk %K methamphetamine %K social media %K substance-related disorders %K discourse analysis %K mental health %K mixed methods %K corpus analysis %K web-based health %D 2023 %7 29.9.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Methamphetamine is a highly addictive stimulant that affects the central nervous system. Crystal methamphetamine is a form of the drug resembling glass fragments or shiny bluish-white rocks that can be taken through smoking, swallowing, snorting, or injecting the powder once it has been dissolved in water or alcohol. Objective: The objective of this study is to examine how identities are socially (discursively) constructed by people who use methamphetamine within a subreddit for people who regularly use crystal meth. Methods: Using a mixed methods approach, we analyzed 1000 threads (318,422 words) from a subreddit for regular crystal meth users. The qualitative component of the analysis used concordancing and corpus-based discourse analysis to identify discursive themes informed by assemblage theory. The quantitative portion of the analysis used corpus linguistic techniques including keyword analysis to identify words occurring with statistically marked frequency in the corpus and collocation analysis to analyze their discursive context. Results: Our findings reveal that the subreddit contributors use a rich and varied lexicon to describe crystal meth and other substances, ranging from a neuroscientific register (eg, methamphetamine and dopamine) to informal vernacular (eg, meth, dope, and fent) and commercial appellations (eg, Adderall and Seroquel). They also use linguistic resources to construct symbolic boundaries between different types of methamphetamine users, differentiating between the esteemed category of “functional addicts” and relegating others to the stigmatized category of “tweakers.” In addition, contributors contest the dominant view that methamphetamine use inevitably leads to psychosis, arguing instead for a more nuanced understanding that considers the interplay of factors such as sleep deprivation, poor nutrition, and neglected hygiene. Conclusions: The subreddit contributors’ discourse offers a “set and setting” perspective, which provides a fresh viewpoint on drug-induced psychosis and can guide future harm reduction strategies and research. In contrast to this view, many previous studies overlook the real-world complexities of methamphetamine use, perhaps due to the use of controlled experimental settings. Actual drug use, intoxication, and addiction are complex, multifaceted, and elusive phenomena that defy straightforward characterization. %M 37773617 %R 10.2196/48189 %U https://infodemiology.jmir.org/2023/1/e48189 %U https://doi.org/10.2196/48189 %U http://www.ncbi.nlm.nih.gov/pubmed/37773617 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 15 %N %P e50936 %T Toxicology Test Results for Public Health Surveillance of the Opioid Epidemic: Retrospective Analysis %A Schleyer,Titus %A Robinson,Bill %A Parmar,Samir %A Janowiak,Diane %A Gibson,P Joseph %A Spangler,Val %+ Center for Biomedical Informatics, Regenstrief Institute, Inc, 1101 W 10th St, Indianapolis, IN, 46202, United States, 1 3172749204, schleyer@regenstrief.org %K opioid epidemic %K clinical laboratory techniques %K public health %K epidemiology %K toxicology %D 2023 %7 28.9.2023 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Addressing the opioid epidemic requires timely insights into population-level factors, such as trends in prevalence of legal and illegal substances, overdoses, and deaths. Objective: This study aimed to examine whether toxicology test results of living individuals from a variety of sources could be useful in surveilling the opioid epidemic. Methods: A retrospective analysis standardized, merged, and linked toxicology results from 24 laboratories in Marion County, Indiana, United States, from September 1, 2018, to August 31, 2019. The data set consisted of 33,787 Marion County residents and their 746,681 results. We related the data to general Marion County demographics and compared alerts generated by toxicology results to opioid overdose–related emergency department visits. Nineteen domain experts helped prototype analytical visualizations. Main outcome measures included test positivity in the county and by ZIP code; selected demographics of individuals with toxicology results; and correlation of toxicology results with opioid overdose–related emergency department visits. Results: Four percent of Marion County residents had at least 1 toxicology result. Test positivity rates ranged from 3% to 19% across ZIP codes. Males were underrepresented in the data set. Age distribution resembled that of Marion County. Alerts for opioid toxicology results were not correlated with opioid overdose–related emergency department visits. Conclusions: Analyzing toxicology results at scale was impeded by varying data formats, completeness, and representativeness; changes in data feeds; and patient matching difficulties. In this study, toxicology results did not predict spikes in opioid overdoses. Larger, more rigorous and well-controlled studies are needed to assess the utility of toxicology tests in predicting opioid overdose spikes. %M 38046561 %R 10.2196/50936 %U https://ojphi.jmir.org/2023/1/e50936 %U https://doi.org/10.2196/50936 %U http://www.ncbi.nlm.nih.gov/pubmed/38046561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46742 %T Differing Behaviors Around Adult Nonmedical Use of Prescription Stimulants and Opioids: Latent Class Analysis %A Rockhill,Karilynn M %A Olson,Richard %A Dart,Richard C %A Iwanicki,Janetta L %A Black,Joshua C %+ Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, 777 Bannock St, Denver, CO, 80204-4531, United States, 1 3033891652, joshua.black@rmpds.org %K stimulant misuse %K opioid misuse %K high-dimensional analysis %K latent class analysis %K general population %K drug overdose %K opioid %K drug use pattern %K nonmedical use of prescription stimulant %K substance abuse %K drugs %K adulthood %D 2023 %7 20.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The availability of central nervous system stimulants has risen in recent years, along with increased dispensing of stimulants for treatment of, for example, parent-reported attention-deficit/hyperactivity disorder in children and new diagnoses during adulthood. Typologies of drug use, as has been done with opioids, fail to include a sufficient range of behavioral factors to contextualize person-centric circumstances surrounding drug use. Understanding these patterns across drug classes would bring public health and regulatory practices toward precision public health. Objective: The objective of this study was to quantitatively delineate the unique behavioral profiles of adults who currently nonmedically use stimulants and opioids using a latent class analysis and to contrast the differences in findings by class. We further evaluated whether the subgroups identified were associated with an increased Drug Abuse Screening Test-10 (DAST-10) score, which is an indicator of average problematic drug use. Methods: This study used a national cross-sectional web-based survey, using 3 survey launches from 2019 to 2020 (before the COVID-19 pandemic). Data from adults who reported nonmedical use of prescription stimulants (n=2083) or prescription opioids (n=6127) in the last 12 months were analyzed. A weighted latent class analysis was used to identify the patterns of use. Drug types, motivations, and behaviors were factors in the model, which characterized unique classes of behavior. Results: Five stimulant nonmedical use classes were identified: amphetamine self-medication, network-sourced stimulant for alertness, nonamphetamine performance use, recreational use, and nondiscriminatory behaviors. The drug used nonmedically, acquisition through a friend or family member, and use to get high were strong differentiators among the stimulant classes. The latter 4 classes had significantly higher DAST-10 scores than amphetamine self-medication (P<.001). In addition, 4 opioid nonmedical use classes were identified: moderate pain with low mental health burden, high pain with higher mental health burden, risky behaviors with diverse motivations, and nondiscriminatory behaviors. There was a progressive and significant increase in DAST-10 scores across classes (P<.001). The potency of the opioid, pain history, the routes of administration, and psychoactive effect behaviors were strong differentiators among the opioid classes. Conclusions: A more precise understanding of how behaviors tend to co-occur would improve efficacy and efficiency in developing interventions and supporting the overall health of those who use drugs, and it would improve communication with, and connection to, those at risk for severe drug outcomes. %M 37728974 %R 10.2196/46742 %U https://www.jmir.org/2023/1/e46742 %U https://doi.org/10.2196/46742 %U http://www.ncbi.nlm.nih.gov/pubmed/37728974 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 15 %N %P e47395 %T Coproduction of Low-Barrier Hepatitis C Virus and HIV Care for People Who Use Drugs in a Rural Community: Brief Qualitative Report %A Bardach,Shoshana H %A Perry,Amanda N %A Eccles,Elizabeth %A Carpenter-Song,Elizabeth A %A Fowler,Ryan %A Miers,Erin M %A Ovalle,Anais %A de Gijsel,David %+ The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Williamson Translational Research Building, Room 563, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH, 03756, United States, 1 603 646 5608, shani.bardach@dartmouth.edu %K hepatitis C %K HIV %K coproducing care %K testing %K people who use drugs %K HCV %K rural community %D 2023 %7 20.9.2023 %9 Original Paper %J J Particip Med %G English %X Background: People who inject drugs are experiencing syndemic conditions with increasing risk of infection with hepatitis C (HCV) and HIV. However, rates of accessing HCV and HIV testing and treatment among people who inject drugs are low for various reasons, including the criminalization of drug use, which leads to a focus on treating drug use rather than caring for drug users. For many people who inject drugs, health care becomes a form of structural violence, resulting in traumatic experiences, fear of police violence, unmet needs, and avoidance of medical care. There is a clear need for novel approaches to health care delivery for people who inject drugs. Objective: This study aimed to analyze the process of a multidisciplinary team—encompassing health care professionals, community representatives, researchers, and people with lived experience using drugs—that was formed to develop a deep understanding of the experiences of people who inject drugs and local ecosystem opportunities and constraints to inform the cocreation of low-barrier, innovative HCV or HIV care in a rural community. Given the need for innovative approaches to redesigning health care, we sought to identify challenges and tensions encountered in this process and strategies for overcoming these challenges. Methods: Analysis was based on an in-depth review of meeting notes from the project year, followed by member-checking with the project team to revise and expand upon the challenges encountered and strategies identified to navigate these challenges. Results: Challenges and tensions included: scoping the project, setting the pace and urgency of the work, adapting to web-based work, navigating ethics and practice of payment, defining success, and situating the project for sustainability. Strategies to navigate these challenges included: dedicated effort to building personal and meaningful connections, fostering mutual respect, identifying common ground to make shared decisions, and redefining successes. Conclusions: While cocreated care presents challenges, the resulting program is strengthened by challenging assumptions and carefully considering various perspectives to think creatively and productively about solutions. %M 37728975 %R 10.2196/47395 %U https://jopm.jmir.org/2023/1/e47395 %U https://doi.org/10.2196/47395 %U http://www.ncbi.nlm.nih.gov/pubmed/37728975 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e49382 %T Parents’ Perceptions of a Serious Game for Educating Families on Prescription Opioid Safety: Qualitative Pilot Study of MedSMARxT: Adventures in PharmaCity %A Abraham,Olufunmilola %A Nixon,Grace Ann %A Seitz,Laura Louise %+ Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Room 2515 Rennebohm Hall, 777 Highland Avenue, Madison, WI, 53705, United States, 1 6082634498, olufunmilola.abraham@wisc.edu %K opioids %K opioid %K parents %K adolescents %K medication safety %K family health %K serious games %K parent %K adolescent %K youths %K gaming %K game %K games %K teenager %K teenagers %K acceptance %K perception %K perceptions %K patient education %K pharmacy %K pharmaceutic %K pharmaceutics %K pharmaceutical %K drug %K safety %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Opioid misuse is a pervasive, worsening problem that affects the health of people throughout the United States, including adolescents. There are few adolescent-focused interventions designed to educate them about opioid medication safety. The MedSMARxT: Adventures in PharmaCity, is a serious educational video game that teaches parents and their youths about safe opioid practices. Objective: This study aimed to elucidate parent’s perceptions of MedSMARxT: Adventures in PharmaCity and its potential use by parents and their adolescents. Methods: Parents of adolescents aged 12 to 18 years who live in the United States were recruited from April to October 2021 via Qualtrics research panels, social media, email listserves, and snowball sampling. The study participants played MedSMARxT: Adventures in PharmaCity for 30 minutes and then participated in a 30-minute postgame interview via WebEx (Cisco). Questions were developed and piloted to examine adults’ perceptions of the game. Participants were asked three sets of open-ended questions: (1) questions about the game and elements of the game, (2) what they learned from the game, and (3) questions about their experience with games. Audio recordings were transcribed verbatim. Interview transcripts were coded using content and thematic analysis by study team members to identify major themes and subthemes from the data. Results: Parent participants (N=67) played MedSMARxT: Adventures in PharmaCity and completed a postgame interview. Analysis extrapolated four primary themes from the data: (1) participant gaming experience, (2) perception of game features, (3) educational purpose of the game, and (4) future use of the game. Most participants (n=56, 84%), had at least some experience with video games. More than half of the participants (n=35, 52%) participants, had positive reactions to the game characters and scenes depicted in MedSMARxT: Adventures in PharmaCity and stated they were realistic for adolescents. Most participants (n=39, 58%), would recommend the game to others. Significant difficulties with gameplay navigation were reported by 38 (57%) participants, as well as a slow game pace. All participants were able to accurately identify the overarching goal of the game: opioid or medication safety. The game reinforced existing knowledge for participants, though many (n=15, 22%), reported a new awareness of the need to store opioid medications in a locked area and the availability of medication disposal drop boxes at pharmacies. Participants stated that they would recommend the game for future use by families and youths in various health care and non–health care settings. Conclusions: The use of a tailored serious game is a novel, engaging tool to educate adolescents on opioid safety. MedSMARxT: Adventures in PharmaCity can be used as a tool for parents and adolescents to facilitate meaningful dialogue about safe and appropriate opioid use. %M 37698899 %R 10.2196/49382 %U https://games.jmir.org/2023/1/e49382 %U https://doi.org/10.2196/49382 %U http://www.ncbi.nlm.nih.gov/pubmed/37698899 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42495 %T Trends in Opioid Medication Adherence During the COVID-19 Pandemic: Retrospective Cohort Study %A Marashi,Amir %A Warren,David %A Call,Gary %A Dras,Mark %+ School of Computing, Macquarie University, 4 Research Park Drive, Macquarie Park, 2109, Australia, 61 9850 9580, mark.dras@mq.edu.au %K COVID-19 %K opioid crisis %K opioids %K medication for opioid use disorder %K MOUD %K pandemic %K public health %K opioid %K medication %K treatment %K care %K patient %K opioid use disorder %K beta regression analysis %K breakpoint analysis %D 2023 %7 1.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The recent pandemic had the potential to worsen the opioid crisis through multiple effects on patients’ lives, such as the disruption of care. In particular, good levels of adherence with respect to medication for opioid use disorder (MOUD), recognized as being important for positive outcomes, may be disrupted. Objective: This study aimed to investigate whether patients on MOUD experienced a drop in medication adherence during the recent COVID-19 pandemic. Methods: This retrospective cohort study used Medicaid claims data from 6 US states from 2018 until the start of 2021. We compared medication adherence for people on MOUD before and after the beginning of the COVID-19 pandemic in March 2020. Our main measure was the proportion of days covered (PDC), a score that measures patients’ adherence to their MOUD. We carried out a breakpoint analysis on PDC, followed by a patient-level beta regression analysis with PDC as the dependent variable while controlling for a set of covariates. Results: A total of 79,991 PDC scores were calculated for 37,604 patients (age: mean 37.6, SD 9.8 years; sex: n=17,825, 47.4% female) between 2018 and 2021. The coefficient for the effect of COVID-19 on PDC score was –0.076 and was statistically significant (odds ratio 0.925, 95% CI 0.90-0.94). Conclusions: The COVID-19 pandemic was negatively associated with patients’ adherence to their medication, which had declined since the beginning of the pandemic. %M 37656492 %R 10.2196/42495 %U https://publichealth.jmir.org/2023/1/e42495 %U https://doi.org/10.2196/42495 %U http://www.ncbi.nlm.nih.gov/pubmed/37656492 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39236 %T Co-Constructing a Community-Based Telemedicine Program for People With Opioid Use Disorder During the COVID-19 Pandemic: Lessons Learned and Implications for Future Service Delivery %A Høj,Stine Bordier %A de Montigny,Catherine %A Chougar,Sofiane %A Léandre,Robert %A Beauchemin-Nadeau,Marie-Ève %A Boyer-Legault,Geneviève %A Goyette,Amélie %A Lamont,Sara-Kim %A Bruneau,Julie %+ Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Montreal, QC, H2X 0A9, Canada, 1 514 890 8000 ext 35713, julie.bruneau@umontreal.ca %K opioid agonist treatment %K opioid use disorder %K medications for opioid use disorder %K harm reduction %K access to care %K retention %K telemedicine %K telehealth %K community-based services %K opioid use %K remote care %K healthcare service %K health care service %K COVID-19 %K substance abuse %K opioid disorder %D 2023 %7 26.7.2023 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic triggered unprecedented expansion of telemedicine, including in the delivery of opioid agonist treatment (OAT) for people with opioid use disorder (OUD). However, many people with OUD lack the technological resources necessary for remote care, have complex needs, and are underserved, with precarious access to mainstream services. To address the needs of these individuals, we devised a unique program to deliver OAT via telemedicine with the support of community outreach workers in Montreal (Quebec, Canada). The program was co-constructed by the service de médecine des toxicomanies of the Centre hospitalier de l’Université de Montréal (CHUM-SMT)—a hospital-based addiction medicine service—and CACTUS Montréal—a community-based harm reduction organization known and trusted by its clientele. All procedures were jointly developed to enable flexible and rapid appointment scheduling. CACTUS Montréal workers promoted the program, facilitated private on-site telemedicine connections to the CHUM-SMT, accompanied patients during web-based appointments if requested, and provided ongoing holistic support and follow-up. The CHUM-SMT offered individualized OAT regimens and other health services as needed. Overall, our experience as clinicians and community-based workers intimately involved in establishing and running this initiative suggests that participants found it to be convenient, nonjudgmental, and responsive to their needs, and that the implication of CACTUS Montréal was highly valued and integral to patient engagement and retention. Beyond the context of the COVID-19 pandemic, similar programs may present a flexible and accessible means to deliver alternative treatment options for people with OUD disengaged from traditional care, bridge gaps between communities and health providers, and improve access to care in rural or remote settings. %M 37494097 %R 10.2196/39236 %U https://publichealth.jmir.org/2023/1/e39236 %U https://doi.org/10.2196/39236 %U http://www.ncbi.nlm.nih.gov/pubmed/37494097 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e46784 %T Cultivating Agents of Change in Medical Students: Addressing the Overdose Epidemic in the United States Through Enhancing Knowledge of Multimodal Pain Medicine and Increasing Accessibility via Open-Access, Web-Based Medical Education and Technology %A Miao,Julia H %+ Renaissance School of Medicine at Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, United States, 1 631 331 3338, jhm344@cornell.edu %K medical education %K overdose epidemic %K opioid epidemic %K pain medicine %K pain management %K opioid use disorder %K open-access %K telemedicine %K teletherapy %K technology %K public health %K opioid %K substance use %K substance abuse %K overdose %K SUD %K substance use disorder %K analgesic %K pain %K medication management %D 2023 %7 25.7.2023 %9 Viewpoint %J JMIR Med Educ %G English %X Medical students of today will soon be physician leaders and teachers of tomorrow about important relevant topics including the overdose epidemic and its devastating impact on our society. In the United States, the overdose crisis, including drug opioid–related overdoses, the increasing prevalence of opioid use disorder along with the increasing number of patients with chronic pain are intensifying and call attention for nationwide action. A strong medical educational foundation of the understanding of the relationship between pain and substance use disorder, their treatment including opioid analgesic therapy, multimodal and interdisciplinary care, and long-term management is needed to help cultivate comprehensive knowledge and training to prepare the next generation’s frontline practitioners to meet these needs. Yet, traditional educational curricula covering these topics are not standardized in medical schools across the nation in the United States. The advent of web-based medical education and the integration of this technology may offer potential solutions to these challenges. Often found equally effective as in-person learning, web-based medical education through open-access modules and other technologies can help increase accessibility, enhance knowledge of multimodal pain management, safe and effective use of opioid analgesics, and other related topics, and provide flexible and powerful teaching initiatives. Our viewpoint is thus that open-access modules and other technology-integrated teaching initiatives can help deliver excellence in pain education, preparing and empowering medical students—our future agents of change—who will be at the forefront of the overdose epidemic. %M 37490329 %R 10.2196/46784 %U https://mededu.jmir.org/2023/1/e46784 %U https://doi.org/10.2196/46784 %U http://www.ncbi.nlm.nih.gov/pubmed/37490329 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44165 %T An Automatically Adaptive Digital Health Intervention to Decrease Opioid-Related Risk While Conserving Counselor Time: Quantitative Analysis of Treatment Decisions Based on Artificial Intelligence and Patient-Reported Risk Measures %A Piette,John D %A Thomas,Laura %A Newman,Sean %A Marinec,Nicolle %A Krauss,Joel %A Chen,Jenny %A Wu,Zhenke %A Bohnert,Amy S B %+ Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, United States, 1 734 223 0127, jpiette@umich.edu %K artificial intelligence %K opioid safety %K telehealth %K reinforcement learning %K pain management %D 2023 %7 11.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Some patients prescribed opioid analgesic (OA) medications for pain experience serious side effects, including dependence, sedation, and overdose. As most patients are at low risk for OA-related harms, risk reduction interventions requiring multiple counseling sessions are impractical on a large scale. Objective: This study evaluates whether an intervention based on reinforcement learning (RL), a field of artificial intelligence, learned through experience to personalize interactions with patients with pain discharged from the emergency department (ED) and decreased self-reported OA misuse behaviors while conserving counselors’ time. Methods: We used data representing 2439 weekly interactions between a digital health intervention (“Prescription Opioid Wellness and Engagement Research in the ED” [PowerED]) and 228 patients with pain discharged from 2 EDs who reported recent opioid misuse. During each patient’s 12 weeks of intervention, PowerED used RL to select from 3 treatment options: a brief motivational message delivered via an interactive voice response (IVR) call, a longer motivational IVR call, or a live call from a counselor. The algorithm selected session types for each patient each week, with the goal of minimizing OA risk, defined in terms of a dynamic score reflecting patient reports during IVR monitoring calls. When a live counseling call was predicted to have a similar impact on future risk as an IVR message, the algorithm favored IVR to conserve counselor time. We used logit models to estimate changes in the relative frequency of each session type as PowerED gained experience. Poisson regression was used to examine the changes in self-reported OA risk scores over calendar time, controlling for the ordinal session number (1st to 12th). Results: Participants on average were 40 (SD 12.7) years of age; 66.7% (152/228) were women and 51.3% (117/228) were unemployed. Most participants (175/228, 76.8%) reported chronic pain, and 46.2% (104/225) had moderate to severe depressive symptoms. As PowerED gained experience through interactions over a period of 142 weeks, it delivered fewer live counseling sessions than brief IVR sessions (P=.006) and extended IVR sessions (P<.001). Live counseling sessions were selected 33.5% of the time in the first 5 weeks of interactions (95% CI 27.4%-39.7%) but only for 16.4% of sessions (95% CI 12.7%-20%) after 125 weeks. Controlling for each patient’s changes during the course of treatment, this adaptation of treatment-type allocation led to progressively greater improvements in self-reported OA risk scores (P<.001) over calendar time, as measured by the number of weeks since enrollment began. Improvement in risk behaviors over time was especially pronounced among patients with the highest risk at baseline (P=.02). Conclusions: The RL-supported program learned which treatment modalities worked best to improve self-reported OA risk behaviors while conserving counselors’ time. RL-supported interventions represent a scalable solution for patients with pain receiving OA prescriptions. Trial Registration: Clinicaltrials.gov NCT02990377; https://classic.clinicaltrials.gov/ct2/show/NCT02990377 %M 37432726 %R 10.2196/44165 %U https://www.jmir.org/2023/1/e44165 %U https://doi.org/10.2196/44165 %U http://www.ncbi.nlm.nih.gov/pubmed/37432726 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43776 %T Correlation Between Opioid Drug Prescription and Opioid-Related Mortality in Spain as a Surveillance Tool: Ecological Study %A Salazar,Alejandro %A Moreno-Pulido,Soledad %A Prego-Meleiro,Pablo %A Henares-Montiel,Jesús %A Pulido,José %A Donat,Marta %A Sotres-Fernandez,Gabriel %A Sordo,Luis %+ Department of Mathematics, University of Cádiz, Avenida de la Universidad de Cádiz, s/n, Puerto Real, 11510, Spain, 34 956483474, soledad.moreno@uca.es %K opioid %K overdose %K drug overdose %K opioid-related deaths %K mortality %K tramadol %K fentanyl %K substance use %K substance misuse %K substance abuse %K ecological study %K death %D 2023 %7 28.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Opioid drug prescription (ODP) and opioid-related mortality (ORM) have increased in Spain. However, their relationship is complex, as ORM is registered without considering the type of opioid (legal or illegal). Objective: This ecological study aimed to examine the correlation between ODP and ORM in Spain and discuss their usefulness as a surveillance tool. Methods: This was an ecological descriptive study using retrospective annual data (2000-2019) from the Spanish general population. Data were collected from people of all ages. Information on ODP was obtained from the Spanish Medicines Agency in daily doses per 1000 inhabitants per day (DHD) for total ODP, total ODP excluding those with better safety protocols (codeine and tramadol), and each opioid drug separately. Rates of ORM (per 1,000,000 inhabitants) were calculated based on deaths registered (International Classification of Diseases, 10th Revision codes) as opioid poisoning by the National Statistics Institute, derived from the drug data recorded by medical examiners in death certificates. Opioid-related deaths were considered to be those that indicated opioid consumption (accidental, infringed, or self-inflicted) as the main cause of death: death due to accidental poisoning (X40-X44), intentional self-inflicted poisoning (X60-X64), drug-induced aggression (X85), and poisoning of undetermined intention (Y10-Y14). A descriptive analysis was carried out, and correlations between the annual rates of ORM and DHD of the prescribed opioid drugs globally, excluding medications of the least potential risk of overdose and lowest treatment tier, were analyzed using Pearson linear correlation coefficient. Their temporal evolution was analyzed using cross-correlations with 24 lags and the cross-correlation function. The analyses were carried out using Stata and StatGraphics Centurion 19. Results: The rate of ORM (2000-2019) ranged between 14 and 23 deaths per 1,000,000 inhabitants, with a minimum in 2006 and an increasing trend starting in 2010. The ODP ranged between 1.51 to 19.94 DHD. The rates of ORM were directly correlated with the DHD of total ODP (r=0.597; P=.006), total ODP without codeine and tramadol (r=0.934; P<.001), and every prescribed opioid except buprenorphine (P=.47). In the time analysis, correlations between DHD and ORM were observed in the same year, although not statistically significant (all P≥.05). Conclusions: There is a correlation between greater availability of prescribed opioid drugs and an increase in opioid-related deaths. The correlation between ODP and ORM may be a useful tool in monitoring legal opiates and possible disturbances in the illegal market. The role of tramadol (an easily prescribed opioid) is important in this correlation, as is that of fentanyl (the strongest opioid). Measures stronger than recommendations need to be taken to reduce off-label prescribing. This study shows that not only is opioid use directly related to the prescribing of opioid drugs above what is desirable but also an increase in deaths. %M 37379061 %R 10.2196/43776 %U https://publichealth.jmir.org/2023/1/e43776 %U https://doi.org/10.2196/43776 %U http://www.ncbi.nlm.nih.gov/pubmed/37379061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45556 %T Patient Engagement in a Multimodal Digital Phenotyping Study of Opioid Use Disorder %A Campbell,Cynthia I %A Chen,Ching-Hua %A Adams,Sara R %A Asyyed,Asma %A Athale,Ninad R %A Does,Monique B %A Hassanpour,Saeed %A Hichborn,Emily %A Jackson-Morris,Melanie %A Jacobson,Nicholas C %A Jones,Heather K %A Kotz,David %A Lambert-Harris,Chantal A %A Li,Zhiguo %A McLeman,Bethany %A Mishra,Varun %A Stanger,Catherine %A Subramaniam,Geetha %A Wu,Weiyi %A Zegers,Christopher %A Marsch,Lisa A %+ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, United States, 1 5108913584, cynthia.i.campbell@kp.org %K opioid use disorder %K digital phenotyping %K medication for opioid use disorder %K MOUD %K ecological momentary assessment %K EMA %K passive sensing %K social media %K opioid %K OUD %K data collection %K smartphone %K digital health %D 2023 %7 13.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD. Objective: The aim is to examine patient engagement with multiple digital phenotyping methods among patients receiving buprenorphine medication for OUD. Methods: The study enrolled 65 patients receiving buprenorphine for OUD between June 2020 and January 2021 from 4 addiction medicine programs in an integrated health care delivery system in Northern California. Ecological momentary assessment (EMA), sensor data, and social media data were collected by smartphone, smartwatch, and social media platforms over a 12-week period. Primary engagement outcomes were meeting measures of minimum phone carry (≥8 hours per day) and watch wear (≥18 hours per day) criteria, EMA response rates, social media consent rate, and data sparsity. Descriptive analyses, bivariate, and trend tests were performed. Results: The participants’ average age was 37 years, 47% of them were female, and 71% of them were White. On average, participants met phone carrying criteria on 94% of study days, met watch wearing criteria on 74% of days, and wore the watch to sleep on 77% of days. The mean EMA response rate was 70%, declining from 83% to 56% from week 1 to week 12. Among participants with social media accounts, 88% of them consented to providing data; of them, 55% of Facebook, 54% of Instagram, and 57% of Twitter participants provided data. The amount of social media data available varied widely across participants. No differences by age, sex, race, or ethnicity were observed for any outcomes. Conclusions: To our knowledge, this is the first study to capture these 3 digital data sources in this clinical population. Our findings demonstrate that patients receiving buprenorphine treatment for OUD had generally high engagement with multiple digital phenotyping data sources, but this was more limited for the social media data. International Registered Report Identifier (IRRID): RR2-10.3389/fpsyt.2022.871916 %M 37310787 %R 10.2196/45556 %U https://www.jmir.org/2023/1/e45556 %U https://doi.org/10.2196/45556 %U http://www.ncbi.nlm.nih.gov/pubmed/37310787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45434 %T An Artificial Intelligence–Based Smartphone App for Assessing the Risk of Opioid Misuse in Working Populations Using Synthetic Data: Pilot Development Study %A Islam,A B M Rezbaul %A Khan,Khalid M %A Scarbrough,Amanda %A Zimpfer,Mariah Jade %A Makkena,Navya %A Omogunwa,Adebola %A Ahamed,Sheikh Iqbal %+ Department of Computer Science, Sam Houston State University, 1803 Avenue I AB1, Room 214, Huntsville, TX, 77341, United States, 1 936294 ext 4198, ari014@shsu.edu %K opioid overused disorder %K OUD %K mobile health %K mHealth %K artificial intelligence %K smartphone app %K opioids %K application %K caregivers %K mobile app %D 2023 %7 30.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Opioid use disorder (OUD) is an addiction crisis in the United States. As recent as 2019, more than 10 million people have misused or abused prescription opioids, making OUD one of the leading causes of accidental death in the United States. Workforces that are physically demanding and laborious in the transportation, construction and extraction, and health care industries are prime targets for OUD due to high-risk occupational activities. Because of this high prevalence of OUD among working populations in the United States, elevated workers’ compensation and health insurance costs, absenteeism, and declined productivity in workplaces have been reported. Objective: With the emergence of new smartphone technologies, health interventions can be widely used outside clinical settings via mobile health tools. The major objective of our pilot study was to develop a smartphone app that can track work-related risk factors leading to OUD with a specific focus on high-risk occupational groups. We used synthetic data analyzed by applying a machine learning algorithm to accomplish our objective. Methods: To make the OUD assessment process more convenient and to motivate potential patients with OUD, we developed a smartphone-based app through a step-by-step process. First, an extensive literature survey was conducted to list a set of critical risk assessment questions that can capture high-risk behaviors leading to OUD. Next, a review panel short-listed 15 questions after careful evaluation with specific emphasis on physically demanding workforces—9 questions had two, 5 questions had five, and 1 question had three response options. Instead of human participant data, synthetic data were used as user responses. Finally, an artificial intelligence algorithm, naive Bayes, was used to predict the OUD risk, trained with the synthetic data collected. Results: The smartphone app we have developed is functional as tested with synthetic data. Using the naive Bayes algorithm on collected synthetic data, we successfully predicted the risk of OUD. This would eventually create a platform to test the functionality of the app further using human participant data. Conclusions: The use of mobile health techniques, such as our mobile app, is highly promising in predicting and offering mitigation plans for disease detection and prevention. Using a naive Bayes algorithm model along with a representational state transfer (REST) application programming interface and cloud-based data encryption storage, respondents can guarantee their privacy and accuracy in estimating their risk. Our app offers a tailored mitigation strategy for specific workforces (eg, transportation and health care workers) that are most impacted by OUD. Despite the limitations of the study, we have developed a robust methodology and believe that our app has the potential to help reduce the opioid crisis. %M 37252763 %R 10.2196/45434 %U https://formative.jmir.org/2023/1/e45434 %U https://doi.org/10.2196/45434 %U http://www.ncbi.nlm.nih.gov/pubmed/37252763 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40897 %T Patient-Centered Outcomes Associated With a Novel Office-Based Opioid Treatment Program in a District Health Department: Mixed Methods Pilot Study %A Coles,Theresa %A Chen,Hillary %A Des Marais,Andrea %A Sachdeva,Nidhi %A Bush,Christopher %A Macon Harrison,Lisa %A Guthrie,Shauna %+ Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC, 27701, United States, 1 919 613 7994, theresa.coles@duke.edu %K integrated care %K mental health %K opioid treatment %K opioid use disorder %K opioid %K patient-centered outcomes %K public health %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Granville and Vance counties have some of the highest opioid-related death rates in North Carolina, and have significant unmet needs with regard to opioid treatment. Medication for opioid use disorder (MOUD) is the most effective evidence-based approach to address opioid use disorder. Despite demonstrated efficacy and substantial need, access to MOUD is still insufficient in many parts of the United States. In order to connect patients with needed MOUD services, the district health department, Granville Vance Public Health (GVPH), established an office-based opioid treatment (OBOT) program. Objective: In this formative pilot study, we sought to describe patients’ goals and outcomes in a program delivered at a rural local health department using an integrated care approach. Methods: We used a mixed methods concurrent nested research design. The primary method of investigation was one-on-one qualitative interviews with active OBOT patients (n=7) focused on patients’ goals and perceived impacts of the program. Trained interviewers followed a semistructured interview guide developed iteratively by the study team. The secondary method was a descriptive quantitative analysis (79 patients; 1478 visits over 2.5 years) of treatment retention and patient-reported outcomes (anxiety and depression). Results: Participants in the OBOT program were 39.6 years of age on average, and 25.3% (20/79) were uninsured. The average retention in the program was 18.4 months. The proportion of individuals in the program with moderate to severe depression (Patient Health Questionnaire-9 scores ≥10) decreased between program initiation (66%, 23/35) and at the most recent assessment (34%, 11/32). In qualitative interviews, participants credited the OBOT program for reducing or stopping the use of opioids and other substances (eg, marijuana, cocaine, and benzodiazepines). Many participants noted how the program helped them manage withdrawal symptoms and cravings, which helped them feel more in control of their use. Participants also attributed improvements in quality of life to the OBOT program, such as improved relationships with loved ones, improved mental and physical health, and improved financial stability. Conclusions: Initial data show promising patient outcomes for active GVPH OBOT participants, including reduction in opioid use and improvements in quality of life. As a pilot study, a limitation of this study is a lack of a comparison group. However, this formative project demonstrates promising patient-centered outcome improvements for GVPH OBOT participants. %M 37223963 %R 10.2196/40897 %U https://formative.jmir.org/2023/1/e40897 %U https://doi.org/10.2196/40897 %U http://www.ncbi.nlm.nih.gov/pubmed/37223963 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45246 %T Using Natural Language Processing to Predict Fatal Drug Overdose From Autopsy Narrative Text: Algorithm Development and Validation Study %A Tang,Leigh Anne %A Korona-Bailey,Jessica %A Zaras,Dimitrios %A Roberts,Allison %A Mukhopadhyay,Sutapa %A Espy,Stephen %A Walsh,Colin G %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1475, Nashville, TN, 37203, United States, 1 510 366 1022, leigh.a.tang@vanderbilt.edu %K fatal drug overdose %K natural language processing %K surveillance %K Tennessee %K State Unintentional Drug Overdose Reporting System %K SUDORS %D 2023 %7 19.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Fatal drug overdose surveillance informs prevention but is often delayed because of autopsy report processing and death certificate coding. Autopsy reports contain narrative text describing scene evidence and medical history (similar to preliminary death scene investigation reports) and may serve as early data sources for identifying fatal drug overdoses. To facilitate timely fatal overdose reporting, natural language processing was applied to narrative texts from autopsies. Objective: This study aimed to develop a natural language processing–based model that predicts the likelihood that an autopsy report narrative describes an accidental or undetermined fatal drug overdose. Methods: Autopsy reports of all manners of death (2019-2021) were obtained from the Tennessee Office of the State Chief Medical Examiner. The text was extracted from autopsy reports (PDFs) using optical character recognition. Three common narrative text sections were identified, concatenated, and preprocessed (bag-of-words) using term frequency–inverse document frequency scoring. Logistic regression, support vector machine (SVM), random forest, and gradient boosted tree classifiers were developed and validated. Models were trained and calibrated using autopsies from 2019 to 2020 and tested using those from 2021. Model discrimination was evaluated using the area under the receiver operating characteristic, precision, recall, F1-score, and F2-score (prioritizes recall over precision). Calibration was performed using logistic regression (Platt scaling) and evaluated using the Spiegelhalter z test. Shapley additive explanations values were generated for models compatible with this method. In a post hoc subgroup analysis of the random forest classifier, model discrimination was evaluated by forensic center, race, age, sex, and education level. Results: A total of 17,342 autopsies (n=5934, 34.22% cases) were used for model development and validation. The training set included 10,215 autopsies (n=3342, 32.72% cases), the calibration set included 538 autopsies (n=183, 34.01% cases), and the test set included 6589 autopsies (n=2409, 36.56% cases). The vocabulary set contained 4002 terms. All models showed excellent performance (area under the receiver operating characteristic ≥0.95, precision ≥0.94, recall ≥0.92, F1-score ≥0.94, and F2-score ≥0.92). The SVM and random forest classifiers achieved the highest F2-scores (0.948 and 0.947, respectively). The logistic regression and random forest were calibrated (P=.95 and P=.85, respectively), whereas the SVM and gradient boosted tree classifiers were miscalibrated (P=.03 and P<.001, respectively). “Fentanyl” and “accident” had the highest Shapley additive explanations values. Post hoc subgroup analyses revealed lower F2-scores for autopsies from forensic centers D and E. Lower F2-score were observed for the American Indian, Asian, ≤14 years, and ≥65 years subgroups, but larger sample sizes are needed to validate these findings. Conclusions: The random forest classifier may be suitable for identifying potential accidental and undetermined fatal overdose autopsies. Further validation studies should be conducted to ensure early detection of accidental and undetermined fatal drug overdoses across all subgroups. %M 37204824 %R 10.2196/45246 %U https://publichealth.jmir.org/2023/1/e45246 %U https://doi.org/10.2196/45246 %U http://www.ncbi.nlm.nih.gov/pubmed/37204824 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42417 %T Opioid Agonist Therapies and Pregnancy Outcomes for Pregnant People With Opioid Use Disorder: Protocol for a Systematic Review %A Wilson,Lindsay A %A Gandhi,Preet %+ Faculty of Medicine, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 822 2772, liwilson@student.ubc.ca %K opioid agonist therapies %K opioid use disorder %K pregnancy %K opioid %K drug %K symptoms %K treatment %K screening %K data %K risk %K clinical %K policy makers %K community %D 2023 %7 10.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Opioid use disorder (OUD) during pregnancy presents a significant risk to maternal, fetal, and neonatal health, increasing the likelihood of adverse events, such as maternal overdose, pregnancy loss, stillbirth, preterm birth, low birth weight, and neonatal abstinence syndrome. In order to reduce the risk of these outcomes, the standard of care for OUD during pregnancy in many jurisdictions within the United States and Canada is opioid agonist therapy (OAT). OAT refers to prescription medications that alleviate or eliminate opioid withdrawal symptoms, so that opioid use can be managed more safely. Although OAT has been recognized as a safe option for pregnant people with OUD, many jurisdictions do not have treatment guidelines regarding pharmacological options, dosing recommendations, side effect management, and individual preferences. There is currently a lack of systematic evidence on the impacts of different OAT regimens on pregnancy outcomes. Objective: We aim to evaluate the impacts of specific OAT agents on pregnancy outcomes and inform recommendations for practitioners treating pregnant people with OUD. Methods: The MEDLINE, Embase, CINAHL, and PsycINFO databases will be searched for published quantitative studies assessing pregnancy outcomes for individuals on OAT. Given the substantially increased risk of preterm birth, low birth weight, small for gestational age, and stillbirth among pregnant people with OUD, these four end points will comprise our primary outcomes. Database searches will not be restricted by date, and conference abstracts will be restricted to the past 2 years. Titles, abstracts, and full-text articles will be independently screened by 2 reviewers. Data will be extracted independently and in duplicate, using a data extraction form to reduce the risk of reviewer bias. The risk of bias within individual studies will be assessed by using the appropriate CASP (Critical Appraisal Skills Programme) checklists. For studies that consider the same research questions, interventions, or outcomes, meta-analyses will be conducted to synthesize the pooled effect size. In the event that studies cannot be compared directly, results will be synthesized in a narrative account. Between-study heterogeneity will be measured by using the τ2 statistic. If more than 10 studies are available for pooling, publication bias will be evaluated by using the Egger regression test. Results: As of January 2023, a total of 3266 abstracts have been identified for screening. Data extraction is expected to commence in February 2023. Conclusions: The topic of OAT and its effect on pregnancy is an understudied area that has the potential to improve health outcomes, clinical practice, education, and community advocacy. The results of our review will be used to inform clinical practice guidelines and improve health outcomes for pregnant people. Findings will be disseminated to diverse groups of stakeholders, including policy makers, clinicians, community partners, and individuals with lived experience of drug use. Trial Registration: PROSPERO CRD42022332082; https://tinyurl.com/2p94pkx5 International Registered Report Identifier (IRRID): DERR1-10.2196/42417 %M 37163329 %R 10.2196/42417 %U https://www.researchprotocols.org/2023/1/e42417 %U https://doi.org/10.2196/42417 %U http://www.ncbi.nlm.nih.gov/pubmed/37163329 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e44977 %T Deployment of Real-time Natural Language Processing and Deep Learning Clinical Decision Support in the Electronic Health Record: Pipeline Implementation for an Opioid Misuse Screener in Hospitalized Adults %A Afshar,Majid %A Adelaine,Sabrina %A Resnik,Felice %A Mundt,Marlon P %A Long,John %A Leaf,Margaret %A Ampian,Theodore %A Wills,Graham J %A Schnapp,Benjamin %A Chao,Michael %A Brown,Randy %A Joyce,Cara %A Sharma,Brihat %A Dligach,Dmitriy %A Burnside,Elizabeth S %A Mahoney,Jane %A Churpek,Matthew M %A Patterson,Brian W %A Liao,Frank %+ University of Wisconsin - Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, United States, 1 3125459462, majid.afshar@wisc.edu %K clinical decision support %K natural language processing %K medical informatics %K opioid related disorder %K opioid use %K electronic health record %K clinical note %K cloud service %K artificial intelligence %K AI %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: The clinical narrative in electronic health records (EHRs) carries valuable information for predictive analytics; however, its free-text form is difficult to mine and analyze for clinical decision support (CDS). Large-scale clinical natural language processing (NLP) pipelines have focused on data warehouse applications for retrospective research efforts. There remains a paucity of evidence for implementing NLP pipelines at the bedside for health care delivery. Objective: We aimed to detail a hospital-wide, operational pipeline to implement a real-time NLP-driven CDS tool and describe a protocol for an implementation framework with a user-centered design of the CDS tool. Methods: The pipeline integrated a previously trained open-source convolutional neural network model for screening opioid misuse that leveraged EHR notes mapped to standardized medical vocabularies in the Unified Medical Language System. A sample of 100 adult encounters were reviewed by a physician informaticist for silent testing of the deep learning algorithm before deployment. An end user interview survey was developed to examine the user acceptability of a best practice alert (BPA) to provide the screening results with recommendations. The planned implementation also included a human-centered design with user feedback on the BPA, an implementation framework with cost-effectiveness, and a noninferiority patient outcome analysis plan. Results: The pipeline was a reproducible workflow with a shared pseudocode for a cloud service to ingest, process, and store clinical notes as Health Level 7 messages from a major EHR vendor in an elastic cloud computing environment. Feature engineering of the notes used an open-source NLP engine, and the features were fed into the deep learning algorithm, with the results returned as a BPA in the EHR. On-site silent testing of the deep learning algorithm demonstrated a sensitivity of 93% (95% CI 66%-99%) and specificity of 92% (95% CI 84%-96%), similar to published validation studies. Before deployment, approvals were received across hospital committees for inpatient operations. Five interviews were conducted; they informed the development of an educational flyer and further modified the BPA to exclude certain patients and allow the refusal of recommendations. The longest delay in pipeline development was because of cybersecurity approvals, especially because of the exchange of protected health information between the Microsoft (Microsoft Corp) and Epic (Epic Systems Corp) cloud vendors. In silent testing, the resultant pipeline provided a BPA to the bedside within minutes of a provider entering a note in the EHR. Conclusions: The components of the real-time NLP pipeline were detailed with open-source tools and pseudocode for other health systems to benchmark. The deployment of medical artificial intelligence systems in routine clinical care presents an important yet unfulfilled opportunity, and our protocol aimed to close the gap in the implementation of artificial intelligence–driven CDS. Trial Registration: ClinicalTrials.gov NCT05745480; https://www.clinicaltrials.gov/ct2/show/NCT05745480 %M 37079367 %R 10.2196/44977 %U https://medinform.jmir.org/2023/1/e44977 %U https://doi.org/10.2196/44977 %U http://www.ncbi.nlm.nih.gov/pubmed/37079367 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40437 %T Patient Feedback on a Mobile Medication Adherence App for Buprenorphine and Naloxone: Closed and Open-Ended Survey on Feasibility and Acceptability %A Smith,Crystal L %A Keever,Abigail %A Bowden,Theresa %A Olson,Katie %A Rodin,Nicole %A McDonell,Michael G %A Roll,John M %A Smoody,Gillian %A LeBrun,Jeff %A Miguel,Andre QC %A McPherson,Sterling M %+ Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA, 99202-2131, United States, 1 509 368 6876, crystal.lederhos@wsu.edu %K opioids %K mobile technology %K medication adherence %K buprenorphine %K naloxone %K opioid use disorder %K opioid agonist therapy %K medication-assisted treatment %K medications for opioid use disorder %K opioid %K opioid use %K well-being %K quality of life %K clinic %K technology %K medication %K remote %K coaching %K tracking %K stress %K incentive %K tool %K mobile phone %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Opioid use disorders impact the health and well-being of millions of Americans. Buprenorphine and naloxone (BUP and NAL) can reduce opioid overdose deaths, decrease misuse, and improve quality of life. Unfortunately, poor medication adherence is a primary barrier to the long-term efficacy of BUP and NAL. Objective: We aimed to examine patient feedback on current and potential features of a Bluetooth-enabled pill bottle cap and associated mobile app for patients prescribed BUP and NAL for an opioid use disorder, and to solicit recommendations for improvement to effectively and appropriately tailor the technology for people in treatment for opioid use disorder. Methods: A convenience sample of patients at an opioid use disorder outpatient clinic were asked about medication adherence, opioid cravings, experience with technology, motivation for treatment, and their existent support system through a brief e-survey. Patients also provided detailed feedback on current features and features being considered for inclusion in a technology designed to increase medication adherence (eg, inclusion of a personal motivational factor, craving and stress tracking, incentives, and web-based coaching). Participants were asked to provide suggestions for improvement and considerations specifically applicable to people in treatment for opioid use disorder with BUP and NAL. Results: Twenty people with an opioid use disorder who were prescribed BUP and NAL participated (mean age 34, SD 8.67 years; 65% female; 80% White). Participants selected the most useful, second-most useful, and least useful features presented; 42.1% of them indicated that motivational reminders would be most useful, followed by craving and stress tracking (26.3%) and web-based support forums (21.1%). Every participant indicated that they had at least 1 strong motivating factor for staying in treatment, and half (n=10) indicated children as that factor. All participants indicated that they had, at some point in their lives, the most extreme craving a person could have; however, 42.1% indicated that they had no cravings in the last month. Most respondents (73.7%) stated that tracking cravings would be helpful. Most respondents (84.2%) also indicated that they believed reinforcers or prizes would help them achieve their treatment goals. Additionally, 94.7% of respondents approved of adherence tracking to accommodate this feature using smart packaging, and 78.9% of them approved of selfie videos of them taking their medication. Conclusions: Engaging patients taking treatment for opioid use disorder with BUP and NAL allowed us to identify preferences and considerations that are unique to this treatment area. As the technology developer of the pill cap and associated mobile app is able to take into consideration or integrate these preferences and suggestions, the smart cap and associated mobile app will become tailored to this population and more useful for them, which may encourage patient use of the smart cap and associated mobile app. %M 37074780 %R 10.2196/40437 %U https://formative.jmir.org/2023/1/e40437 %U https://doi.org/10.2196/40437 %U http://www.ncbi.nlm.nih.gov/pubmed/37074780 %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 %@ 2292-9495 %I JMIR Publications %V 10 %N %P e37351 %T Text Messages Exchanged Between Individuals With Opioid Use Disorder and Their mHealth e-Coaches: Content Analysis Study %A Ranjit,Yerina S %A Davis,Warren M %A Fentem,Andrea %A Riordan,Raven %A Roscoe,Rikki %A Cavazos-Rehg,Patricia %+ Department of Communication, University of Missouri, 207 Switzler Hall, Columbia, MO, 65211, United States, 1 573 882 4431, ranjity@missouri.edu %K opioid use disorder %K opioid %K opium %K overdose %K drug %K substance use %K content analysis %K text message intervention %K text message %K text messaging %K mobile health %K mHealth %K social support %K e-coach %K counseling %K mental health %K depression %K recovery support %K eHealth %K digital health %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Opioid use disorder (OUD) has affected 2.2 million people in the United States. About 7.2 million people reported using illicit drugs in 2019, which contributed to over 70,000 overdose deaths. SMS text messaging interventions have been shown to be effective in OUD recovery. However, the interpersonal communication between individuals in OUD treatment and a support team on digital platforms has not been well examined. Objective: This study aims to understand the communication between participants undergoing OUD recovery and their e-coaches by examining the SMS text messages exchanged from the lens of social support and the issues related to OUD treatment. Methods: A content analysis of messages exchanged between individuals recovering from OUD and members of a support team was conducted. Participants were enrolled in a mobile health intervention titled “uMAT-R,” a primary feature of which is the ability for patients to instantly connect with a recovery support staff or an “e-coach” via in-app messaging. Our team analyzed dyadic text-based messages of over 12 months. In total, 70 participants’ messages and 1196 unique messages were analyzed using a social support framework and OUD recovery topics. Results: Out of 70 participants, 44 (63%) were between the ages of 31 and 50 years, 47 (67%) were female, 41 (59%) were Caucasian, and 42 (60%) reported living in unstable housing conditions. An average of 17 (SD 16.05) messages were exchanged between each participant and their e-coach. Out of 1196 messages, 64% (n=766) messages were sent by e-coaches and 36% (n=430) by participants. Messages of emotional support occurred the most, with 196 occurrences (n=9, 0.8%) and e-coaches (n=187, 15.6%). Messages of material support had 110 occurrences (participants: n=8, 0.7%; e-coaches: n=102, 8.5%). With OUD recovery topics, opioid use risk factors appeared in most (n=72) occurrences (patient: n=66, 5.5%; e-coach: n=6, 0.5%), followed by a message of avoidance of drug use 3.9% (n=47), which occurred mainly from participants. Depression was correlated with messages of social support (r=0.27; P=.02). Conclusions: Individuals with OUD who had mobile health needs tended to engage in instant messaging with the recovery support staff. Participants who are engaged in messaging often engage in conversations around risk factors and avoidance of drug use. Instant messaging services can be instrumental in providing the social and educational support needs of individuals recovering from OUD. %M 36897632 %R 10.2196/37351 %U https://humanfactors.jmir.org/2023/1/e37351 %U https://doi.org/10.2196/37351 %U http://www.ncbi.nlm.nih.gov/pubmed/36897632 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40389 %T Overdose Alert and Response Technologies: State-of-the-art Review %A Oteo,Alberto %A Daneshvar,Hadi %A Baldacchino,Alexander %A Matheson,Catriona %+ Salvation Army Centre for Addiction Services, Faculty of Social Sciences, University of Stirling, R G Bomont Building, Stirling, FK9 4LA, United Kingdom, 44 1786473171, hadi.daneshvar@stir.ac.uk %K drug overdose %K technology %K opioids %K telemedicine %K mobile health %K mHealth %K apnea %K sensor %K naloxone %K mobile phone %D 2023 %7 15.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Drug overdose deaths, particularly from opioids, are a major global burden, with 128,000 deaths estimated in 2019. Opioid overdoses can be reversed through the timely administration of naloxone but only if responders are able to administer it. There is an emerging body of research and development in technologies that can detect the early signs of an overdose and facilitate timely responses. Objective: Our aim was to identify and classify overdose-specific digital technologies being developed, implemented, and evaluated. Methods: We conducted a “state-of-the-art review.” A systematic search was conducted in MEDLINE, Embase, Web of Science, Scopus, ACM, IEEE Xplore, and SciELO. We also searched references from articles and scanned the gray literature. The search included terms related to telehealth and digital technologies, drugs, and overdose and papers published since 2010. We classified our findings by type of technology and its function, year of publication, country of study, study design, and theme. We performed a thematic analysis to classify the papers according to the main subject. Results: Included in the selection were 17 original research papers, 2 proof-of-concept studies, 4 reviews, 3 US government grant registries, and 6 commercial devices that had not been named in peer-reviewed literature. All articles were published between 2017 and 2022, with a marked increase since 2019. All were based in or referred to the United States or Canada and concerned opioid overdose. In total, 39% (9/23) of the papers either evaluated or described devices designed to monitor vital signs and prompt an alert once a certain threshold indicating a potential overdose has been reached. A total of 43% (10/23) of the papers focused on technologies to alert potential responders to overdoses and facilitate response. In total, 48% (11/23) of the papers and 67% (4/6) of the commercial devices described combined alert and response devices. Sensors monitor a range of vital signs, such as oxygen saturation level, respiratory rate, or movement. Response devices are mostly smartphone apps enabling responders to arrive earlier to an overdose site. Closed-loop devices that can detect an overdose through a sensor and automatically administer naloxone without any external intervention are still in the experimental or proof-of-concept phase. The studies were grouped into 4 themes: acceptability (7/23, 30%), efficacy or effectiveness (5/23, 22%), device use and decision-making (3/23, 13%), and description of devices (6/23, 26%). Conclusions: There has been increasing interest in the research and application of these technologies in recent years. Literature suggests willingness to use these devices by people who use drugs and affected communities. More real-life studies are needed to test the effectiveness of these technologies to adapt them to the different settings and populations that might benefit from them. %M 36790860 %R 10.2196/40389 %U https://www.jmir.org/2023/1/e40389 %U https://doi.org/10.2196/40389 %U http://www.ncbi.nlm.nih.gov/pubmed/36790860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42162 %T Estimating County-Level Overdose Rates Using Opioid-Related Twitter Data: Interdisciplinary Infodemiology Study %A Cuomo,Raphael %A Purushothaman,Vidya %A Calac,Alec J %A McMann,Tiana %A Li,Zhuoran %A Mackey,Tim %+ School of Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 3104352218, racuomo@ucsd.edu %K overdose %K mortality %K geospatial analysis %K social media %K drug overuse %K substance use %K social media data %K mortality estimates %K real-time data %K public health data %K demographic variables %K county-level %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There were an estimated 100,306 drug overdose deaths between April 2020 and April 2021, a three-quarter increase from the prior 12-month period. There is an approximate 6-month reporting lag for provisional counts of drug overdose deaths from the National Vital Statistics System, and the highest level of geospatial resolution is at the state level. By contrast, public social media data are available close to real-time and are often accessible with precise coordinates. Objective: The purpose of this study is to assess whether county-level overdose mortality burden could be estimated using opioid-related Twitter data. Methods: International Classification of Diseases (ICD) codes for poisoning or exposure to overdose at the county level were obtained from CDC WONDER. Demographics were collected from the American Community Survey. The Twitter Application Programming Interface was used to obtain tweets that contained any of the 36 terms with drug names. An unsupervised classification approach was used for clustering tweets. Population-normalized variables and polynomial population-normalized variables were produced. Furthermore, z scores of the Getis Ord Gi clustering statistic were produced, and both these scores and their polynomial counterparts were explored in regression modeling of county-level overdose mortality burden. A series of linear regression models were used for predictive modeling to explore the interpretability of the analytical output. Results: Modeling overdose mortality with normalized demographic variables alone explained only 7.4% of the variability in county-level overdose mortality, whereas this was approximately doubled by the use of specific demographic and Twitter data covariates based on a backward selection approach. The highest adjusted R2 and lowest AIC (Akaike Info Criterion) were obtained for the model with normalized demographic variables, normalized z scores from geospatial analyses, and normalized topic counts (adjusted R2=0.133, AIC=8546.8). The z scores of the Getis Ord Gi statistic appeared to have improved utility over population-normalization alone. In this model, median age, female population, and tweets about web-based drug sales were positively associated with opioid mortality. Asian race and Hispanic ethnicity were significantly negatively associated with county-level burdens of overdose mortality. Conclusions: Social media data, when transformed using certain statistical approaches, may add utility to the goal of producing closer to real-time county-level estimates of overdose mortality. Prediction of opioid-related outcomes can be advanced to inform prevention and treatment decisions. This interdisciplinary approach can facilitate evidence-based funding decisions for various substance use disorder prevention and treatment programs. %M 36548118 %R 10.2196/42162 %U https://formative.jmir.org/2023/1/e42162 %U https://doi.org/10.2196/42162 %U http://www.ncbi.nlm.nih.gov/pubmed/36548118 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e37207 %T Predicting Patient Satisfaction With Medications for Treating Opioid Use Disorder: Case Study Applying Natural Language Processing to Reviews of Methadone and Buprenorphine/Naloxone on Health-Related Social Media %A Omranian,Samaneh %A Zolnoori,Maryam %A Huang,Ming %A Campos-Castillo,Celeste %A McRoy,Susan %+ Department of Electrical Engineering and Computer Science, College of Engineering & Applied Science, University of Wisconsin-Milwaukee, 3200 N Cramer St, Milwaukee, WI, 53211, United States, 1 414 229 4000, omranian@uwm.edu %K machine learning %K online forums %K text classification %K topic modeling %K MetaMap %K drug review %K opioid treatment, opioid use disorder %K patient-generated text %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Medication-assisted treatment (MAT) is an effective method for treating opioid use disorder (OUD), which combines behavioral therapies with one of three Food and Drug Administration–approved medications: methadone, buprenorphine, and naloxone. While MAT has been shown to be effective initially, there is a need for more information from the patient perspective about the satisfaction with medications. Existing research focuses on patient satisfaction with the entirety of the treatment, making it difficult to determine the unique role of medication and overlooking the views of those who may lack access to treatment due to being uninsured or concerns over stigma. Studies focusing on patients’ perspectives are also limited by the lack of scales that can efficiently collect self-reports across domains of concerns. Objective: A broad survey of patients’ viewpoints can be obtained through social media and drug review forums, which are then assessed using automated methods to discover factors associated with medication satisfaction. Because the text is unstructured, it may contain a mix of formal and informal language. The primary aim of this study was to use natural language processing methods on text posted on health-related social media to detect patients’ satisfaction with two well-studied OUD medications: methadone and buprenorphine/naloxone. Methods: We collected 4353 patient reviews of methadone and buprenorphine/naloxone from 2008 to 2021 posted on WebMD and Drugs.com. To build our predictive models for detecting patient satisfaction, we first employed different analyses to build four input feature sets using the vectorized text, topic models, duration of treatment, and biomedical concepts by applying MetaMap. We then developed six prediction models: logistic regression, Elastic Net, least absolute shrinkage and selection operator, random forest classifier, Ridge classifier, and extreme gradient boosting to predict patients’ satisfaction. Lastly, we compared the prediction models’ performance over different feature sets. Results: Topics discovered included oral sensation, side effects, insurance, and doctor visits. Biomedical concepts included symptoms, drugs, and illnesses. The F-score of the predictive models across all methods ranged from 89.9% to 90.8%. The Ridge classifier model, a regression-based method, outperformed the other models. Conclusions: Assessment of patients’ satisfaction with opioid dependency treatment medication can be predicted using automated text analysis. Adding biomedical concepts such as symptoms, drug name, and illness, along with the duration of treatment and topic models, had the most benefits for improving the prediction performance of the Elastic Net model compared to other models. Some of the factors associated with patient satisfaction overlap with domains covered in medication satisfaction scales (eg, side effects) and qualitative patient reports (eg, doctors’ visits), while others (insurance) are overlooked, thereby underscoring the value added from processing text on online health forums to better understand patient adherence. %M 37113381 %R 10.2196/37207 %U https://infodemiology.jmir.org/2023/1/e37207 %U https://doi.org/10.2196/37207 %U http://www.ncbi.nlm.nih.gov/pubmed/37113381 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e24938 %T Drug Abuse Ontology to Harness Web-Based Data for Substance Use Epidemiology Research: Ontology Development Study %A Lokala,Usha %A Lamy,Francois %A Daniulaityte,Raminta %A Gaur,Manas %A Gyrard,Amelie %A Thirunarayan,Krishnaprasad %A Kursuncu,Ugur %A Sheth,Amit %+ AI Institute, University of South Carolina, 1112 Greene St, Columbia, SC, 29208, United States, 1 803 777 9707, nlokala@email.sc.edu %K ontology %K knowledge graph %K semantic web %K illicit drugs %K cryptomarket %K social media %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Web-based resources and social media platforms play an increasingly important role in health-related knowledge and experience sharing. There is a growing interest in the use of these novel data sources for epidemiological surveillance of substance use behaviors and trends. Objective: The key aims were to describe the development and application of the drug abuse ontology (DAO) as a framework for analyzing web-based and social media data to inform public health and substance use research in the following areas: determining user knowledge, attitudes, and behaviors related to nonmedical use of buprenorphine and illicitly manufactured opioids through the analysis of web forum data Prescription Drug Abuse Online Surveillance; analyzing patterns and trends of cannabis product use in the context of evolving cannabis legalization policies in the United States through analysis of Twitter and web forum data (eDrugTrends); assessing trends in the availability of novel synthetic opioids through the analysis of cryptomarket data (eDarkTrends); and analyzing COVID-19 pandemic trends in social media data related to 13 states in the United States as per Mental Health America reports. Methods: The domain and scope of the DAO were defined using competency questions from popular ontology methodology (101 ontology development). The 101 method includes determining the domain and scope of ontology, reusing existing knowledge, enumerating important terms in ontology, defining the classes, their properties and creating instances of the classes. The quality of the ontology was evaluated using a set of tools and best practices recognized by the semantic web community and the artificial intelligence community that engage in natural language processing. Results: The current version of the DAO comprises 315 classes, 31 relationships, and 814 instances among the classes. The ontology is flexible and can easily accommodate new concepts. The integration of the ontology with machine learning algorithms dramatically decreased the false alarm rate by adding external knowledge to the machine learning process. The ontology is recurrently updated to capture evolving concepts in different contexts and applied to analyze data related to social media and dark web marketplaces. Conclusions: The DAO provides a powerful framework and a useful resource that can be expanded and adapted to a wide range of substance use and mental health domains to help advance big data analytics of web-based data for substance use epidemiology research. %M 36563032 %R 10.2196/24938 %U https://publichealth.jmir.org/2022/12/e24938 %U https://doi.org/10.2196/24938 %U http://www.ncbi.nlm.nih.gov/pubmed/36563032 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e38158 %T Machine Learning Techniques to Explore Clinical Presentations of COVID-19 Severity and to Test the Association With Unhealthy Opioid Use: Retrospective Cross-sectional Cohort Study %A Thompson,Hale M %A Sharma,Brihat %A Smith,Dale L %A Bhalla,Sameer %A Erondu,Ihuoma %A Hazra,Aniruddha %A Ilyas,Yousaf %A Pachwicewicz,Paul %A Sheth,Neeral K %A Chhabra,Neeraj %A Karnik,Niranjan S %A Afshar,Majid %+ Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Suite 302, 1645 W. Jackson Boulevard, Chicago, IL, 60612, United States, 1 4153108569, hale_thompson@rush.edu %K unhealthy opioid use %K substance misuse %K COVID-19 %K severity of illness %K overdose %K topic modeling %K machine learning %K opioid use %K pandemic %K health outcome %K public health %K disease severity %K electronic health record %K COVID-19 outcome %K risk factor %K patient data %D 2022 %7 8.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has exacerbated health inequities in the United States. People with unhealthy opioid use (UOU) may face disproportionate challenges with COVID-19 precautions, and the pandemic has disrupted access to opioids and UOU treatments. UOU impairs the immunological, cardiovascular, pulmonary, renal, and neurological systems and may increase severity of outcomes for COVID-19. Objective: We applied machine learning techniques to explore clinical presentations of hospitalized patients with UOU and COVID-19 and to test the association between UOU and COVID-19 disease severity. Methods: This retrospective, cross-sectional cohort study was conducted based on data from 4110 electronic health record patient encounters at an academic health center in Chicago between January 1, 2020, and December 31, 2020. The inclusion criterion was an unplanned admission of a patient aged ≥18 years; encounters were counted as COVID-19-positive if there was a positive test for COVID-19 or 2 COVID-19 International Classification of Disease, Tenth Revision codes. Using a predefined cutoff with optimal sensitivity and specificity to identify UOU, we ran a machine learning UOU classifier on the data for patients with COVID-19 to estimate the subcohort of patients with UOU. Topic modeling was used to explore and compare the clinical presentations documented for 2 subgroups: encounters with UOU and COVID-19 and those with no UOU and COVID-19. Mixed effects logistic regression accounted for multiple encounters for some patients and tested the association between UOU and COVID-19 outcome severity. Severity was measured with 3 utilization metrics: low-severity unplanned admission, medium-severity unplanned admission and receiving mechanical ventilation, and high-severity unplanned admission with in-hospital death. All models controlled for age, sex, race/ethnicity, insurance status, and BMI. Results: Topic modeling yielded 10 topics per subgroup and highlighted unique comorbidities associated with UOU and COVID-19 (eg, HIV) and no UOU and COVID-19 (eg, diabetes). In the regression analysis, each incremental increase in the classifier’s predicted probability of UOU was associated with 1.16 higher odds of COVID-19 outcome severity (odds ratio 1.16, 95% CI 1.04-1.29; P=.009). Conclusions: Among patients hospitalized with COVID-19, UOU is an independent risk factor associated with greater outcome severity, including in-hospital death. Social determinants of health and opioid-related overdose are unique comorbidities in the clinical presentation of the UOU patient subgroup. Additional research is needed on the role of COVID-19 therapeutics and inpatient management of acute COVID-19 pneumonia for patients with UOU. Further research is needed to test associations between expanded evidence-based harm reduction strategies for UOU and vaccination rates, hospitalizations, and risks for overdose and death among people with UOU and COVID-19. Machine learning techniques may offer more exhaustive means for cohort discovery and a novel mixed methods approach to population health. %M 36265163 %R 10.2196/38158 %U https://publichealth.jmir.org/2022/12/e38158 %U https://doi.org/10.2196/38158 %U http://www.ncbi.nlm.nih.gov/pubmed/36265163 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e42585 %T Nurse Practitioner–Led Integrated Rapid Access to HIV Prevention for People Who Inject Drugs (iRaPID): Protocol for a Pilot Randomized Controlled Trial %A Khati,Antoine %A Altice,Frederick L %A Vlahov,David %A Eger,William H %A Lee,Jessica %A Bohonnon,Terry %A Wickersham,Jeffrey A %A Maviglia,Francesca %A Copenhaver,Nicholas %A Shrestha,Roman %+ Department of Allied Health Sciences, University of Connecticut, Unit 1101, 358 Mansfield Rd, Storrs, CT, 06269, United States, 1 860 486 2834, roman.shrestha@uconn.edu %K HIV prevention %K people who inject drugs %K sexual risk %K pre-exposure prophylaxis %K opioid agonist therapy %K medications for opioid use disorder %K opioid use disorder %D 2022 %7 11.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The ongoing volatile opioid epidemic remains a significant public health concern, alongside continued outbreaks of HIV and hepatitis C virus among people who inject drugs. The limited access to and scale-up of medications for opioid use disorder (MOUD) among people who inject drugs, coupled with multilevel barriers to pre-exposure prophylaxis (PrEP) uptake, makes it imperative to integrate evidence-based risk reduction and HIV prevention strategies in innovative ways. To address this need, we developed an integrated rapid access to HIV prevention program for people who inject drugs (iRaPID) that incorporates same-day PrEP and MOUD for this population. Objective: The primary objective of this pilot study is to assess the feasibility and acceptability of the program and evaluate its preliminary efficacy on PrEP and MOUD uptake for a future randomized controlled trial (RCT). We also aim to explore information on the implementation of the program in a real-world setting using a type I hybrid implementation trial design. Methods: Using a type I hybrid implementation trial design, we are pilot testing the nurse practitioner–led iRaPID program while exploring information on its implementation in a real-world setting. Specifically, we will assess the feasibility and acceptability of the iRaPID program and evaluate its preliminary efficacy on PrEP and MOUD uptake in a pilot RCT. The enrolled 50 people who inject drugs will be randomized (1:1) to either iRaPID or treatment as usual (TAU). Behavioral assessments will occur at baseline, and at 1, 3, and 6 months. Additionally, we will conduct a process evaluation of the delivery and implementation of the iRaPID program to collect information for future implementation. Results: Recruitment began in July 2021 and was completed in August 2022. Data collection is planned through February 2023. The Institutional Review Boards at Yale University and the University of Connecticut approved this study (2000028740). Conclusions: This prospective pilot study will test a nurse practitioner–led, integrated HIV prevention program that incorporates same-day PrEP and MOUD for people who inject drugs. This low-threshold protocol delivers integrated prevention via one-stop shopping under the direction of nurse practitioners. iRaPID seeks to overcome barriers to delayed PrEP and MOUD initiation, which is crucial for people who inject drugs who have had minimal access to evidence-based prevention. Trial Registration: ClinicalTrials.gov NCT04531670; https://clinicaltrials.gov/ct2/show/NCT04531670 International Registered Report Identifier (IRRID): DERR1-10.2196/42585 %M 36222826 %R 10.2196/42585 %U https://www.researchprotocols.org/2022/10/e42585 %U https://doi.org/10.2196/42585 %U http://www.ncbi.nlm.nih.gov/pubmed/36222826 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37474 %T Acceptability and Usability of a Reward-Based Mobile App for Opioid Treatment Settings: Mixed Methods Pilot Study %A Proctor,Steven L %A Rigg,Khary K %A Tien,Allen Y %+ Thriving Mind South Florida, 7205 Corporate Center Drive, Suite 200, Miami, FL, 33126, United States, 1 305 858 3335, sproctor@thrivingmind.org %K opioids %K contingency management %K mHealth %K digital health %K mobile app %K innovation %K opioid use disorder %K recovery %K acceptability %D 2022 %7 5.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Contingency management is an evidence-based yet underutilized approach for opioid use disorder (OUD). Reasons for limited adoption in real-world practice include ethical, moral, and philosophical concerns regarding use of monetary incentives, and lack of technological innovation. In light of surging opioid overdose deaths, there is a need for development of technology-enabled solutions leveraging the power of contingency management in a way that is viewed by both patients and providers as acceptable and feasible. Objective: This mixed methods pilot study sought to determine the perceived acceptability and usability of PROCare Recovery, a reward-based, technology-enabled recovery monitoring smartphone app designed to automate contingency management by immediately delivering micropayments to patients for achieving recovery goals via smart debit card with blocking capabilities. Methods: Participants included patients receiving buprenorphine for OUD (n=10) and licensed prescribers (n=5). Qualitative interviews were conducted by 2 PhD-level researchers via video conferencing to explore a priori hypotheses. Thematic analysis of interviews was conducted and synthesized into major themes. Results: Participants were overwhelmingly in favor of microrewards (eg, US $1) to incentivize treatment participation (up to US $150 monthly). Participants reported high acceptability of the planned debit card spending restrictions (blocking cash withdrawals and purchases at bars or liquor stores, casinos or online gambling). Quantitative data revealed a high level of perceived usability of the PROCare Recovery app. Conclusions: Patients and providers alike appear receptive to microfinancial incentives in standard OUD treatment practices. Further pilot testing of PROCare is underway to determine acceptability, feasibility, and preliminary effectiveness in a rigorous randomized controlled trial. %M 36197705 %R 10.2196/37474 %U https://formative.jmir.org/2022/10/e37474 %U https://doi.org/10.2196/37474 %U http://www.ncbi.nlm.nih.gov/pubmed/36197705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39772 %T Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program %A Williams,Kimberly D %A Jurkovitz,Claudine T %A Papas,Mia A %A Muther,Ann Kathryn %A Anderson,Sharon L %A Anderson,Tammy L %+ Institute for Research on Equity and Community Health, ChristianaCare, Avenue North, 4000 Nexus Drive, Suite CE1-300, Wilmington, DE, 19803, United States, 1 302 428 2662, kimwilliams@christianacare.org %K opioid use disorder %K substance use %K drug addiction %K opioid treatment program %K COVID-19 %K telehealth %K telemedicine %K eHealth %K Short Message Service %K SMS %K text messaging %K text message %K opioid use %K opioid %K care management %K patient care management %K health intervention %K telehealth intervention %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The emergence of COVID-19 exacerbated the existing epidemic of opioid use disorder (OUD) across the United States due to the disruption of in-person treatment and support services. Increased use of technology including telehealth and the development of new partnerships may facilitate coordinated treatment interventions that comprehensively address the health and well-being of individuals with OUD. Objective: The analysis of this pilot program aimed to determine the feasibility of delivering a COVID-19 telehealth care management program using SMS text messages for patients receiving OUD treatment. Methods: Eligible individuals were identified from a statewide opioid treatment program (OTP) network. Those who screened positive for COVID-19 symptoms were invited to connect to care management through a secure SMS text message that was compliant with Health Insurance Portability and Accountability Act standards. Care management monitoring for COVID-19 was provided for a period of up to 14 days. Monitoring services consisted of daily SMS text messages from the care manager inquiring about the participant’s physical health in relation to COVID-19 symptoms by confirming their temperature, if the participant was feeling worse since the prior day, and if the participant was experiencing symptoms such as coughing or shortness of breath. If COVID-19 symptoms worsened during this observation period, the care manager was instructed to refer participants to the hospital for acute care services. The feasibility of the telehealth care management intervention was assessed by the rates of adoption in terms of program enrollment, engagement as measured by the number of SMS text message responses per participant, and retention in terms of the number of days participants remained in the program. Results: Between January and April 2021, OTP staff members referred 21 patients with COVID-19 symptoms, and 18 (82%) agreed to be contacted by a care manager. Participants ranged in age from 27 to 65 years and primarily identified as female (n=12, 67%) and White (n=15, 83%). The majority of participants were Medicaid recipients (n=14, 78%). There were no statistically significant differences in the demographic characteristics between those enrolled and not enrolled in the program. A total of 12 (67%) patients were enrolled in the program, with 2 (11%) opting out of SMS text message communication and choosing instead to speak with a care manager verbally by telephone. The remaining 10 participants answered a median of 7 (IQR 4-10) SMS text messages and were enrolled in the program for a median of 9 (IQR 7.5-12) days. No participants were referred for acute care services or hospitalized during program enrollment. Conclusions: These results demonstrate the feasibility of a novel telehealth intervention to monitor COVID-19 symptoms among OTP patients in treatment for OUD. Further research is needed to determine the applicability of this intervention to monitor patients with comorbid chronic conditions in addition to the acceptability among patients and providers using the SMS text messaging modality. %M 35973033 %R 10.2196/39772 %U https://formative.jmir.org/2022/8/e39772 %U https://doi.org/10.2196/39772 %U http://www.ncbi.nlm.nih.gov/pubmed/35973033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e16996 %T Characterizing the Experience of Tapentadol Nonmedical Use: Mixed Methods Study %A Vosburg,Suzanne K %A Dailey-Govoni,Taryn %A Beaumont,Jared %A Butler,Stephen F %A Green,Jody L %+ Inflexxion, An Uprise Health | IBH Company, 2 Park Plaza, Suite 1200, Irvine, CA, 92614, United States, 1 617 765 3138, Jody.Green@uprisehealth.com %K tapentadol %K opioid %K prescription opioid %K nonmedical use %K addiction %K chronic pain %K web-based survey %K Bluelight %K drug safety %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of abuse, diversion, and web-based endorsement of tapentadol (extended-release [ER], immediate-release [IR]) has been characterized as low compared with other prescription opioids. Little is known about individual experience with tapentadol nonmedical use (NMU). Objective: This study aims to pilot web-based survey technologies to investigate the motivation for tapentadol NMU, sources of procurement, routes of administration, tampering methods, doses used, and impressions of tapentadol products (Nucynta and Nucynta ER). Methods: Recruitment flyers and banner advertisements were placed on the Bluelight website [DragonByte Technologies Ltd] with a link to a web-based survey (Qualtrics) designed to query about individuals’ lifetime tapentadol NMU. This web-based survey was followed by an interactive web-based chat (Cryptocat) with respondents who were willing to be contacted. Respondents were queried about sources for obtaining tapentadol, motives for use, routes of administration, tampering methods, drugs used in combination, tablet strengths and dosages, and reasons for continued or discontinued use. Desirability and attractiveness for NMU was rated. Results: Web-based recruitment successfully attracted difficult-to-find study participants. A total of 78 participants reported that tapentadol was obtained from friends and family (ER 11/30, 37%; IR 18/67, 27%), the internet (ER 11/30, 37%; IR 12/67, 18%) or participants’ own prescriptions from a doctor (ER 9/30, 30%; IR 17/67, 25%). It was used nonmedically for pain relief (ER 18/30, 60%; IR 33/67, 49%) and multiple psychotropic effects, including relaxation (ER 13/30, 43%; IR 29/67, 43%), reduction in depression or anxiety (ER 7/30, 23%; IR 30/67, 45%), or getting high (ER 12/30, 40%; IR 33/67, 49%). Tapentadol was primarily swallowed (ER 22/30, 73%; IR 55/67, 82%), although snorting (ER 2/30, 7%; IR 8/67, 12%) and injection (ER 2/30, 7%; IR 5/67, 8%) were also reported. The preferred dose for NMU was 100 mg (both ER and IR). The participants reported tapentadol use with benzodiazepines (ER 12/21, 57%; IR 28/47, 60%). Most participants had discontinued tapentadol NMU at the time of survey completion (ER 22/30, 73%; IR 55/67, 82%). Reasons for discontinued ER NMU included side effects (10/22, 46%) and lack of effective treatment (10/22, 46%). Reasons for discontinued IR NMU included lack of access (26/55, 47%) and better NMU options (IR 21/55, 38%). Few individuals were willing to divulge identifying information about themselves for the interactive chat (8/78, 10%), demonstrating the strength of anonymous, web-based surveys. Interactive chat supported the survey findings. A subgroup of participants (4/78, 5%) reported hallucinogenic side effects with high doses. Conclusions: Web-based surveys can successfully recruit individuals who report drug NMU and those who are difficult to find. Tapentadol NMU appears to occur primarily for pain relief and for its psychotropic effects. Although it was liked by some, tapentadol did not receive a robust pattern of endorsement for NMU. %M 35687397 %R 10.2196/16996 %U https://formative.jmir.org/2022/6/e16996 %U https://doi.org/10.2196/16996 %U http://www.ncbi.nlm.nih.gov/pubmed/35687397 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e32902 %T Effects of Pharmacogenomic Testing in Clinical Pain Management: Retrospective Study %A Tagwerker,Christian %A Carias-Marines,Mary Jane %A Smith,David J %+ Alcala Testing and Analysis Services, 3703 Camino del Rio South, San Diego, CA, 92108, United States, 1 6194505870 ext 205, christian.tagwerker@alcalalabs.com %K pharmacogenomics %K pain management %K drug-drug interaction %K DDI %K pharmacy %K prescriptions %K genetics %K genomics %K drug-gene interaction %K pain %D 2022 %7 3.5.2022 %9 Original Paper %J JMIRx Med %G English %X Background: The availability of pharmacogenomic (PGx) methods to determine the right drug and dosage for individualized patient treatment has increased over the past decade. Adoption of the resulting PGx reports in a clinical setting and monitoring of clinical outcomes is a challenging and long-term commitment. Objective: This study summarizes an extended PGx deep sequencing panel intended for medication dosing and prescription guidance newly adopted in a pain management clinic. The primary outcome of this retrospective study reports the number of cases and types of drugs covered, for which PGx data appears to have assisted in optimal drug prescription and dosing. Methods: A PGx panel is described, encompassing 23 genes and 141 single-nucleotide polymorphisms or indels, combined with PGx dosing guidance and drug-gene interaction (DGI) and drug-drug interaction (DDI) reporting to prevent adverse drug reactions (ADRs). During a 2-year period, patients (N=171) were monitored in a pain management clinic. Urine toxicology, PGx reports, and progress notes were studied retrospectively for changes in prescription regimens before and after the PGx report was made available to the provider. An additional algorithm provided DGIs and DDIs to prevent ADRs. Results: Among patient PGx reports with medication lists provided (n=146), 57.5% (n=84) showed one or more moderate and 5.5% (n=8) at least one serious PGx interaction. A total of 96 (65.8%) patients showed at least one moderate and 15.1% (n=22) one or more serious DGIs or DDIs. A significant number of active changes in prescriptions based on the 102 PGx/DGI/DDI report results provided was observed for 85 (83.3%) patients for which a specific drug was either discontinued or switched within the defined drug classes of the report, or a new drug was added. Conclusions: Preventative action was observed for all serious interactions, and only moderate interactions were tolerated for the lack of other alternatives. This study demonstrates the application of an extended PGx panel combined with a customized informational report to prevent ADRs and improve patient care. %M 37725552 %R 10.2196/32902 %U https://med.jmirx.org/2022/2/e32902 %U https://doi.org/10.2196/32902 %U http://www.ncbi.nlm.nih.gov/pubmed/37725552 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e32133 %T Where Opioid Overdose Patients Live Far From Treatment: Geospatial Analysis of Underserved Populations in New York State %A Abell-Hart,Kayley %A Rashidian,Sina %A Teng,Dejun %A Rosenthal,Richard N %A Wang,Fusheng %+ Department of Biomedical Informatics, Stony Brook University, 2313D Computer Science, Stony Brook, NY, 11794, United States, 1 631 632 2594, fusheng.wang@stonybrook.edu %K opioid use disorder %K opioid overdose %K buprenorphine %K naloxone %K geospatial analysis %K epidemiology %K opioid pandemic %K public health %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Opioid addiction and overdose have a large burden of disease and mortality in New York State (NYS). The medication naloxone can reverse an overdose, and buprenorphine can treat opioid use disorder. Efforts to increase the accessibility of both medications include a naloxone standing order and a waiver program for prescribing buprenorphine outside a licensed drug treatment program. However, only a slim majority of NYS pharmacies are listed as participating in the naloxone standing order, and less than 7% of prescribers in NYS have a buprenorphine waiver. Therefore, there is a significant opportunity to increase access. Objective: Identifying the geographic regions of NYS that are farthest from resources can help target interventions to improve access to naloxone and buprenorphine. To maximize the efficiency of such efforts, we also sought to determine where these underserved regions overlap with the largest numbers of actual patients who have experienced opioid overdose. Methods: We used address data to assess the spatial distribution of naloxone pharmacies and buprenorphine prescribers. Using the home addresses of patients who had an opioid overdose, we identified geographic locations of resource deficits. We report findings at the high spatial granularity of census tracts, with some neighboring census tracts merged to preserve privacy. Results: We identified several hot spots, where many patients live far from the nearest resource of each type. The highest density of patients in areas far from naloxone pharmacies was found in eastern Broome county. For areas far from buprenorphine prescribers, we identified subregions of Oswego county and Wayne county as having a high number of potentially underserved patients. Conclusions: Although NYS is home to thousands of naloxone pharmacies and potential buprenorphine prescribers, access is not uniform. Spatial analysis revealed census tract areas that are far from resources, yet contain the residences of many patients who have experienced opioid overdose. Our findings have implications for public health decision support in NYS. Our methods for privacy can also be applied to other spatial supply-demand problems involving sensitive data. %M 35412467 %R 10.2196/32133 %U https://publichealth.jmir.org/2022/4/e32133 %U https://doi.org/10.2196/32133 %U http://www.ncbi.nlm.nih.gov/pubmed/35412467 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e36357 %T Community Opioid Dispensing After Injury (CODI): Protocol for a Population-Based Data Linkage Study %A Cameron,Cate M %A McCreanor,Victoria %A Shibl,Rania %A Smyth,Tanya %A Proper,Melanie %A Warren,Jacelle %A Vallmuur,Kirsten %A Bradford,Natalie %A Carter,Hannah %A Graves,Nicholas %A Loveday,Bill %+ Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Butterfield Street, Brisbane, QLD 4029, Australia, 61 0401034179, cate.cameron@health.qld.gov.au %K opioids %K injury %K data linkage %K cohort study %K outcomes %K epidemiology %K population-based study %K health records %D 2022 %7 12.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is an urgent need to reduce preventable deaths and hospitalizations from prescription opioid harms and minimize the negative effect opioid misuse can have on injured individuals, families, and the wider community. Data linkage between administrative hospitalization records for injured patients and community opioid dispensing can improve our understanding of the health and surgical trajectories of injured persons and generate insights into corresponding opioid dispensing patterns. Objective: The Community Opioid Dispensing after Injury (CODI) study aims to link inpatient hospitalization data with opioid dispensing data to examine the distribution and predictive factors associated with high or prolonged community opioid dispensing among adults, for 2 years following an injury-related hospital admission. Methods: This is a retrospective population-based cohort study of adults aged 18 years or older hospitalized with an injury in Queensland, Australia. The study involves the linkage of statewide hospital admissions, opioid prescription dispensing, and mortality data collections. All adults hospitalized for an injury between January 1, 2014, and December 31, 2015, will be included in the cohort. Demographics and injury factors are recorded at the time of the injury admission. Opioid dispensing data will be linked and extracted for 3 months prior to the injury admission date to 2 years after the injury separation date (last date December 31, 2017). Deaths data will be extracted for the 2-year follow-up period. The primary outcome measure will be opioid dispensing (frequency and quantity) in the 2 years following the injury admission. Patterns and factors associated with community opioid dispensing will be examined for different injury types, mechanisms, and population subgroups. Appropriate descriptive statistics will be used to describe the cohort. Regression models will be used to examine factors predictive of levels and duration of opioid use. Nonparametric methods will be applied when the data are not normally distributed. Results: The project is funded by the Royal Brisbane and Women’s Hospital Foundation. As of November 2021, all ethics and data custodian approvals have been granted. Data extraction and linkage has been completed. Data management and analysis is underway with results relating to an analysis for blunt chest trauma patients expected to be published in 2022. Conclusions: Little is currently known of the true prevalence or patterns of opioid dispensing following injury across Queensland. This study will provide new insights about factors associated with high and long-term opioid dispensing at a population level. This information is essential to inform targeted public policy and interventions to reduce the risk of prolonged opioid use and dependence for those injured. The novel work undertaken for this project will be vital to planning, delivering, monitoring, and evaluating health care services for those injured. The findings of this study will be used to inform key stakeholders as well as clinicians and pain management services. International Registered Report Identifier (IRRID): RR1-10.2196/36357 %M 35412468 %R 10.2196/36357 %U https://www.researchprotocols.org/2022/4/e36357 %U https://doi.org/10.2196/36357 %U http://www.ncbi.nlm.nih.gov/pubmed/35412468 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33073 %T Patient- and Provider-Reported Experiences of a Mobile Novel Digital Therapeutic in People With Opioid Use Disorder (reSET-O): Feasibility and Acceptability Study %A Kawasaki,Sarah %A Mills-Huffnagle,Sara %A Aydinoglo,Nicole %A Maxin,Halley %A Nunes,Edward %+ Department of Psychiatry and Behavioral Health, Penn State Health, 500 University Drive, Box H073, Hershey, PA, 17033, United States, 1 7177826844, skawasaki@pennstatehealth.psu.edu %K reSET-O %K digital therapeutic %K opioid use disorder %K prescription digital therapeutic %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Medications for the treatment of opioid use disorder, such as buprenorphine, are effective and essential for addressing the opioid epidemic. However, high dropout rates from medication remain a challenge. Behavioral treatment with contingency management and cognitive behavioral counseling has shown promise for improving the outcomes of buprenorphine treatment but is complicated to deliver. The delivery of behavioral treatment through technology-based platforms has the potential to make it more feasible for widespread dissemination. Objective: reSET-O is a prescription digital therapeutic and a commercial adaptation of the Therapeutic Education System, an internet-based program with a Community Reinforcement Approach to cognitive behavioral therapy. It delivers cognitive behavioral therapy modules and contingency management rewards upon completion of modules and negative urine drug screens. This pilot study aims to assess the feasibility and acceptability of reSET-O in a community-based opioid treatment program with a Hub and Spoke model of care as part of a larger strategy to maintain individuals in treatment. Objective and qualitative results, as well as acceptability and likeability of reSET-O, were obtained from 15 individuals. Methods: English-speaking individuals aged ≥18 years with a diagnosis of current opioid use disorder were recruited after being on buprenorphine for at least 1 week of treatment. Two 12-week prescriptions for reSET-O were written for the 24-week study. Patient reports of drug use and likeability scales of reSET-O were conducted at weeks 4, 8, 12, and 24 of the study. Qualitative interviews were also conducted. A total of 4 providers were recruited and provided feedback on the acceptability and feasibility of reSET-O. Results: Of the 15 participants who participated in this pilot study, 7 (47%) completed 24 weeks, and 8 (53%) were unable to complete because of dropout after enrollment, attrition in treatment, or incarceration. An average of US $96 in contingency management rewards were earned by participants for the completion of modules for the duration of the pilot study. Participants’ subjective feedback revealed that reSET-O was easy to use, enjoyable, and helped provide a safe space to admit recurring substance use. Conclusions: reSET-O was well accepted based on patient and provider feedback in this pilot study; however, adherence and retention in treatment remain areas for improvement. Randomized control trials are needed to assess whether retention of community-based buprenorphine treatment is enhanced through the use of technology-based behavioral interventions such as reSET-O. %M 35333189 %R 10.2196/33073 %U https://formative.jmir.org/2022/3/e33073 %U https://doi.org/10.2196/33073 %U http://www.ncbi.nlm.nih.gov/pubmed/35333189 %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 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32871 %T Informal Coping Strategies Among People Who Use Opioids During COVID-19: Thematic Analysis of Reddit Forums %A Arshonsky,Josh %A Krawczyk,Noa %A Bunting,Amanda M %A Frank,David %A Friedman,Samuel R %A Bragg,Marie A %+ Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, United States, 1 646 501 2717, SeedProgramPaperSubmissions@nyulangone.org %K opioid use %K Reddit %K coping strategies %K COVID-19 %K opioid %K drug %K coping %K social media %K strategy %K content analysis %K abstain %K addiction %K data mining %K support %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has transformed how people seeking to reduce opioid use access treatment services and navigate efforts to abstain from using opioids. Social distancing policies have drastically reduced access to many forms of social support, but they may have also upended some perceived barriers to reducing or abstaining from opioid use. Objective: This qualitative study aims to identify informal coping strategies for reducing and abstaining from opioid use among Reddit users who have posted in opioid-related subreddits at the beginning of the COVID-19 pandemic. Methods: We extracted data from 2 major opioid-related subreddits. Thematic data analysis was used to evaluate subreddit posts dated from March 5 to May 13, 2020, that referenced COVID-19 and opioid use, resulting in a final sample of 300 posts that were coded and analyzed. Results: Of the 300 subreddit posts, 100 (33.3%) discussed at least 1 type of informal coping strategy. Those strategies included psychological and behavioral coping skills, adoption of healthy habits, and use of substances to manage withdrawal symptoms. In addition, 12 (4%) subreddit posts explicitly mentioned using social distancing as an opportunity for cessation of or reduction in opioid use. Conclusions: Reddit discussion forums have provided a community for people to share strategies for reducing opioid use and support others during the COVID-19 pandemic. Future research needs to assess the impact of COVID-19 on opioid use behaviors, especially during periods of limited treatment access and isolation, as these can inform future efforts in curbing the opioid epidemic and other substance-related harms. %M 35084345 %R 10.2196/32871 %U https://formative.jmir.org/2022/3/e32871 %U https://doi.org/10.2196/32871 %U http://www.ncbi.nlm.nih.gov/pubmed/35084345 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e33451 %T Evaluation of an Experimental Web-based Educational Module on Opioid-related Occupational Safety Among Police Officers: Protocol for a Randomized Pragmatic Trial to Minimize Barriers to Overdose Response %A Simmons,Janie %A Elliott,Luther %A Bennett,Alex S %A Beletsky,Leo %A Rajan,Sonali %A Anders,Brad %A Dastparvardeh,Nicole %+ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, 4th floor, Rm. 459, New York, NY, 10003, United States, 1 2129923807, js8822@nyu.edu %K occupational health %K law enforcement %K police/education %K naloxone %K opioid overdose prevention and response training %K online education %K opioids %K occupational risk %D 2022 %7 25.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: As drug-related morbidity and mortality continue to surge, police officers are on the front lines of the North American overdose (OD) crisis. Drug law enforcement shapes health risks among people who use drugs (PWUD), while also impacting the occupational health and wellness of officers. Effective interventions to align law enforcement practices with public health and occupational safety goals remain underresearched. Objective: The Opioids and Police Safety Study (OPS) aims to shift police practices relating to PWUD. It adapts and evaluates the relative effectiveness of a curriculum that bundles content on public health promotion with occupational risk reduction (ORR) to supplement a web-based OD response and naloxone training platform (GetNaloxoneNow.org, or GNN). This novel approach has the potential to improve public health and occupational safety practices, including using naloxone to reverse ODs, referring PWUD to treatment and other supportive services, and avoiding syringe confiscation. Methods: This longitudinal study uses a randomized pragmatic trial design. A sample of 300 active-duty police officers from select counties in Pennsylvania, Vermont, and New Hampshire with high OD fatality rates will be randomized (n=150 each) to either the experimental arm (GNN + OPS) or the control arm (GNN + COVID-19 ORR). A pre- and posttraining survey will be administered to all 300 officers, after which they will be administered quarterly surveys for 12 months. A subsample of police officers will also be qualitatively followed in a simultaneous embedded mixed-methods approach. Research ethics approval was obtained from the New York University Institutional Review Board. Results: Results will provide an understanding of the experiences, knowledge, and perceptions of this sample of law enforcement personnel. Generalized linear models will be used to analyze differences in key behavioral outcomes between the participants in each of the 2 study arms and across multiple time points (anticipated minimum effect size to be detected, d=0.50). Findings will be disseminated widely, and the training products will be available nationally once the study is completed. Conclusions: The OPS is the first study to longitudinally assess the impact of a web-based opioid-related ORR intervention for law enforcement in the U.S. Our randomized pragmatic clinical trial aims to remove barriers to life-saving police engagement with PWUD/people who inject drugs by focusing both on the safety of law enforcement and evidence-based and best practices for working with persons at risk of an opioid OD. Our simultaneous embedded mixed-methods approach will provide empirical evaluation of the diffusion of the naloxone-based response among law enforcement. Trial Registration: ClinicalTrail.gov NCT05008523; https://clinicaltrials.gov/show/NCT05008523 International Registered Report Identifier (IRRID): DERR1-10.2196/33451 %M 35212639 %R 10.2196/33451 %U https://www.researchprotocols.org/2022/2/e33451 %U https://doi.org/10.2196/33451 %U http://www.ncbi.nlm.nih.gov/pubmed/35212639 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e32759 %T Patient Engagement With a Game-Based Digital Therapeutic for the Treatment of Opioid Use Disorder: Protocol for a Randomized Controlled Open-Label, Decentralized Trial %A Luderer,Hilary %A Chiodo,Lisa %A Wilson,Amanda %A Brezing,Christina %A Martinez,Suky %A Xiong,Xiaorui %A Gerwien,Robert %A Imbert,Bruce %A Deeg,Mark %A Maricich,Yuri %A Campbell,Aimee %+ Pear Therapeutics, Inc, 200 State St., Boston, MA, 02109, United States, 1 (617) 932 7504, hilary.luderer@peartherapeutics.com %K decentralized trial %K game-based %K gamification %K prescription digital therapeutic %K digital therapeutics %K opioid use disorder %K reSET-O %K virtual trial %K trial %K game %K therapy %K opioid %K drug %K engagement %K treatment %K disorder %K addiction %K randomized controlled trial %K mental health %K symptom %D 2022 %7 26.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Prescription digital therapeutics are software-based disease treatments that are regulated by the US Food and Drug Administration; the reSET-O prescription digital therapeutic was authorized in 2018 and delivers behavioral treatment for individuals receiving buprenorphine for opioid use disorder. Although reSET-O improves outcomes for individuals with opioid use disorder, most of the therapeutic content is delivered as narrative text. PEAR-008 is an investigational device based on reSET-O that uses an interactive, game-based platform to deliver similar therapeutic content designed to enhance patient engagement, which may further improve treatment outcomes. Objective: We aim to investigate how participants interact with the prescription digital therapeutic’s new content delivery format. Secondary objectives include evaluating treatment success, symptoms of co-occurring mental health disorders, recovery capital, and skill development. Methods: Due to the COVID-19 pandemic, this study was redesigned using a decentralized model because it was not possible to conduct medication initiation and study visits in person, as initially intended. A decentralized, randomized controlled trial design will be utilized to compare patient engagement with PEAR-008 and that with reSET-O using both subjective and objective assessments. The study population will consist of approximately 130 individuals with opioid use disorder (based on Diagnostic and Statistical Manual of Mental Disorders 5 criteria) who have recently started buprenorphine treatment for opioid use disorder. Participants will be virtually recruited and randomly assigned to receive either PEAR-008 or reSET-O. All study sessions will be virtual, and the duration of the study is 12 weeks. The primary outcome measure of engagement is operationalized as the number of active sessions per week with either PEAR-008 or reSET-O. (An active session is any session that contains some active participation in the app, such as navigating to a different screen, engaging with a learning module, or responding to a notification.) Subjective dimensions of engagement will be assessed with participant surveys. The hypothesis is that PEAR-008 will have significantly greater participant engagement than reSET-O. Results: As of February 2021, participant enrollment is ongoing. Conclusions: This randomized controlled trial will investigate if changing the delivery format and enhancing the content of a prescription digital therapeutic for opioid use disorder will affect how participants use and interact with the prescription digital therapeutic. The study design may serve as a useful model for conducting decentralized studies in this patient population. Trial Registration: ClinicalTrials.gov NCT04542642; https://clinicaltrials.gov/ct2/show/NCT04542642 International Registered Report Identifier (IRRID): DERR1-10.2196/32759 %M 35080499 %R 10.2196/32759 %U https://www.researchprotocols.org/2022/1/e32759 %U https://doi.org/10.2196/32759 %U http://www.ncbi.nlm.nih.gov/pubmed/35080499 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e33975 %T Investigating the Use of a Serious Game to Improve Opioid Safety Awareness Among Adolescents: Quantitative Study %A Abraham,Olufunmilola %A Rosenberger,Claire %A Tierney,Kathleen %A Birstler,Jen %+ Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin–Madison, 777 Highland Ave, Madison, WI, 53705, United States, 1 6082634498, olufunmilola.abraham@wisc.edu %K opioids %K adolescents %K opioid safety %K medication safety %K opioid knowledge %K serious games %K naloxone %K Narcan %K youth %K technology %K safety %K gaming %K addiction %K drug %K young adult %K teenager %K survey %K awareness %D 2021 %7 23.12.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The misuse of opioid medications among adolescents is a serious problem in the United States. Serious games (SGs) are a novel way to promote the safe and responsible management of opioid medications among adolescents, thereby reducing the number of adolescent opioid misuse cases reported annually. Objective: This study aimed to examine the effect of the SG MedSMART: Adventures in PharmaCity on adolescents’ opioid safety knowledge, awareness, behavioral intent, and self-efficacy. Methods: A nationally representative sample of adolescents aged 12 to 18 years were recruited online through Qualtrics panels from October to November 2020. Data collection consisted of a pregame survey, 30 minutes of gameplay, and a postgame survey. The pregame and postgame surveys included 66 items examining the participants’ baseline opioid knowledge, safety, use, and demographic information. The postgame survey had 25 additional questions regarding the MedSMART game. Gameplay scenarios included 5 levels intended to mimic adolescents’ daily life while educating the players about appropriate opioid storage and disposable practices, negative consequences of sharing opioid medications, and the use of Narcan. Survey questions were divided into 10 categories to represent key concepts and were summarized into concept scores. Differences in concept scores were described by overall mean (SD) when stratified by gender, race, school, grade, and age. Differences of change in concept score were analyzed using the Kruskal-Wallis and correlation tests. Results: A total of 117 responses were analyzed. The results showed significant improvement on all concept scores except for Narcan knowledge (mean change -0.04, SD 0.29; P=.60) and safe storage (mean change 0.03, SD 0.20; P=.09). Female participants had greater improvement than males for safe disposal (female mean 0.12, SD 0.25 vs male mean 0.04, SD 0.17; P=.05). Male participants had higher improvement than female participants for misuse behavior (female mean 0.05, SD 0.28 vs male mean 0.14, SD 0.27; P=.04). Perceived knowledge for participants who had non-White or Hispanic racial backgrounds had higher improvement than for non-Hispanic White participants (non-White mean 1.10, SD 1.06 vs White mean 0.75, SD 0.91; P=.03). Older grades were associated with greater improvement in opioid knowledge (correlation coefficient -0.23, 95% CI -0.40 to -0.05; P=.01). There were 28 (23.9%) participants who played all 5 levels of the game and had better improvement in opioid use self-efficacy. Conclusions: Our findings suggest MedSMART: Adventures in PharmaCity can be used as an effective tool to educate adolescents on the safe and responsible use of prescribed opioid medications. Future testing of the effectiveness of this SG should involve a randomized controlled trial. Additionally, the feasibility of implementing and disseminating MedSMART: Adventures in PharmaCity in schools and health care settings such as adolescent health or primary care clinics, emergency departments, and pharmacies should be investigated. %M 34747712 %R 10.2196/33975 %U https://games.jmir.org/2021/4/e33975 %U https://doi.org/10.2196/33975 %U http://www.ncbi.nlm.nih.gov/pubmed/34747712 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e30753 %T Characterizing and Identifying the Prevalence of Web-Based Misinformation Relating to Medication for Opioid Use Disorder: Machine Learning Approach %A ElSherief,Mai %A Sumner,Steven A %A Jones,Christopher M %A Law,Royal K %A Kacha-Ochana,Akadia %A Shieber,Lyna %A Cordier,LeShaundra %A Holton,Kelly %A De Choudhury,Munmun %+ School of Interactive Computing, Georgia Institute of Technology, 756 W Peachtree St NW, Atlanta, GA, 30308, United States, 1 4043858603, munmund@gatech.edu %K opioid use disorder %K substance use %K addiction treatment %K misinformation %K social media %K machine learning %K natural language processing %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Expanding access to and use of medication for opioid use disorder (MOUD) is a key component of overdose prevention. An important barrier to the uptake of MOUD is exposure to inaccurate and potentially harmful health misinformation on social media or web-based forums where individuals commonly seek information. There is a significant need to devise computational techniques to describe the prevalence of web-based health misinformation related to MOUD to facilitate mitigation efforts. Objective: By adopting a multidisciplinary, mixed methods strategy, this paper aims to present machine learning and natural language analysis approaches to identify the characteristics and prevalence of web-based misinformation related to MOUD to inform future prevention, treatment, and response efforts. Methods: The team harnessed public social media posts and comments in the English language from Twitter (6,365,245 posts), YouTube (99,386 posts), Reddit (13,483,419 posts), and Drugs-Forum (5549 posts). Leveraging public health expert annotations on a sample of 2400 of these social media posts that were found to be semantically most similar to a variety of prevailing opioid use disorder–related myths based on representational learning, the team developed a supervised machine learning classifier. This classifier identified whether a post’s language promoted one of the leading myths challenging addiction treatment: that the use of agonist therapy for MOUD is simply replacing one drug with another. Platform-level prevalence was calculated thereafter by machine labeling all unannotated posts with the classifier and noting the proportion of myth-indicative posts over all posts. Results: Our results demonstrate promise in identifying social media postings that center on treatment myths about opioid use disorder with an accuracy of 91% and an area under the curve of 0.9, including how these discussions vary across platforms in terms of prevalence and linguistic characteristics, with the lowest prevalence on web-based health communities such as Reddit and Drugs-Forum and the highest on Twitter. Specifically, the prevalence of the stated MOUD myth ranged from 0.4% on web-based health communities to 0.9% on Twitter. Conclusions: This work provides one of the first large-scale assessments of a key MOUD-related myth across multiple social media platforms and highlights the feasibility and importance of ongoing assessment of health misinformation related to addiction treatment. %M 34941555 %R 10.2196/30753 %U https://www.jmir.org/2021/12/e30753 %U https://doi.org/10.2196/30753 %U http://www.ncbi.nlm.nih.gov/pubmed/34941555 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e29187 %T Web-Based Discussion and Illicit Street Sales of Tapentadol and Oxycodone in Australia: Epidemiological Surveillance Study %A Black,Joshua %A Margolin,Zachary R %A Bau,Gabrielle %A Olson,Richard %A Iwanicki,Janetta L %A Dart,Richard C %+ Rocky Mountain Poison and Drug Safety, 1391 N Speer Blvd, #600, M/C 0180, Denver, CO, 80204, United States, 1 303 389 1652, joshua.black@rmpds.org %K Australia %K opioids %K web-based discussion %K diversion %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Opioid use disorder and its consequences are a persistent public health concern for Australians. Web activity has been used to understand the perception of drug safety and diversion of drugs in contexts outside of Australia. The anonymity of the internet offers several advantages for surveilling and inquiring about specific covert behaviors, such as diversion or discussion of sensitive subjects where traditional surveillance approaches might be limited. Objective: This study aims to characterize the content of web posts and compare reports of illicit sales of tapentadol and oxycodone from sources originating in Australia. First, post content is evaluated to determine whether internet discussion encourages or discourages proper therapeutic use of the drugs. Second, we hypothesize that tapentadol would have lower street price and fewer illicit sales than oxycodone. Methods: Web posts originating in Australia between 2017 and 2019 were collected using the Researched Abuse, Diversion, and Addiction-Related Surveillance System Web Monitoring Program. Using a manual coding process, unstructured post content from social media, blogs, and forums was categorized into topics of discussion related to the harms and behaviors that could lead to harm. Illicit sales data in a structured format were collected through a crowdsourcing website between 2016 and 2019 using the Researched Abuse, Diversion, and Addiction-Related Surveillance System StreetRx Program. In total, 2 multivariable regression models assessed the differences in illicit price and number of sales. Results: A total of 4.7% (28/600) of tapentadol posts discussed an adverse event, whereas 10.27% (95% CI 9.32-11.21) of oxycodone posts discussed this topic. A total of 10% (60/600) of tapentadol posts discussed unsafe use or side effects, whereas 20.17% (95% CI 18.92-21.41) of oxycodone posts discussed unsafe use or side effects. There were 31 illicit sales reports for tapentadol (geometric mean price per milligram: Aus $0.12 [US $0.09]) and 756 illicit sales reports for oxycodone (Aus $1.28 [US $0.91]). Models detected no differences in the street price or number of sales between the drugs when covariates were included, although the potency of the pill significantly predicted the street price (P<.001) and availability predicted the number of sales (P=.03). Conclusions: Australians searching the web for opinions could judge tapentadol as safer than oxycodone because of the web post content. The illicit sales market for tapentadol was smaller than that of oxycodone, and drug potency and licit availability are likely important factors influencing the illicit market. %M 34932012 %R 10.2196/29187 %U https://publichealth.jmir.org/2021/12/e29187 %U https://doi.org/10.2196/29187 %U http://www.ncbi.nlm.nih.gov/pubmed/34932012 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e29563 %T Prospective Prediction of Lapses in Opioid Use Disorder: Protocol for a Personal Sensing Study %A Moshontz,Hannah %A Colmenares,Alejandra J %A Fronk,Gaylen E %A Sant'Ana,Sarah J %A Wyant,Kendra %A Wanta,Susan E %A Maus,Adam %A Gustafson Jr,David H %A Shah,Dhavan %A Curtin,John J %+ Department of Psychology, University of Wisconsin-Madison, 1202 W Johnson St, Madison, WI, 53706, United States, 1 (608) 262 1040, jjcurtin@wisc.edu %K digital therapeutics %K risk prediction %K opioid lapse %K mobile phone %D 2021 %7 7.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Successful long-term recovery from opioid use disorder (OUD) requires continuous lapse risk monitoring and appropriate use and adaptation of recovery-supportive behaviors as lapse risk changes. Available treatments often fail to support long-term recovery by failing to account for the dynamic nature of long-term recovery. Objective: The aim of this protocol paper is to describe research that aims to develop a highly contextualized lapse risk prediction model that forecasts the ongoing probability of lapse. Methods: The participants will include 480 US adults in their first year of recovery from OUD. Participants will report lapses and provide data relevant to lapse risk for a year with a digital therapeutic smartphone app through both self-report and passive personal sensing methods (eg, cellular communications and geolocation). The lapse risk prediction model will be developed using contemporary rigorous machine learning methods that optimize prediction in new data. Results: The National Institute of Drug Abuse funded this project (R01DA047315) on July 18, 2019 with a funding period from August 1, 2019 to June 30, 2024. The University of Wisconsin-Madison Health Sciences Institutional Review Board approved this project on July 9, 2019. Pilot enrollment began on April 16, 2021. Full enrollment began in September 2021. Conclusions: The model that will be developed in this project could support long-term recovery from OUD—for example, by enabling just-in-time interventions within digital therapeutics. International Registered Report Identifier (IRRID): DERR1-10.2196/29563 %M 34559061 %R 10.2196/29563 %U https://www.researchprotocols.org/2021/12/e29563 %U https://doi.org/10.2196/29563 %U http://www.ncbi.nlm.nih.gov/pubmed/34559061 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e32851 %T Risk Factors Associated With Nonfatal Opioid Overdose Leading to Intensive Care Unit Admission: A Cross-sectional Study %A Mitra,Avijit %A Ahsan,Hiba %A Li,Wenjun %A Liu,Weisong %A Kerns,Robert D %A Tsai,Jack %A Becker,William %A Smelson,David A %A Yu,Hong %+ Department of Computer Science, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA, 01854, United States, 1 508 612 7292, Hong_Yu@uml.edu %K opioids %K overdose %K risk factors %K electronic health records %K social and behavioral determinants of health %K natural language processing %K intensive care unit %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Opioid overdose (OD) and related deaths have significantly increased in the United States over the last 2 decades. Existing studies have mostly focused on demographic and clinical risk factors in noncritical care settings. Social and behavioral determinants of health (SBDH) are infrequently coded in the electronic health record (EHR) and usually buried in unstructured EHR notes, reflecting possible gaps in clinical care and observational research. Therefore, SBDH often receive less attention despite being important risk factors for OD. Natural language processing (NLP) can alleviate this problem. Objective: The objectives of this study were two-fold: First, we examined the usefulness of NLP for SBDH extraction from unstructured EHR text, and second, for intensive care unit (ICU) admissions, we investigated risk factors including SBDH for nonfatal OD. Methods: We performed a cross-sectional analysis of admission data from the EHR of patients in the ICU of Beth Israel Deaconess Medical Center between 2001 and 2012. We used patient admission data and International Classification of Diseases, Ninth Revision (ICD-9) diagnoses to extract demographics, nonfatal OD, SBDH, and other clinical variables. In addition to obtaining SBDH information from the ICD codes, an NLP model was developed to extract 6 SBDH variables from EHR notes, namely, housing insecurity, unemployment, social isolation, alcohol use, smoking, and illicit drug use. We adopted a sequential forward selection process to select relevant clinical variables. Multivariable logistic regression analysis was used to evaluate the associations with nonfatal OD, and relative risks were quantified as covariate-adjusted odds ratios (aOR). Results: The strongest association with nonfatal OD was found to be drug use disorder (aOR 8.17, 95% CI 5.44-12.27), followed by bipolar disorder (aOR 2.69, 95% CI 1.68-4.29). Among others, major depressive disorder (aOR 2.57, 95% CI 1.12-5.88), being on a Medicaid health insurance program (aOR 2.26, 95% CI 1.43-3.58), history of illicit drug use (aOR 2.09, 95% CI 1.15-3.79), and current use of illicit drugs (aOR 2.06, 95% CI 1.20-3.55) were strongly associated with increased risk of nonfatal OD. Conversely, Blacks (aOR 0.51, 95% CI 0.28-0.94), older age groups (40-64 years: aOR 0.65, 95% CI 0.44-0.96; >64 years: aOR 0.16, 95% CI 0.08-0.34) and those with tobacco use disorder (aOR 0.53, 95% CI 0.32-0.89) or alcohol use disorder (aOR 0.64, 95% CI 0.42-1.00) had decreased risk of nonfatal OD. Moreover, 99.82% of all SBDH information was identified by the NLP model, in contrast to only 0.18% identified by the ICD codes. Conclusions: This is the first study to analyze the risk factors for nonfatal OD in an ICU setting using NLP-extracted SBDH from EHR notes. We found several risk factors associated with nonfatal OD including SBDH. SBDH are richly described in EHR notes, supporting the importance of integrating NLP-derived SBDH into OD risk assessment. More studies in ICU settings can help health care systems better understand and respond to the opioid epidemic. %M 34747714 %R 10.2196/32851 %U https://medinform.jmir.org/2021/11/e32851 %U https://doi.org/10.2196/32851 %U http://www.ncbi.nlm.nih.gov/pubmed/34747714 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28235 %T Development, Validation, and Assessment of Clinical Impact of Real-time Alerts to Detect Inpatient As-Needed Opioid Orders With Duplicate Indications: Prospective Study %A Rizk,Elsie %A Swan,Joshua T %+ Department of Surgery, Houston Methodist, 6550 Fannin St, SM1661, Houston, TX, 77035, United States, 1 713 441 0165, swan.joshua@gmail.com %K opioid stewardship %K pain %K as-needed opioids %K duplicate orders %K automated alerts %D 2021 %7 25.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As-needed (PRN) opioid orders with duplicate indications can lead to medication errors and opioid-related adverse drug events. Objective: The objective of our study was to build and validate real-time alerts that detect duplicate PRN opioid orders and assist clinicians in optimizing the safety of opioid orders. Methods: This single-center, prospective study used an iterative, 3-step process to refine alert performance by advancing from small sample evaluations of positive predictive values (PPVs) (step 1) through intensive evaluations of accuracy (step 2) to evaluations of clinical impact (step 3). Validation cohorts were randomly sampled from eligible patients for each step. Results: During step 1, the PPV was 100% (one-sided, 97.5% CI 70%-100%) for moderate and severe pain alerts. During step 2, duplication of 1 or more PRN opioid orders was identified for 17% (34/201; 95% CI, 12%-23%) of patients during chart review. This bundle of alerts showed 94% sensitivity (95% CI 80%-99%) and 96% specificity (95% CI 92%-98%) for identifying patients who had duplicate PRN opioid orders. During step 3, at least 1 intervention was made to the medication profile for 77% (46/60; 95% CI 64%-87%) of patients, and at least 1 inappropriate duplicate PRN opioid order was discontinued for 53% (32/60; 95% CI 40%-66%) of patients. Conclusions: The bundle of alerts developed in this study was validated against chart review by a pharmacist and identified patients who benefited from medication safety interventions to optimize PRN opioid orders. %M 34694235 %R 10.2196/28235 %U https://www.jmir.org/2021/10/e28235 %U https://doi.org/10.2196/28235 %U http://www.ncbi.nlm.nih.gov/pubmed/34694235 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e31173 %T A Personalized, Interactive, Cognitive Behavioral Therapy–Based Digital Therapeutic (MODIA) for Adjunctive Treatment of Opioid Use Disorder: Development Study %A Meyer,Björn %A Utter,Geri-Lynn %A Hillman,Catherine %+ GAIA AG, Hans-Henny-Jahnn-Weg 53, Hamburg, 22085, Germany, 49 40351052 ext 31, bjoern.meyer@gaia-group.com %K MODIA %K opioid use disorder %K digital therapeutic %K cognitive behavioral therapy %K medication-assisted treatment %K Broca %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Opioid use disorder (OUD) is characterized by the inability to control opioid use despite attempts to stop use and negative consequences to oneself and others. The burden of opioid misuse and OUD is a national crisis in the United States with substantial public health, social, and economic implications. Although medication-assisted treatment (MAT) has demonstrated efficacy in the management of OUD, access to effective counseling and psychosocial support is a limiting factor and a significant problem for many patients and physicians. Digital therapeutics are an innovative class of interventions that help prevent, manage, or treat diseases by delivering therapy using software programs. These applications can circumvent barriers to uptake, improve treatment adherence, and enable broad delivery of evidence-based management strategies to meet service gaps. However, few digital therapeutics specifically targeting OUD are available, and additional options are needed. Objective: To this end, we describe the development of the novel digital therapeutic MODIA. Methods: MODIA was developed by an international, multidisciplinary team that aims to provide effective, accessible, and sustainable management for patients with OUD. Although MODIA is aligned with principles of cognitive behavioral therapy, it was not designed to present any 1 specific treatment and uses a broad range of evidence-based behavior change techniques drawn from cognitive behavioral therapy, mindfulness, acceptance and commitment therapy, and motivational interviewing. Results: MODIA uses proprietary software that dynamically tailors content to the users’ responses. The MODIA program comprises 24 modules or “chats” that patients are instructed to work through independently. Patient responses dictate subsequent content, creating a “simulated dialogue” experience between the patient and program. MODIA also includes brief motivational text messages that are sent regularly to prompt patients to use the program and help them transfer therapeutic techniques into their daily routines. Thus, MODIA offers individuals with OUD a custom-tailored, interactive digital psychotherapy intervention that maximizes the personal relevance and emotional impact of the interaction. Conclusions: As part of a clinician-supervised MAT program, MODIA will allow more patients to begin psychotherapy concurrently with opioid maintenance treatment. We expect access to MODIA will improve the OUD management experience and provide sustainable positive outcomes for patients. %M 34623309 %R 10.2196/31173 %U https://mental.jmir.org/2021/10/e31173 %U https://doi.org/10.2196/31173 %U http://www.ncbi.nlm.nih.gov/pubmed/34623309 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e25575 %T Health Behavior Survey Among People Who Use Opioids: Protocol for Implementing Technology-Based Rapid Response Surveillance in Community Settings %A Frew,Paula M %A Randall,Laura A %A King,Adrian R %A Schamel,Jay T %A Spaulding,Anne C %A , %A Holloway,Ian W %+ University of Nevada Las Vegas School of Public Health, 4505 S Maryland Parkway, Las Vegas, NV, 89154, United States, 1 702 895 1734, pfrew@emory.edu %K substance use %K opioid %K opioid crisis %K social determinants %K hidden populations %K health equity %D 2021 %7 10.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In 2018, 2 million Americans met the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic criteria for an opioid use disorder, and 9.9 million Americans had misused prescription pain relievers the previous year. Despite a rapid increase in opioid misuse, opioid use disorders, and overdoses, data are limited on the behavioral and contextual risks as well as the protective factors fueling the opioid epidemic in some hard hit US cities—Atlanta, Los Angeles, and Las Vegas. Opioid use also contributes to the risk of other health problems such as HIV and hepatitis C virus infections or mental health disorders and is linked to behavioral and environmental risks (eg, homelessness, experiences of violence, involvement in the justice system). Knowledge of the relationships between these linked vulnerabilities and how they influence service utilization is critical to effective policy and interventions. Objective: This survey explores the relationships between demographic and economic characteristics, behavioral and environmental risk factors, and service utilization of people who use opioids to inform public health practice, policy, and future efforts to mitigate the risks faced by this population experiencing multiple health, social, and economic vulnerabilities. The results of this survey will be used to identify needs and intervention points for people who use drugs currently served by public health organizations. Methods: We implemented a community-engaged strategy that involved development and execution of a two-stage purposive sampling plan involving selection of partner organizations (syringe exchange programs in urban settings) and recruitment and enrollment of participants aged 18-69 years served by these organizations in Atlanta, Los Angeles, and Las Vegas from 2019 to 2020. The recruited participants completed a survey, including a variety of measures to assess health (physical and mental) and health behaviors such as sexual behavior, vaccine receipt, and HIV/ hepatitis C virus infection testing. Additional items assessed drug use and misuse, syringe exchange and health service utilization, sex exchange, histories of interpersonal violence, and vaccine confidence. Results: This protocol was successfully implemented despite challenges such as real-time technology issues and rapidly finding and surveying a difficult-to-reach population. We sampled 1127 unique participants (248 in Atlanta, 465 in Los Angeles, and 414 in Las Vegas). Conclusions: The establishment and utilization of strong community partnerships enabled the rapid collection of data from a typically difficult-to-reach population. Local efforts such as these are needed to develop policies and practices that promote harm reduction among people who use opioids. International Registered Report Identifier (IRRID): RR1-10.2196/25575 %M 34505834 %R 10.2196/25575 %U https://www.researchprotocols.org/2021/9/e25575 %U https://doi.org/10.2196/25575 %U http://www.ncbi.nlm.nih.gov/pubmed/34505834 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e25387 %T Informing the Development of a Standardized Clinical Definition of Neonatal Abstinence Syndrome: Protocol for a Modified-Delphi Expert Panel %A Khodyakov,Dmitry %A Jilani,Shahla M %A Dellva,Stephanie %A Faherty,Laura J %+ RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, United States, 1 310 393 0411 ext 6159, dmitry_khodyakov@rand.org %K Delphi %K ExpertLens %K expert panel %K neonatal abstinence syndrome %K neonatal opioid withdrawal syndrome %K neonatal withdrawal %K neonatal %K neonates %K opioid %K opioids %K withdrawal %K infants %K clinical %K newborn %K newborns %K perinatal %K postnatal %D 2021 %7 7.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome that most commonly results from prenatal opioid exposure. Every 15 minutes, an infant is born in the United States with signs of NAS. The field lacks a standardized clinical definition of NAS, complicating discussions on programmatic and policy development to support opioid-exposed mothers and infants. Objective: The goal of this paper is to describe a protocol for a systematic expert panel process to inform the development of a clinical definition of NAS. Methods: We will conduct two three-round online modified-Delphi panels using the ExpertLens system and will follow the recommendations for Conducting and REporting of DElphi Studies (CREDES). One panel will focus on developing key components of a clinical definition of NAS, and the second panel will focus on neonatal opioid withdrawal syndrome (NOWS), which is a term that has come into use to differentiate opioid-exposed infants from infants exposed to other substances in utero. However, there is lack of agreement on the precise clinical definition of NOWS and how it is distinct from or overlaps with NAS. Each panel will complete two rating rounds and a discussion round using a similar protocol. We will analyze all rating data descriptively and determine the presence of agreement within and between the two panels. We will also perform thematic analysis of the qualitative comments to contextualize the panel findings. Results: The panels were convened between October 29 and December 17, 2020. Their results were disseminated and discussed at a national conference on NAS that took place on March 17-18, 2021. Conclusions: A standardized clinical definition of NAS will help to better characterize NAS incidence and to design effective clinical, public health, and policy interventions to support opioid-exposed mother-infant dyads. International Registered Report Identifier (IRRID): DERR1-10.2196/25387 %M 34491203 %R 10.2196/25387 %U https://www.researchprotocols.org/2021/9/e25387 %U https://doi.org/10.2196/25387 %U http://www.ncbi.nlm.nih.gov/pubmed/34491203 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e30951 %T Web- and Mindfulness-Based Intervention to Prevent Chronic Pain After Cardiac Surgery: Protocol for a Pilot Randomized Controlled Trial %A Martorella,Geraldine %A Hanley,Adam W %A Pickett,Scott M %A Gelinas,Céline %+ Tallahassee Memorial Healthcare Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, 32306, United States, 1 8506446028, gmartorella@fsu.edu %K postoperative pain %K cardiac surgery %K chronic pain %K web-based %K mindfulness %K mobile phone %D 2021 %7 30.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cardiac surgery is a frequently performed procedure. However, pain after cardiac surgery may become chronic (lasting >3 months) in adults. Once discharged from the hospital, patients are at greater risk of developing chronic postsurgical pain (CPSP) and of prolonged opioid use, as they need to self-manage their pain. Psychological risk and protective factors such as pain-related catastrophic thoughts and pain acceptance determine their ability to cope and their use of opioids, which is crucial for self-management of pain. Studies on mindfulness-based cognitive therapy (MBCT) have multiplied their potential effects on pain acceptance and catastrophic thoughts. However, web-based MBCT for the prevention of CPSP has not yet been examined. Objective: The aim of this study is to pilot test a 4-week-long web-based MBCT intervention for adults following discharge from the hospital by assessing the acceptability or feasibility of the intervention and examining preliminary effects on pain intensity, pain interference with activities and opioid use, and pain acceptance and catastrophic thoughts in the 6 months following surgery. Methods: A double-blinded pilot randomized controlled trial will be used to assess a web-based MBCT intervention. Patients will be selected according to the following criteria: age ≥18 years; first-time elective cardiac surgery via a median sternotomy; worst pain in the past week score ≥4/10; ability to understand and complete questionnaires in English; and ability to use an electronic device such as a smartphone, computer, or tablet. After baseline measures, 32 participants will be randomized into two groups: one receiving both the brief, 4-week-long web-based MBCT intervention and usual care (experimental group) and the other receiving only one standardized, web-based educational session with weekly reminders and usual care (attention control group). Peer-reviewed competitive funding was received from Florida State University’s Council on Research & Creativity in January 2021, as well as research ethics approval from Florida State University's institutional review board. Results: Recruitment began in June 2021. Unfortunately, because of the current COVID-19 pandemic, recruitment is not progressing as expected. Recruitment strategies are constantly monitored and updated according to latest data and restrictions surrounding the pandemic. Conclusions: This research is significant because it targets the trajectory of CPSP, a leading cause of disability and opioid misuse. This is the first study to assess MBCT for the prevention of CPSP after cardiac surgery in the recovery phase. This approach is innovative because it promotes self-management of pain through the modulation of individual factors. If successful, the intervention could be expanded to numerous populations at risk of chronic pain. International Registered Report Identifier (IRRID): DERR1-10.2196/30951 %M 34459749 %R 10.2196/30951 %U https://www.researchprotocols.org/2021/8/e30951 %U https://doi.org/10.2196/30951 %U http://www.ncbi.nlm.nih.gov/pubmed/34459749 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 8 %P e16293 %T Potential Uses of Blockchain Technology for Outcomes Research on Opioids %A Gonzales,Aldren %A Smith,Scott R %A Dullabh,Prashila %A Hovey,Lauren %A Heaney-Huls,Krysta %A Robichaud,Meagan %A Boodoo,Roger %+ US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, 200 Independence Ave SW, Washington, DC, 20201, United States, 1 2028707414, aldren.gonzales@hhs.gov %K blockchain %K distributed ledger %K opioid crisis %K outcomes research %K patient-centered outcomes research %K mobile phone %D 2021 %7 27.8.2021 %9 Viewpoint %J JMIR Med Inform %G English %X The scale and severity of the opioid epidemic call for innovative, multipronged solutions. Research and development is key to accelerate the discovery and evaluation of interventions that support pain and substance use disorder management. In parallel, the use and integration of blockchain technology within research networks holds the potential to address some of the unique challenges facing opioid research. This paper discusses the applications of blockchain technology and illustrates potential ways in which it could be applied to strengthen the validity of outcomes research on the opioid epidemic. We reviewed published and gray literature to identify useful applications of blockchain, specifically those that address the challenges faced by opioid research networks and programs. We then convened a panel of experts to discuss the strengths, limitations, and feasibility of each application. Blockchain has the potential to address some of the issues surrounding health data management, including data availability, data sharing and interoperability, and privacy and security. We identified five primary applications of blockchain to opioids: clinical trials and pharmaceutical research, incentivizing data donation and behavior change, secure exchange and management of e-prescriptions, supply chain management, and secondary use of clinical data for research and public health surveillance. The published literature was limited, leading us to rely on gray literature, which was also limited in its discussion of the technical aspects of implementation. The technical expert panel provided additional context and an assessment of feasibility that was lacking in the literature. Research on opioid use and misuse is challenging because of disparate data stored across different systems, data and system interoperability issues, and legal requirements. These areas must be navigated to make data accessible, timely, and useful to researchers. Blockchain technologies have the potential to act as a facilitator in this process, offering a more efficient, secure, and privacy-preserving solution for data exchange. Among the 5 primary applications, we found that clinical trial research, supply chain management, and secondary use of data had the most examples in practice and the potential effectiveness of blockchain. More discussions and studies should focus on addressing technical questions concerning scalability and tackling practical concerns such as cost, standards, and governance around the implementation of blockchain in health care. Policy concerns related to balancing the need for data accessibility that also protects patient privacy and autonomy in revoking consent should also be examined. %M 34448721 %R 10.2196/16293 %U https://medinform.jmir.org/2021/8/e16293 %U https://doi.org/10.2196/16293 %U http://www.ncbi.nlm.nih.gov/pubmed/34448721 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e25866 %T Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives %A Glass,Joseph E %A Matson,Theresa E %A Lim,Catherine %A Hartzler,Andrea L %A Kimbel,Kilian %A Lee,Amy K %A Beatty,Tara %A Parrish,Rebecca %A Caldeiro,Ryan M %A Garza McWethy,Angela %A Curran,Geoffrey M %A Bradley,Katharine A %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1466, United States, 1 734 678 3709, Joseph.E.Glass@kp.org %K user-centered design %K qualitative %K drug use disorders %K stimulants %K cannabis %K opioids %K primary care %K mHealth %K mobile phone %D 2021 %7 6.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. Objective: This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. Methods: The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. Results: Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). Conclusions: A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients’ needs for structure, support in and outside of visits, and desire for convenience. %M 34255666 %R 10.2196/25866 %U https://www.jmir.org/2021/7/e25866 %U https://doi.org/10.2196/25866 %U http://www.ncbi.nlm.nih.gov/pubmed/34255666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24353 %T Virtual Engagement in a Social Media Community of Mothers With Substance Use Disorders: Content Analysis %A Mazel,Shayna %A Zisman-Ilani,Yaara %A Hennig,Shannon %A Garnick,Deborah %A Nicholson,Joanne %+ Heller School for Social Policy and Management, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA, 02454-9110, United States, 1 (781) 736 3820, mazel@brandeis.edu %K virtual engagement %K virtual community participation %K social media %K mental health %K opioids %K substance use %D 2021 %7 24.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Co-occurring substance use disorder is common among pregnant and parenting women with mental illness, but their engagement with and utilization of relevant services and treatment is low. Social media has the potential to convey benefits and facilitate engagement among this target group. Objective: This study aimed to explore the reach and engagement of specific social media posts among pregnant women and mothers with substance use disorders. Methods: Eighteen posts providing content related to substance use (cannabis, opioids, or alcohol), varying in type of content (informational or experiential) and target (policy-, practice-, or perception-related), were posted in a closed Facebook community page comprising over 33,000 pregnant women and mothers between May 2019 and October 2019. Results: The overall level of reach of these Facebook posts ranged from 453 to 3045 community members. Engagement levels, measured via the number of likes, comments, or posts shared, varied based on the type of post content (ie, informational or experiential). Conclusions: Participation in a virtual community via social media platforms can facilitate engagement among pregnant women and mothers with mental illness by communicating relevant information about substance use, as well as potentially promoting awareness of, access to, and engagement with treatment services. %M 34184993 %R 10.2196/24353 %U https://formative.jmir.org/2021/6/e24353/ %U https://doi.org/10.2196/24353 %U http://www.ncbi.nlm.nih.gov/pubmed/34184993 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e29298 %T Increases in Naloxone Administrations by Emergency Medical Services Providers During the COVID-19 Pandemic: Retrospective Time Series Study %A Khoury,Dalia %A Preiss,Alexander %A Geiger,Paul %A Anwar,Mohd %A Conway,Kevin Paul %+ Research Triangle Institute International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 9195411227, dkhoury@rti.org %K opioids %K naloxone %K EMS %K emergency medical services %K COVID-19 %K pandemic %K medical services %K overdose %K outcomes %K opioid crisis %K public health %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The opioid crisis in the United States may be exacerbated by the COVID-19 pandemic. Increases in opioid use, emergency medical services (EMS) runs for opioid-related overdoses, and opioid overdose deaths have been reported. No study has examined changes in multiple naloxone administrations, an indicator of overdose severity, during the COVID-19 pandemic. Objective: This study examines changes in the occurrence of naloxone administrations and multiple naloxone administrations during EMS runs for opioid-related overdoses during the COVID-19 pandemic in Guilford County, North Carolina (NC). Methods: Using a period-over-period approach, we compared the occurrence of opioid-related EMS runs, naloxone administrations, and multiple naloxone administrations during the 29-week period before (September 1, 2019, to March 9, 2020) and after NC’s COVID-19 state of emergency declaration (ie, the COVID-19 period of March 10 to September 30, 2020). Furthermore, historical data were used to generate a quasi-control distribution of period-over-period changes to compare the occurrence of each outcome during the COVID-19 period to each 29-week period back to January 1, 2014. Results: All outcomes increased during the COVID-19 period. Compared to the previous 29 weeks, the COVID-19 period experienced increases in the weekly mean number of opioid-related EMS runs (25.6, SD 5.6 vs 18.6, SD 6.6; P<.001), naloxone administrations (22.3, SD 6.2 vs 14.1, SD 6.0; P<.001), and multiple naloxone administrations (5.0, SD 1.9 vs 2.7, SD 1.9; P<.001), corresponding to proportional increases of 37.4%, 57.8%, and 84.8%, respectively. Additionally, the increases during the COVID-19 period were greater than 91% of all historical 29-week periods analyzed. Conclusions: The occurrence of EMS runs for opioid-related overdoses, naloxone administrations, and multiple naloxone administrations during EMS runs increased during the COVID-19 pandemic in Guilford County, NC. For a host of reasons that need to be explored, the COVID-19 pandemic appears to have exacerbated the opioid crisis. %M 33999828 %R 10.2196/29298 %U https://publichealth.jmir.org/2021/5/e29298 %U https://doi.org/10.2196/29298 %U http://www.ncbi.nlm.nih.gov/pubmed/33999828 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25969 %T mHealth Interventions to Support Prescription Opioid Tapering in Patients With Chronic Pain: Qualitative Study of Patients’ Perspectives %A Magee,Michael Reece %A McNeilage,Amy Gray %A Avery,Nicholas %A Glare,Paul %A Ashton-James,Claire Elizabeth %+ Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Lvl 2 Douglas Building, Royal North Shore Hospital, St Leonards, 2065, Australia, 61 294631528, claire.ashton-james@sydney.edu.au %K prescription opioids %K chronic noncancer pain %K tapering %K digital health %K support %K mobile health technology %K SMS %K mobile phone %D 2021 %7 18.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic pain who are tapering prescription opioids report a need for greater support for coping with symptoms of pain and withdrawal. Mobile health (mHealth) technologies (SMS text messaging– or app-based) have the potential to provide patients with educational, emotional, and motivational support for opioid tapering beyond what is offered by their health care provider. However, it is not known whether patients with chronic pain who are tapering opioids would be willing or able to engage with technology-based support. Objective: This study aims to examine patients’ use of mobile technologies in health care, interest in using mHealth support, preferences for the form and content of mHealth support, and potential barriers to and facilitators of engagement with mHealth support for opioid tapering. Methods: A total of 21 patients (11 women and 10 men; age range 29-83 years) with chronic noncancer pain on long-term opioid therapy who had recently initiated a voluntary opioid taper were recruited from primary and tertiary care clinics in metropolitan and regional Australia for a larger study of patients’ experiences of opioid tapering. Participants had been taking prescription opioids for a mean duration of 13 (SD 9.6; range 0.25-30) years at the time of the study. Survey items characterized participants’ typical mobile phone use and level of interest in mobile technology–based support for opioid tapering. Semistructured interviews further explored patients’ use of mobile technologies and their interest in, preferences for, and perspectives on potential barriers to and facilitators of engagement with mHealth support for opioid tapering. Two researchers collaborated to conduct a thematic analysis of the interview data. Results: All participants reported owning and using a mobile phone, and most (17/21, 81%) participants reported using mobile apps. The majority of participants expressed interest in SMS text messaging–based (17/21, 81%) and app-based (15/21, 71%) support for opioid tapering. Participants expected that messages delivering both informational and socioemotional support would be helpful. Participants expected that access to technology, mobile reception, internet connectivity, vision impairment, and low self-efficacy for using apps may be barriers to user engagement. Patients expected that continuity of care from their health care provider, flexible message dosing, responsivity, and familiarity with pain self-management strategies would increase user engagement. Conclusions: The results of this study indicate that patients with chronic noncancer pain may be willing to engage with SMS text messaging–based and app-based mHealth interventions to support opioid tapering. However, the feasibility and acceptability of these interventions may depend on how patients’ preferences for functionality, content, and design are addressed. %M 34003133 %R 10.2196/25969 %U https://formative.jmir.org/2021/5/e25969 %U https://doi.org/10.2196/25969 %U http://www.ncbi.nlm.nih.gov/pubmed/34003133 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e20183 %T Virtual Overdose Response for People Who Use Opioids Alone: Protocol for a Feasibility and Clinical Trial Study %A Bristowe,Sean Kristina %A Ghosh,Sumantra Monty %A Trew,Michael %A , %A Rittenbach,Katherine %+ Department of Psychiatry, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada, 1 780 710 0705, katherine.rittenbach@albertahealthservices.ca %K harm reduction %K opioid crisis %K overdose response %K people with lived experience %K peers %D 2021 %7 12.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A recent quarterly report released by Alberta Health reports that on average 2.5 Albertans die every day from accidental overdose deaths, and that between April 1, 2020, and June 30, 2020, the province lost a total of 301 people. In Canada, between January 2016 and March 2020, a total of 16,364 people died due to opioid-related overdose. The World Health Organization reports that 70% of the 0.5 million deaths worldwide caused by drugs are related to opioid overdose. Although supervised consumption sites or safe injection sites have been shown to be effective in reducing the harms associated with the use of illicit substances and increasing uptake of addiction treatment and other health services, there is still significant stigma associated with them, and it is unlikely that all of the people who would benefit from supervised consumption service will ever access a site. Objective: To help prevent deaths in populations that cannot or will not access physical safer consumption services in Alberta, we propose to provide virtual (telephone-based) overdose response services, staffed by people with lived experience.The primary outcome for this study is uptake of the service as measured by the number of calls to the service. Secondary outcomes will include patterns of use of the phone line (days of the week and time of calls) and outcomes from the calls (number of emergency medical services dispatches for overdoses from the service and the results of those dispatches). Methods: This phase 1 clinical study is set to officially launch in early May 2020. The service will be available to up to 15 participants who self-disclose as using opioids unobserved and have given informed consent for both data collection and interviews. This group will have access to a toll-free telephone number and be invited to call when they plan to use opioids alone. Results: The analysis will include mixed methods. To improve the design of the service and ensure safety of all involved, quantitative data will be collected on phone calls and participant health care usage, while qualitative data will be collected from both participants and virtual overdose response operators Conclusions: This clinical trial aims to test the feasibility of a service that provides virtual overdose response in order to help prevent deaths in populations that cannot or will not access physical supervised consumption services in Alberta. Trial Registration: ClinicalTrials.gov NCT04391192; https://www.clinicaltrials.gov/ct2/show/NCT04391192 International Registered Report Identifier (IRRID): DERR1-10.2196/20183 %M 33978598 %R 10.2196/20183 %U https://www.researchprotocols.org/2021/5/e20183 %U https://doi.org/10.2196/20183 %U http://www.ncbi.nlm.nih.gov/pubmed/33978598 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e18734 %T Development of an Emergency Department–Based Intervention to Expand Access to Medications for Opioid Use Disorder in a Medicaid Nonexpansion Setting: Protocol for Engagement and Community Collaboration %A Walter,Lauren A %A Li,Li %A Rodgers,Joel B %A Hess,Jennifer J %A Skains,Rachel M %A Delaney,Matthew C %A Booth,James %A Hess,Erik P %+ Department of Emergency Medicine, University of Alabama at Birmingham, 619 19th St S, OHB 251, Birmingham, AL, 35249, United States, 1 205 975 9358, lwalter@uabmc.edu %K opioid use disorder %K mediation for opioid use disorder %K emergency medicine %K buprenorphine %K peer support services %D 2021 %7 29.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The opioid epidemic has disproportionately impacted areas in the Appalachian region of the United States. Characterized by persistent Medicaid nonexpansion, higher poverty rates, and health care access challenges, populations residing in these areas of the United States have experienced higher opioid overdose death rates than those in other parts of the country. Jefferson County, Alabama, located in Southern Appalachia, has been especially affected, with overdose rates over 2 times greater than the statewide average (48.8 vs 19.9 overdoses per 10,000 persons). Emergency departments (EDs) have been recognized as a major health care source for persons with opioid use disorder (OUD). A program to initiate medications for OUD in the ED has been shown to be effective in treatment retention. Likewise, continued patient engagement in a recovery or treatment program after ED discharge has been shown to be efficient for long-term treatment success. Objective: This protocol outlines a framework for ED-initiated medications for OUD in a resource-limited region of the United States; the study will be made possible through community partnerships with referral resources for definitive OUD care. Methods: When a patient presents to the ED with symptoms of opioid withdrawal, nonfatal opioid overdose, or requesting opioid detoxification, clinicians will consider the diagnosis of OUD using the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) criteria. All patients meeting the diagnostic criteria for moderate to severe OUD will be further engaged and assessed for study eligibility. Recruited subjects will be evaluated for signs and symptoms of withdrawal, treated with buprenorphine-naloxone as appropriate, and given a prescription for take-home induction along with an intranasal naloxone kit. At the time of ED discharge, a peer navigator from a local substance use coordinating center will be engaged to facilitate patient referral to a regional substance abuse coordinating center for longitudinal addiction treatment. Results: This project is currently ongoing; it received funding in February 2019 and was approved by the institutional review board of the University of Alabama at Birmingham in June 2019. Data collection began on July 7, 2019, with a projected end date in February 2022. In total, 79 subjects have been enrolled to date. Results will be published in the summer of 2022. Conclusions: ED recognition of OUD accompanied by buprenorphine-naloxone induction and referral for subsequent long-term treatment engagement have been shown to be components of an effective strategy for addressing the ongoing opioid crisis. Establishing community and local partnerships, particularly in resource-limited areas, is crucial for the continuity of addiction care and rehabilitation outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/18734 %M 33913818 %R 10.2196/18734 %U https://www.researchprotocols.org/2021/4/e18734 %U https://doi.org/10.2196/18734 %U http://www.ncbi.nlm.nih.gov/pubmed/33913818 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e23426 %T Association of Opioid Use Disorder With 2016 Presidential Voting Patterns: Cross-sectional Study in New York State at Census Tract Level %A Xiang,Anthony %A Hou,Wei %A Rashidian,Sina %A Rosenthal,Richard N %A Abell-Hart,Kayley %A Zhao,Xia %A Wang,Fusheng %+ Stony Brook University, 2313D Computer Science, Stony Brook, NY, United States, 1 631 632 2594, fusheng.wang@stonybrook.edu %K opioid use disorder %K opioid poisoning %K racial and ethnic disparities %K geographic variance %K sociodemographic factors %K presidential election %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Opioid overdose-related deaths have increased dramatically in recent years. Combating the opioid epidemic requires better understanding of the epidemiology of opioid poisoning (OP) and opioid use disorder (OUD). Objective: We aimed to discover geospatial patterns in nonmedical opioid use and its correlations with demographic features related to despair and economic hardship, most notably the US presidential voting patterns in 2016 at census tract level in New York State. Methods: This cross-sectional analysis used data from New York Statewide Planning and Research Cooperative System claims data and the presidential voting results of 2016 in New York State from the Harvard Election Data Archive. We included 63,958 patients who had at least one OUD diagnosis between 2010 and 2016 and 36,004 patients with at least one OP diagnosis between 2012 and 2016. Geospatial mappings were created to compare areas of New York in OUD rates and presidential voting patterns. A multiple regression model examines the extent that certain factors explain OUD rate variation. Results: Several areas shared similar patterns of OUD rates and Republican vote: census tracts in western New York, central New York, and Suffolk County. The correlation between OUD rates and the Republican vote was .38 (P<.001). The regression model with census tract level of demographic and socioeconomic factors explains 30% of the variance in OUD rates, with disability and Republican vote as the most significant predictors. Conclusions: At the census tract level, OUD rates were positively correlated with Republican support in the 2016 presidential election, disability, unemployment, and unmarried status. Socioeconomic and demographic despair-related features explain a large portion of the association between the Republican vote and OUD. Together, these findings underscore the importance of socioeconomic interventions in combating the opioid epidemic. %M 33881409 %R 10.2196/23426 %U https://publichealth.jmir.org/2021/4/e23426 %U https://doi.org/10.2196/23426 %U http://www.ncbi.nlm.nih.gov/pubmed/33881409 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e23412 %T The EMERALD (Enabling Mobilization, Empowerment, Risk Reduction, and Lasting Dignity) Study: Protocol for the Design, Implementation, and Evaluation of a Community-Based Combination HIV Prevention Intervention for Female Sex Workers in Baltimore, Maryland %A Silberzahn,Bradley E %A Tomko,Catherine A %A Clouse,Emily %A Haney,Katherine %A Allen,Sean T %A Galai,Noya %A Footer,Katherine H A %A Sherman,Susan G %+ Department of Sociology, The University of Texas at Austin, 305 E 23rd St, A1700, RLP 3.306, Austin, TX, 78712, United States, 1 410 614 3518, BradleySilberzahn@utexas.edu %K sex work %K female sex worker %K recruitment %K retention %K sexually transmitted infection %K human immunodeficiency virus %K intervention %K community cohesion %K protocol design %D 2021 %7 16.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cisgender female sex workers (FSWs) experience high rates of HIV and sexually transmitted infections (STIs), including chlamydia and gonorrhea. Community empowerment–based responses to the risk environment of FSWs have been associated with significant reductions in HIV and STI risk and associated risk behaviors; however, evaluations of US-based interventions targeting FSWs are limited. Objective: The objective of this study is to describe the design, implementation, and planned evaluation strategy of an ongoing comprehensive community-level intervention in Baltimore City, Maryland, which aims to improve HIV and STI risk and cumulative incidence among FSWs. The two intervention components are the SPARC (Sex Workers Promoting Action, Risk Reduction, and Community Mobilization) drop-in center and the accompanying comprehensive mobile outreach program. The mission of SPARC is to provide low-barrier harm reduction services to FSWs, with a special focus on women who sell sex and use drugs. Services are provided through a harm reduction framework and include reproductive health and sexual health care; medication-assisted treatment; legal aid; counseling; showers, lockers, and laundry; and the distribution of harm reduction tools, including naloxone and sterile drug use supplies (eg, cookers, cotton, syringes, and pipes). Methods: The SPARC intervention is being evaluated through the EMERALD (Enabling Mobilization, Empowerment, Risk Reduction, and Lasting Dignity) study, which consists of a prospective 2-group comparative nonrandomized trial (n=385), a cross-sectional survey (n=100), and in-depth interviews assessing SPARC implementation (n=45). Participants enrolled in the nonrandomized trial completed a survey and HIV and STI testing at 4 intervals (baseline and 6, 12, and 18 months). Participants recruited from predefined areas closest to SPARC comprised the intervention group, and participants from all other areas of Baltimore were included in the control group. Results: We hypothesize that addressing structural drivers and more immediate medical needs, in combination with peer outreach, will improve the HIV and STI risk environment, leading to community empowerment, and reduce the HIV and STI cumulative incidence and behavioral risks of FSWs. Data collection is ongoing. A baseline description of the cohort is presented. Conclusions: In the United States, structural interventions aimed at reducing HIV and STIs among FSWs are scarce; to our knowledge, this is the first intervention of its kind in the United States. The results of the EMERALD study can be used to inform the development of future interventions targeting FSWs and other at-risk populations. Trial Registration: ClinicalTrials.gov NCT04413591; https://clinicaltrials.gov/ct2/show/NCT04413591. International Registered Report Identifier (IRRID): DERR1-10.2196/23412 %M 33861210 %R 10.2196/23412 %U https://www.researchprotocols.org/2021/4/e23412 %U https://doi.org/10.2196/23412 %U http://www.ncbi.nlm.nih.gov/pubmed/33861210 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e27382 %T Development and Implementation of a Mobile Tool for High-Risk Pregnant Women to Deliver Effective Caregiving for Neonatal Abstinence Syndrome: Protocol for a Mixed Methods Study %A Burduli,Ekaterina %A Jones,Hendrée E %A Brooks,Olivia %A Barbosa-Leiker,Celestina %A Johnson,Ron Kim %A Roll,John %A McPherson,Sterling Marshall %+ College of Nursing, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA, 99202, United States, 1 509 324 7368, eburduli@wsu.edu %K neonatal abstinence syndrome %K opioid use disorder %K mHealth %K maternal child outcomes %D 2021 %7 15.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The United States continues to experience an alarming rise in opioid use that includes women who become pregnant and related neonatal abstinence syndrome (NAS) in newborns. Most newborns experiencing NAS require nonpharmacological care, which entails, most importantly, maternal involvement with the newborn. To facilitate positive maternal-newborn interactions, mothers need to learn effective caregiving NAS strategies when they are pregnant; however, an enormous gap exists in the early education of mothers on the symptoms and progression of NAS, partly because no education, training, or other interventions exist to prepare future mothers for the challenges of caring for their newborns at risk for NAS. Objective: In this paper, we describe a mixed methods, multistage study to adapt an existing mobile NAS tool for high-risk pregnant women and assess its usability, acceptability, and feasibility in a small randomized controlled trial. Methods: Stage 1 will include 20 semistructured interviews with a panel of neonatology experts, NAS care providers, and mothers with experience caring for NAS-affected newborns to gather their recommendations on the management of NAS and explore their perspectives on the care of these newborns. The findings will guide the adaptation of existing mobile NAS tools for high-risk pregnant women. In stage 2, we will test the usability, acceptability, and feasibility of the adapted mobile tool via surveys with 10 pregnant women receiving opioid agonist therapy (OAT). Finally, in stage 3, we will randomize 30 high-risk pregnant women receiving OAT to either receive the adapted mobile NAS caregiving tool or usual care. We will compare these women on primary outcomes—maternal drug relapse and OAT continuation—and secondary outcomes—maternal-newborn bonding; length of newborn hospital stays; readmission rates; breastfeeding initiation and duration; and postpartum depression and anxiety at 4, 8, and 12 weeks postpartum. Results: This project was funded in July 2020 and approved by the institutional review board in April 2020. Data collection for stage 1 began in December 2020, and as of January 2021, we completed 18 semistructured interviews (10 with NAS providers and 8 with perinatal women receiving OAT). Common themes from all interviews will be analyzed in spring 2021 to inform the adaptation of the NAS caregiving tool. The results from stage 1 are expected to be published in summer 2021. Stage 2 data collection will commence in fall 2021. Conclusions: The findings of this study have the potential to improve NAS care and maternal-newborn outcomes and lead to commercialized product development. If effective, our new tool will be well suited to tailoring for other high-risk perinatal women with substance use disorders. Trial Registration: ClinicalTrials.gov NCT04783558; https://clinicaltrials.gov/ct2/show/NCT04783558 International Registered Report Identifier (IRRID): DERR1-10.2196/27382 %M 33856360 %R 10.2196/27382 %U https://www.researchprotocols.org/2021/4/e27382 %U https://doi.org/10.2196/27382 %U http://www.ncbi.nlm.nih.gov/pubmed/33856360 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24360 %T Reduction in Hospital System Opioid Prescribing for Acute Pain Through Default Prescription Preference Settings: Pre–Post Study %A Slovis,Benjamin Heritier %A Riggio,Jeffrey M %A Girondo,Melanie %A Martino,Cara %A Babula,Bracken %A Roke,Lindsey M %A Kairys,John C %+ Office of Clinical Informatics, Thomas Jefferson University, 833 Chestnut Street Floor 10, Philadelphia, PA, 19107, United States, 1 (215) 955 6844, bxs088@jefferson.edu %K informatics %K electronic health record %K opioids %K prescriptions %K oxycodone %D 2021 %7 14.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The United States is in an opioid epidemic. Passive decision support in the electronic health record (EHR) through opioid prescription presets may aid in curbing opioid dependence. Objective: The objective of this study is to determine whether modification of opioid prescribing presets in the EHR could change prescribing patterns for an entire hospital system. Methods: We performed a quasi-experimental retrospective pre–post analysis of a 24-month period before and after modifications to our EHR’s opioid prescription presets to match Centers for Disease Control and Prevention guidelines. We included all opioid prescriptions prescribed at our institution for nonchronic pain. Our modifications to the EHR include (1) making duration of treatment for an opioid prescription mandatory, (2) adding a quick button for 3 days’ duration while removing others, and (3) setting the default quantity of all oral opioid formulations to 10 tablets. We examined the quantity in tablets, duration in days, and proportion of prescriptions greater than 90 morphine milligram equivalents/day for our hospital system, and compared these values before and after our intervention for effect. Results: There were 78,246 prescriptions included in our study written on 30,975 unique patients. There was a significant reduction for all opioid prescriptions pre versus post in (1) the overall median quantity of tablets dispensed (54 [IQR 40-120] vs 42 [IQR 18-90]; P<.001), (2) median duration of treatment (10.5 days [IQR 5.0-30] vs 7.5 days [IQR 3.0-30]; P<.001), and (3) proportion of prescriptions greater than 90 morphine milligram equivalents/day (27.46% [10,704/38,976; 95% CI 27.02%-27.91%] vs 22.86% [8979/39,270; 95% CI 22.45%-23.28%]; P<.001). Conclusions: Modifications of opioid prescribing presets in the EHR can improve prescribing practice patterns. Reducing duration and quantity of opioid prescriptions could reduce the risk of dependence and overdose. %M 33851922 %R 10.2196/24360 %U https://www.jmir.org/2021/4/e24360 %U https://doi.org/10.2196/24360 %U http://www.ncbi.nlm.nih.gov/pubmed/33851922 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24342 %T De-Implementing Opioid Use and Implementing Optimal Pain Management Following Dental Extractions (DIODE): Protocol for a Cluster Randomized Trial %A Rindal,D Brad %A Asche,Stephen E %A Gryczynski,Jan %A Kane,Sheryl M %A Truitt,Anjali R %A Shea,Tracy L %A Ziegenfuss,Jeanette Y %A Schwartz,Robert P %A Worley,Donald C %A Mitchell,Shannon G %+ HealthPartners Institute, 8170 33rd Ave So, MS21112R, Bloomington, MN, United States, 1 952 967 5026, donald.b.rindal@healthpartners.com %K analgesics %K opioid %K prescriptions %K tooth extraction %K pain, postoperative %K dentistry %K oral surgery %K shared decision-making %K health communications %K implementation science %D 2021 %7 12.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Overdose deaths from prescription opioid analgesics are a continuing crisis in the United States. Opioid analgesics are among the most frequently prescribed drugs by dentists. An estimated 5 million people undergo third-molar extractions in the United States each year, resulting in postoperative pain. Studies show that, in most cases, the combination of ibuprofen and acetaminophen is an effective alternative to commonly prescribed opioid analgesics for the management of postextraction pain. Nevertheless, many dentists routinely prescribe opioids after dental extractions. Objective: We describe the rationale, design, and methods for a randomized trial of interventions designed to de-implement opioid prescribing by dentists while implementing effective nonopioid analgesics following dental extractions. Methods: Using a prospective, 3-arm, cluster randomized trial design with dentists as the unit randomized and patient-level prescribing data as the primary outcome, we will compare different strategies to reduce the reliance on opioids and increase the use of alternative pain management approaches utilizing information support tools aimed at both providers and their patients. The study will test the efficacy of 2 interventions to decrease opioid prescribing following dental extractions: clinical decision support with (CDS-E) and without patient education (CDS). Providers will be randomized to CDS, CDS-E, or standard practice. Patient-level outcomes will be determined via review of comprehensive electronic health records. We will compare study arms on differential change in prescribing patterns from pre- to postimplementation of the intervention. The primary outcome of interest is a binary indicator of whether or not the patient received an opioid prescription on the day of the extraction encounter. We will also examine recommendations or prescriptions for nonopioid analgesics, patients’ perceptions of shared decision making, and patients’ pain experiences following the extraction. Results: The HealthPartners Institutional Review Board approved the study. All study materials including the CDS and patient education materials have been developed and pilot tested, and the protocol has been approved by the National Institute of Dental and Craniofacial Research. The intervention was implemented in February 2020, with 51 dentists who were randomized to 1 of the 3 arms. Conclusions: If the intervention strategies are shown to be effective, they could be implemented more broadly in dental settings with high levels of opioid prescribing. Trial Registration: ClinicalTrials.gov NCT03584789, https://clinicaltrials.gov/ct2/show/NCT03584789 International Registered Report Identifier (IRRID): DERR1-10.2196/24342 %M 33843594 %R 10.2196/24342 %U https://www.researchprotocols.org/2021/4/e24342 %U https://doi.org/10.2196/24342 %U http://www.ncbi.nlm.nih.gov/pubmed/33843594 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e24939 %T Exploring the Association Between the “Big Five” Personality Traits and Fatal Opioid Overdose: County-Level Empirical Analysis %A Tacheva,Zhasmina %A Ivanov,Anton %+ School of Information Studies, Syracuse University, 324 Hinds Hall, Syracuse, NY, 13210, United States, 1 7169866636, ztacheva@syr.edu %K opioid addiction %K personality traits %K community health %K text mining %K opioid %K addiction %K psychological %D 2021 %7 8.3.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Opioid-related deaths constitute a problem of pandemic proportions in the United States, with no clear solution in sight. Although addressing addiction—the heart of this problem—ought to remain a priority for health practitioners, examining the community-level psychological factors with a known impact on health behaviors may provide valuable insights for attenuating this health crisis by curbing risky behaviors before they evolve into addiction. Objective: The goal of this study is twofold: to demonstrate the relationship between community-level psychological traits and fatal opioid overdose both theoretically and empirically, and to provide a blueprint for using social media data to glean these psychological factors in a real-time, reliable, and scalable manner. Methods: We collected annual panel data from Twitter for 2891 counties in the United States between 2014-2016 and used a novel data mining technique to obtain average county-level “Big Five” psychological trait scores. We then performed interval regression, using a control function to alleviate omitted variable bias, to empirically test the relationship between county-level psychological traits and the prevalence of fatal opioid overdoses in each county. Results: After controlling for a wide range of community-level biopsychosocial factors related to health outcomes, we found that three of the operationalizations of the five psychological traits examined at the community level in the study were significantly associated with fatal opioid overdoses: extraversion (β=.308, P<.001), neuroticism (β=.248, P<.001), and conscientiousness (β=.229, P<.001). Conclusions: Analyzing the psychological characteristics of a community can be a valuable tool in the local, state, and national fight against the opioid pandemic. Health providers and community health organizations can benefit from this research by evaluating the psychological profile of the communities they serve and assessing the projected risk of fatal opioid overdose based on the relationships our study predict when making decisions for the allocation of overdose-reversal medication and other vital resources. %M 33683210 %R 10.2196/24939 %U https://mental.jmir.org/2021/3/e24939 %U https://doi.org/10.2196/24939 %U http://www.ncbi.nlm.nih.gov/pubmed/33683210 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e18487 %T Evaluating the Effectiveness of a Web-Based Program (POP4Teens) to Prevent Prescription Opioid Misuse Among Adolescents: Randomized Controlled Trial %A Marsch,Lisa A %A Moore,Sarah K %A Grabinski,Michael %A Bessen,Sarah Y %A Borodovsky,Jacob %A Scherer,Emily %+ Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Pkwy, Lebanon, NH, 03766, United States, 1 9176789280, sarah.k.moore@dartmouth.edu %K opioids %K prevention and control %K adolescent %K randomized controlled trial %K internet %D 2021 %7 25.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Prescription opioid (PO) use is common among adolescents in the United States. Despite recent declines from unprecedented peaks in adolescent PO use (eg, in 2012-2013), there is seemingly paradoxical evidence that PO-related consequences (eg, opioid use disorder and overdoses) are increasing. These trends and their possible consequences emphasize the importance of prevention efforts targeting PO misuse. To our knowledge, we have developed the first interactive web-based program (POP4Teens [P4T]) focused specifically on the prevention of PO misuse among adolescents. Objective: This study aimed to evaluate the effectiveness of P4T, a web-based program designed to prevent adolescent PO misuse, in comparison with JustThinkTwice (JTT), an active control website, on PO-related attitudes, knowledge, risk perception, and intentions to use. Methods: We conducted a web-based randomized controlled trial in 2018. A total of 406 adolescents (aged 12-17 years) were randomly assigned to either P4T or JTT. The outcome variables were attitudes, knowledge, and risk perceptions associated with PO misuse, intentions to use POs, and program feedback. Data were collected at baseline and at 1, 3, and 6 months. Results: Both programs resulted in significant and sustained improvements in intention to use POs, increased perceived risk, impacted expectancies consistent with prevention, and improved PO refusal skills. P4T produced significantly greater increases in PO-related knowledge than JTT did, and it was reportedly easier to use and more liked. Baseline scores for youth reporting past-year medical use of POs, friends who engage in nonmedical use of POs, and/or poor mental health underscored their at-risk status compared with youth from the other groups. Conclusions: P4T positively impacted all study variables that are known to prevent PO misuse among teens. Moreover, its web-based nature simplifies the dissemination and implementation of this novel tool designed to help meet the challenges of the evolving national opioid crisis. Trial Registration: ClinicalTrials.gov NCT02737696; https://clinicaltrials.gov/ct2/show/NCT02737696 %M 33629961 %R 10.2196/18487 %U https://publichealth.jmir.org/2021/2/e18487 %U https://doi.org/10.2196/18487 %U http://www.ncbi.nlm.nih.gov/pubmed/33629961 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e24561 %T A Mobile Health App to Support Patients Receiving Medication-Assisted Treatment for Opioid Use Disorder: Development and Feasibility Study %A Waselewski,Marika Elise %A Flickinger,Tabor Elisabeth %A Canan,Chelsea %A Harrington,William %A Franklin,Taylor %A Otero,Kori Nicole %A Huynh,Jacqueline %A Waldman,Ava Lena Davila %A Hilgart,Michelle %A Ingersoll,Karen %A Ait-Daoud Tiouririne,Nassima %A Dillingham,Rebecca Anne %+ Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St, Ann Arbor, MI, 48104, United States, 1 734 647 3305, marikag@med.umich.edu %K opioid use disorder %K mHealth %K retention in care %K self-management %K opioids %K public health %K mobile phone %D 2021 %7 23.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Opioid use disorder (OUD) is a public health crisis with more than 2 million people living with OUD in the United States. Medication-assisted treatment (MAT) is an evidence-based approach for the treatment of OUD that relies on a combination of behavioral therapy and medication. Less than half of those living with OUD are accessing this treatment. Mobile technology can enhance the treatment of chronic diseases in readily accessible and cost-effective ways through self-monitoring and support. Objective: The aim of this study is to describe the adaptation of a mobile platform for patients undergoing treatment for OUD and preliminary pilot testing results. Methods: Our study was conducted with patient and provider participants at the University of Virginia MAT clinic and was approved by the institutional review board. The formative phase included semistructured interviews to understand the needs of patients with OUD, providers’ perspectives, and opportunities for MAT support via a mobile app. A second round of formative interviews used mock-ups of app features to collect feedback on feature function and desirability. Formative participants’ input from 16 interviews then informed the development of a functional smartphone app. Patient participants (n=25) and provider participants (n=3) were enrolled in a 6-month pilot study of the completed platform. Patient app use and usability interviews, including a system usability score and open-ended questions, were completed 1 month into the pilot study. Open-ended responses were analyzed for prevalent themes. Results: Formative interviews resulted in the development of a mobile app, named HOPE, which includes both evidence-based and participant-suggested features. The features included daily prompts for monitoring mood, stress, treatment adherence, and substance use; patient tracking of goals, reminders, and triggering or encouraging experiences; informational resources; an anonymous community board to share support with other patients; and secure messaging for communication between patients and providers. All patient participants engaged with at least one app feature during their first month of pilot study participation, and the daily self-monitoring prompts were the most used. Patients and providers reported high levels of system usability (mean 86.9, SD 10.2 and mean 83.3, SD 12.8, respectively). Qualitative analysis of open-ended usability questions highlighted the value of self-monitoring, access to support through the app, and perceived improvement in connection to care and communication for both patient and provider participants. Conclusions: The use of the HOPE program by pilot participants, high usability scoring, and positive perceptions from 1-month interviews indicate successful program development. By engaging with end users and eliciting feedback throughout the development process, we were able to create an app and a web portal that was highly usable and acceptable to study participants. Further work is needed to understand the program’s effect on clinical outcomes, patient linkage, and engagement in care. %M 33620324 %R 10.2196/24561 %U https://formative.jmir.org/2021/2/e24561 %U https://doi.org/10.2196/24561 %U http://www.ncbi.nlm.nih.gov/pubmed/33620324 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e23080 %T Effect of an mHealth Intervention on Hepatitis C Testing Uptake Among People With Opioid Use Disorder: Randomized Controlled Trial %A Hochstatter,Karli R %A Gustafson Sr,David H %A Landucci,Gina %A Pe-Romashko,Klaren %A Cody,Olivia %A Maus,Adam %A Shah,Dhavan V %A Westergaard,Ryan P %+ School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, United States, 1 9209600002, khochsta@medicine.wisc.edu %K intravenous injections %K mHealth %K hepatitis C virus %K opioid use disorder %K mobile phone %D 2021 %7 22.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The growing epidemic of opioid use disorder (OUD) and associated injection drug use has resulted in a surge of new hepatitis C virus (HCV) infections. Approximately half of the people with HCV infection are unaware of their HCV status. Improving HCV awareness and increasing screening among people with OUD are critical. Addiction-Comprehensive Health Enhancement Support System (A-CHESS) is an evidence-based, smartphone-delivered relapse prevention system that has been implemented among people with OUD who are receiving medications for addiction treatment (MAT) to improve long-term recovery. Objective: We incorporated HCV-related content and functionality into A-CHESS to characterize the HCV care continuum among people in early remission and receiving MAT for OUD and to determine whether incorporating such content and functionality into A-CHESS increases HCV testing. Methods: HCV intervention content, including dissemination of educational information, private messages tailored to individuals’ stage of HCV care, and a public discussion forum, was implemented into the A-CHESS platform. Between April 2016 and April 2020, 416 participants with OUD were enrolled in this study. Participants were randomly assigned to receive MAT alone (control arm) or MAT+A-CHESS (experimental arm). Quarterly telephone interviews were conducted from baseline to month 24 to assess risk behaviors and HCV testing history. Cox proportional hazards regression was used to assess whether participants who used A-CHESS were tested for HCV (either antibody [Ab] or RNA testing) at a higher rate than those in the control arm. To assess the effect of A-CHESS on subsets of participants at the highest risk for HCV, additional analyses were performed to examine the effect of the intervention among participants who injected drugs and shared injection equipment. Results: Overall, 44.2% (184/416) of the study participants were HCV Ab positive, 30.3% (126/416) were HCV Ab negative, and 25.5% (106/416) were considered untested at baseline. At month 24, there was no overall difference in HCV testing uptake between the intervention and control participants. However, among the subset of 109 participants who engaged in injection drug use, there was a slight trend toward increased HCV testing uptake among those who used A-CHESS (89% vs 85%; hazard ratio: 1.34; 95% CI 0.87-2.05; P=.18), and a stronger trend was observed when focusing on the subset of 32 participants who reported sharing injection equipment (87% vs 56%; hazard ratio: 2.92; 95% CI 0.959-8.86; P=.06). Conclusions: Incorporating HCV prevention and care information into A-CHESS may increase the uptake of HCV testing while preventing opioid relapse when implemented among populations who engage in high-risk behaviors such as sharing contaminated injection equipment. However, more studies that are powered to detect differences in HCV testing among high-risk groups are needed. Trial Registration: ClinicalTrials.gov NCT02712034; https://clinicaltrials.gov/ct2/show/NCT02712034 International Registered Report Identifier (IRRID): RR2-10.2196/12620 %M 33616545 %R 10.2196/23080 %U https://mhealth.jmir.org/2021/2/e23080 %U https://doi.org/10.2196/23080 %U http://www.ncbi.nlm.nih.gov/pubmed/33616545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24486 %T Demystifying the Dark Web Opioid Trade: Content Analysis on Anonymous Market Listings and Forum Posts %A Li,Zhengyi %A Du,Xiangyu %A Liao,Xiaojing %A Jiang,Xiaoqian %A Champagne-Langabeer,Tiffany %+ Department of Computer Science, Indiana University Bloomington, 700 N Woodlawn Ave, Bloomington, IN, United States, 1 8646508137, xliao@indiana.edu %K opioids %K black market %K anonymous markets and forums %K opioid supply chain %K text mining %K machine learning %K opioid crisis %K opioid epidemic %K drug abuse %D 2021 %7 17.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Opioid use disorder presents a public health issue afflicting millions across the globe. There is a pressing need to understand the opioid supply chain to gain new insights into the mitigation of opioid use and effectively combat the opioid crisis. The role of anonymous online marketplaces and forums that resemble eBay or Amazon, where anyone can post, browse, and purchase opioid commodities, has become increasingly important in opioid trading. Therefore, a greater understanding of anonymous markets and forums may enable public health officials and other stakeholders to comprehend the scope of the crisis. However, to the best of our knowledge, no large-scale study, which may cross multiple anonymous marketplaces and is cross-sectional, has been conducted to profile the opioid supply chain and unveil characteristics of opioid suppliers, commodities, and transactions. Objective: We aimed to profile the opioid supply chain in anonymous markets and forums via a large-scale, longitudinal measurement study on anonymous market listings and posts. Toward this, we propose a series of techniques to collect data; identify opioid jargon terms used in the anonymous marketplaces and forums; and profile the opioid commodities, suppliers, and transactions. Methods: We first conducted a whole-site crawl of anonymous online marketplaces and forums to solicit data. We then developed a suite of opioid domain–specific text mining techniques (eg, opioid jargon detection and opioid trading information retrieval) to recognize information relevant to opioid trading activities (eg, commodities, price, shipping information, and suppliers). Subsequently, we conducted a comprehensive, large-scale, longitudinal study to demystify opioid trading activities in anonymous markets and forums. Results: A total of 248,359 listings from 10 anonymous online marketplaces and 1,138,961 traces (ie, threads of posts) from 6 underground forums were collected. Among them, we identified 28,106 opioid product listings and 13,508 opioid-related promotional and review forum traces from 5147 unique opioid suppliers’ IDs and 2778 unique opioid buyers’ IDs. Our study characterized opioid suppliers (eg, activeness and cross-market activities), commodities (eg, popular items and their evolution), and transactions (eg, origins and shipping destination) in anonymous marketplaces and forums, which enabled a greater understanding of the underground trading activities involved in international opioid supply and demand. Conclusions: The results provide insight into opioid trading in the anonymous markets and forums and may prove an effective mitigation data point for illuminating the opioid supply chain. %M 33595442 %R 10.2196/24486 %U http://www.jmir.org/2021/2/e24486/ %U https://doi.org/10.2196/24486 %U http://www.ncbi.nlm.nih.gov/pubmed/33595442 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e18296 %T Identifying Self-Management Support Needs for Pregnant Women With Opioid Misuse in Online Health Communities: Mixed Methods Analysis of Web Posts %A Liang,Ou Stella %A Chen,Yunan %A Bennett,David S %A Yang,Christopher C %+ College of Computing and Informatics, Drexel University, 3675 Market St, Philadelphia, PA, United States, 1 215 895 1631, chris.yang@drexel.edu %K self-management %K online health community %K opioid use disorder %K pregnancy %D 2021 %7 4.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The current opioid crisis in the United States impacts broad population groups, including pregnant women. Opioid use during pregnancy can affect the health and wellness of both mothers and their infants. Understanding women’s efforts to self-manage opioid use or misuse in pregnancy is needed to identify intervention points for improving maternal outcomes. Objective: This study aims to identify the characteristics of women in an online health community (OHC) with opioid use or misuse during pregnancy and the self-management support needs of these mothers. Methods: A total of 200 web posts by pregnant women with opioid use participating in an OHC were double coded. Concepts and their thematic connections were identified through an inductive process until theoretical saturation was reached. Statistical tests were performed to identify patterns. Results: The majority of pregnant women (150/200, 75.0%) in the OHC exhibited signs of misuse, and 62.5% (125/200) of the participants were either contemplating or pursuing dosage reduction. Self-managed withdrawal was more common (P<.001) than professional treatment among the population. A total of 5 themes of self-management support needs were identified as women sought information about the potential adverse effects of gestational opioid use, protocols for self-managed withdrawal, pain management safety during pregnancy, hospital policies and legal procedures related to child protection, and strategies for navigating offline support systems. In addition, 58.5% (117/200) of the pregnant women expressed negative emotions, of whom only 10.2% (12/117) sought to address their emotional needs with the help of the OHC. Conclusions: OHCs provide vital self-management support for pregnant women with opioid use or misuse. Women pursuing self-managed dosage reduction are prone to misinformation and repeated relapses, which can result in extreme measures to avoid testing positive for drug use at labor. The study findings provide evidence for public policy considerations, including universal screening of substance use for pregnant women, emphasis on treatment rather than legal punishment, and further expansion of the Drug Addiction Treatment Act waiver training program. The improvement of web-based platforms that can organize geo-relevant information, dispense clinically validated withdrawal schedules, and offer structured peer support is envisioned for harm reduction among pregnant women who opt for self-management of opioid misuse. %M 33538695 %R 10.2196/18296 %U https://www.jmir.org/2021/2/e18296 %U https://doi.org/10.2196/18296 %U http://www.ncbi.nlm.nih.gov/pubmed/33538695 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e21212 %T Patterns of Routes of Administration and Drug Tampering for Nonmedical Opioid Consumption: Data Mining and Content Analysis of Reddit Discussions %A Balsamo,Duilio %A Bajardi,Paolo %A Salomone,Alberto %A Schifanella,Rossano %+ Department of Mathematics, University of Turin, Via Carlo Alberto, 10, Turin, 10124, Italy, 39 3331371972, duilio.balsamo@unito.it %K routes of administration %K drug tampering %K Reddit %K word embedding %K social media %K opioid %K heroin %K buprenorphine %K oxycodone %K fentanyl %D 2021 %7 4.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The complex unfolding of the US opioid epidemic in the last 20 years has been the subject of a large body of medical and pharmacological research, and it has sparked a multidisciplinary discussion on how to implement interventions and policies to effectively control its impact on public health. Objective: This study leverages Reddit, a social media platform, as the primary data source to investigate the opioid crisis. We aimed to find a large cohort of Reddit users interested in discussing the use of opioids, trace the temporal evolution of their interest, and extensively characterize patterns of the nonmedical consumption of opioids, with a focus on routes of administration and drug tampering. Methods: We used a semiautomatic information retrieval algorithm to identify subreddits discussing nonmedical opioid consumption and developed a methodology based on word embedding to find alternative colloquial and nonmedical terms referring to opioid substances, routes of administration, and drug-tampering methods. We modeled the preferences of adoption of substances and routes of administration, estimating their prevalence and temporal unfolding. Ultimately, through the evaluation of odds ratios based on co-mentions, we measured the strength of association between opioid substances, routes of administration, and drug tampering. Results: We identified 32 subreddits discussing nonmedical opioid usage from 2014 to 2018 and observed the evolution of interest among over 86,000 Reddit users potentially involved in firsthand opioid usage. We learned the language model of opioid consumption and provided alternative vocabularies for opioid substances, routes of administration, and drug tampering. A data-driven taxonomy of nonmedical routes of administration was proposed. We modeled the temporal evolution of interest in opioid consumption by ranking the popularity of the adoption of opioid substances and routes of administration, observing relevant trends, such as the surge in synthetic opioids like fentanyl and an increasing interest in rectal administration. In addition, we measured the strength of association between drug tampering, routes of administration, and substance consumption, finding evidence of understudied abusive behaviors, like chewing fentanyl patches and dissolving buprenorphine sublingually. Conclusions: This work investigated some important consumption-related aspects of the opioid epidemic using Reddit data. We believe that our approach may provide a novel perspective for a more comprehensive understanding of nonmedical abuse of opioids substances and inform the prevention, treatment, and control of the public health effects. %M 33393910 %R 10.2196/21212 %U https://www.jmir.org/2021/1/e21212 %U https://doi.org/10.2196/21212 %U http://www.ncbi.nlm.nih.gov/pubmed/33393910 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e22411 %T Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study %A Bennett,Alex S %A Freeman,Robert %A Des Jarlais,Don C %A Aronson,Ian David %+ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 665 Broadway, 11th Floor, New York, NY, 10012, United States, 1 917 470 7000, asb19@nyu.edu %K overdose %K opioids %K naloxone %K people who use opioids %K messaging %K harm reduction %K public health intervention %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people use opioids and are at risk of overdose. Naloxone is an opioid antagonist used to counter the effects of opioid overdose. There is an increased availability of naloxone in New York City; however, many who use opioids decline no-cost naloxone even when offered. Others may have the medication but opt not to carry it and report that they would be reluctant to administer it if they were to witness an overdose. Objective: We aim to better understand why people who use opioids may be reluctant to accept, carry, and administer naloxone, and to inform the development of messaging content that addresses barriers to its acceptance and use. Methods: We conducted formative qualitative interviews with 20 people who use opioids who are 18 years and older in New York City. Participants were recruited via key informants and chain referral. Results: Participants cited 4 main barriers that may impede rates of naloxone acceptance, possession, and use: (1) stigma related to substance use, (2) indifference toward overdose, (3) fear of negative consequences of carrying naloxone, and (4) fear of misrecognizing the need for naloxone. Participants also offered suggestions about messaging content to tackle the identified barriers, including messages designed to normalize naloxone possession and use, encourage shared responsibility for community health, and elicit empathy for people who use drugs. Taken together, participants’ narratives hold implications for the following potential messaging content: (1) naloxone is short-acting, and withdrawal sickness does not have to be long-lasting; (2) it is critical to accurately identify an opioid-involved overdose; (3) anyone can overdose; (4) naloxone cannot do harm; and (5) the prompt administration of the medication can help ensure that someone can enjoy another day. Finally, participants suggested that messaging should also debunk myths and stereotypes about people who use drugs more generally; people who use opioids who reverse overdoses should be framed as lay public health advocates and not just “others” to be managed with stigmatizing practices and language. Conclusions: It must be made a public health priority to get naloxone to people who use opioids who are best positioned to reverse an overdose, and to increase the likelihood that they will carry naloxone and use it when needed. Developing, tailoring, and deploying messages to address stigma, indifference toward overdose, fear and trepidation about reversing an overdose, and fear of police involvement may help alleviate fears among some people who are reluctant to obtain naloxone and use the medication on someone in an overdose situation. %M 33355094 %R 10.2196/22411 %U http://formative.jmir.org/2020/12/e22411/ %U https://doi.org/10.2196/22411 %U http://www.ncbi.nlm.nih.gov/pubmed/33355094 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e15293 %T Detection of Suicidality Among Opioid Users on Reddit: Machine Learning–Based Approach %A Yao,Hannah %A Rashidian,Sina %A Dong,Xinyu %A Duanmu,Hongyi %A Rosenthal,Richard N %A Wang,Fusheng %+ Stony Brook University, 2313D Computer Science, Stony Brook, NY, 11794, United States, 1 631 632 2594, fusheng.wang@stonybrook.edu %K opioid epidemic %K opioid-related disorders %K suicide %K social media %K machine learning %K deep learning %K natural language processing %D 2020 %7 27.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, both suicide and overdose rates have been increasing. Many individuals who struggle with opioid use disorder are prone to suicidal ideation; this may often result in overdose. However, these fatal overdoses are difficult to classify as intentional or unintentional. Intentional overdose is difficult to detect, partially due to the lack of predictors and social stigmas that push individuals away from seeking help. These individuals may instead use web-based means to articulate their concerns. Objective: This study aimed to extract posts of suicidality among opioid users on Reddit using machine learning methods. The performance of the models is derivative of the data purity, and the results will help us to better understand the rationale of these users, providing new insights into individuals who are part of the opioid epidemic. Methods: Reddit posts between June 2017 and June 2018 were collected from r/suicidewatch, r/depression, a set of opioid-related subreddits, and a control subreddit set. We first classified suicidal versus nonsuicidal languages and then classified users with opioid usage versus those without opioid usage. Several traditional baselines and neural network (NN) text classifiers were trained using subreddit names as the labels and combinations of semantic inputs. We then attempted to extract out-of-sample data belonging to the intersection of suicide ideation and opioid abuse. Amazon Mechanical Turk was used to provide labels for the out-of-sample data. Results: Classification results were at least 90% across all models for at least one combination of input; the best classifier was convolutional neural network, which obtained an F1 score of 96.6%. When predicting out-of-sample data for posts containing both suicidal ideation and signs of opioid addiction, NN classifiers produced more false positives and traditional methods produced more false negatives, which is less desirable for predicting suicidal sentiments. Conclusions: Opioid abuse is linked to the risk of unintentional overdose and suicide risk. Social media platforms such as Reddit contain metadata that can aid machine learning and provide information at a personal level that cannot be obtained elsewhere. We demonstrate that it is possible to use NNs as a tool to predict an out-of-sample target with a model built from data sets labeled by characteristics we wish to distinguish in the out-of-sample target. %M 33245287 %R 10.2196/15293 %U http://www.jmir.org/2020/11/e15293/ %U https://doi.org/10.2196/15293 %U http://www.ncbi.nlm.nih.gov/pubmed/33245287 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e21015 %T Reducing Alcohol and Opioid Use Among Youth in Rural Counties: An Innovative Training Protocol for Primary Health Care Providers and School Personnel %A Francis,Erica %A Shifler Bowers,Kara %A Buchberger,Glenn %A Ryan,Sheryl %A Milchak,William %A Kraschnewski,Jennifer %+ College of Medicine, Penn State University, 90 Hope Drive, Hershey, PA, 17033, United States, 1 17175990866, kbowers1@pennstatehealth.psu.edu %K alcoholism %K adolescent behavior %K binge drinking %K rural health %K underage drinking %K adolescent %K young adult %K alcohol %K drinking %K behavior %K screening %K intervention %K referral %D 2020 %7 6.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Given that youth alcohol use is more common in rural communities, such communities can play a key role in preventing alcohol use among adolescents. Guidelines recommend primary care providers incorporate screening, brief intervention, and referral to treatment (SBIRT) into routine care. Objective: The aim is to train primary care providers and school nurses within a rural 10-county catchment area in Pennsylvania to use SBIRT and facilitate collaboration with community organizations to better coordinate substance use prevention efforts. Methods: To build capacity to address underage drinking and opioid use among youth aged 9-20 years, this project uses telehealth, specifically Project ECHO (Extension for Community Healthcare Outcomes), to train primary care providers and school nurses to address substance use with SBIRT. Our project will provide 120 primary care providers and allied health professionals as well as 20 school nurses with SBIRT training. Community-based providers will participate in weekly virtual ECHO sessions with a multidisciplinary team from Penn State College of Medicine that will provide SBIRT training and facilitate case discussions among participants. Results: To date, we have launched one SBIRT ECHO project with school personnel, enrolling 34 participants. ECHO participants are from both rural (n=17) and urban (n=17) counties and include school nurses (n=15), school counselors (n=8), teachers (n=5), administrators (n=3), and social workers (n=3). Before the study began, only 2/13 (15.5%) of schools were screening for alcohol use. Conclusions: This project teaches primary care clinics and schools to use SBIRT to prevent the onset and reduce the progression of substance use disorders, reduce problems associated with substance use disorders, and strengthen communities’ prevention capacity. Ours is an innovative model to improve rural adolescent health by reducing alcohol and opioid use. International Registered Report Identifier (IRRID): DERR1-10.2196/21015 %M 33155572 %R 10.2196/21015 %U http://www.researchprotocols.org/2020/11/e21015/ %U https://doi.org/10.2196/21015 %U http://www.ncbi.nlm.nih.gov/pubmed/33155572 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e23463 %T Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward? %A Stull,Samuel W %A McKnight,Erin R %A Bonny,Andrea E %+ Department of Biobehavioral Health, The Pennsylvania State University, Biobehavioral Health Building, University Park, PA, 16802, United States, 1 6145518640, sws6084@psu.edu %K adolescent %K opioid use disorder %K treatment %K telehealth %K drug %K perspective %K opioid %K COVID-19 %K young adult %D 2020 %7 9.10.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Opioid use disorder (OUD) is one of the most pressing public health problems in the United States and is highly prevalent among adolescents and young adults (AYAs). However, only a small percentage of AYAs with OUD ever receive treatment. Further, among those that do receive treatment, a substantial proportion of patients continue to struggle with OUD, and many prematurely drop out of treatment. These challenges have only been heightened in the face of the COVID-19 pandemic, but greater utilization of telehealth and mobile technologies by OUD patients may help counter these barriers, which ultimately may improve AYA OUD treatment in the postpandemic period. This viewpoint presents the perspective of a person in OUD recovery using online and mobile technology to support his own OUD recovery combined with thoughts from two clinicians supporting AYAs with OUD. Their perspectives may provide insights to help counter COVID-19–related consequences and offer clues to improving AYA OUD treatment in the long term. %M 33016885 %R 10.2196/23463 %U http://pediatrics.jmir.org/2020/2/e23463/ %U https://doi.org/10.2196/23463 %U http://www.ncbi.nlm.nih.gov/pubmed/33016885 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21676 %T Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: Ecological Momentary Assessment Study %A Papp,Lauren M %A Barringer,Alexandra %A Blumenstock,Shari M %A Gu,Pamela %A Blaydes,Madison %A Lam,Jaime %A Kouros,Chrystyna D %+ Department of Human Development and Family Studies, University of Wisconsin-Madison, 1300 Linden Drive, Madison, WI, 53706, United States, 1 608 262 8611, papp@wisc.edu %K compliance %K ecological momentary assessment %K prescription drug misuse %K young adult %D 2020 %7 1.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prescription drug misuse and abuse is an established public health challenge, and young adults are particularly affected. There is a striking lack of real-time, naturalistic data collection assessing intentions to misuse and other precipitating factors at the time of actual misuse, leaving the conditions under which individuals are most likely to misuse prescription medications unknown. Ecological momentary assessment (EMA) apps and protocols designed to capture this information would accelerate and expand the knowledge base and could directly contribute to prevention and treatment efforts. Objective: The objectives of this study are to describe the development and administration of a mobile app and the EMA protocol designed to collect real-time factors associated with college students’ prescription drug misuse intentions and behaviors in daily life; present completion rates, compliance, acceptability, and reactivity associated with the EMA protocol for participants who endorsed recent prescription drug misuse at screening (ie, risk group; n=300) and those who did not (ie, nonrisk group; n=55); and establish initial construct validity by linking the reports of misuse behaviors in daily life collected via the EMA app to prescription drug misuse reported on a standard survey. Methods: An EMA data collection app and protocol were designed specifically to capture hypothesized contextual factors along with prescription drug misuse intentions and behaviors in daily life. Using this protocol, young adult college students (N=352) completed signal- and event-contingent reports over a 28-day period. When the intention to misuse a prescription drug was endorsed, a brief follow-up prompt was sent 15 min later to collect participants’ indications of whether or not misuse had occurred. Results: Risk-group participants were significantly more likely than nonrisk counterparts to endorse any prescription drug misuse intentions in daily life (P<.001), to complete one or more follow-up reports (P<.001), and to endorse any prescription drug misuse behavior in daily life on the follow-ups (P<.001). Overall, participants demonstrated consistent engagement with the EMA procedures and returned an average of 74.5 (SD 23.82; range 10-122) reports. Participants in the risk and nonrisk groups did not differ in the number of reports they completed (P=.12), the number of their reporting days (P=.32), or their average completion rates (P=.14). The results indicated some evidence of reactivity to the momentary reporting procedure. Participants reported uniformly positive experiences and remained highly engaged throughout the reporting protocol and broader study. Conclusions: The novel EMA app and protocol provide an effective way to assess real-time factors associated with prescription drug misuse intentions and behaviors in daily life. The resulting investigations offer the potential to provide highly translatable information for research and prevention efforts. %M 32877351 %R 10.2196/21676 %U https://mhealth.jmir.org/2020/10/e21676 %U https://doi.org/10.2196/21676 %U http://www.ncbi.nlm.nih.gov/pubmed/32877351 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e19496 %T Stories to Communicate Individual Risk for Opioid Prescriptions for Back and Kidney Stone Pain: Protocol for the Life STORRIED Multicenter Randomized Clinical Trial %A Meisel,Zachary F %A Goldberg,Erica B %A Dolan,Abby R %A Bansal,Esha %A Rhodes,Karin V %A Hess,Erik P %A Cannuscio,Carolyn C %A Schapira,Marilyn M %A Perrone,Jeanmarie %A Rodgers,Melissa A %A Zyla,Michael M %A Bell,Jeffrey J %A McCollum,Sharon %A Shofer,Frances S %+ Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Blockley Hall, Philadelphia, PA, 19104, United States, 1 225 586 0267, zfm@pennmedicine.upenn.edu %K prescription opioids %K opioid misuse %K acute pain: opioid risk %K probabilistic risk tool %K renal colic %K musculoskeletal back pain %K narratives %K randomized controlled trial %D 2020 %7 24.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Prescription opioid misuse in the United States is a devastating public health crisis; many chronic opioid users were originally prescribed this class of medication for acute pain. Video narrative–enhanced risk communication may improve patient outcomes, such as knowledge of opioid risk and opioid use behaviors after an episode of acute pain. Objective: Our objective is to assess the effect of probabilistic and narrative-enhanced opioid risk communication on patient-reported outcomes, including knowledge, opioid use, and patient preferences, for patients who present to emergency departments with back pain and kidney stone pain. Methods: This is a multisite randomized controlled trial. Patients presenting to the acute care facilities of four geographically and ethnically diverse US hospital centers with acute renal colic pain or musculoskeletal back and/or neck pain are eligible for this randomized controlled trial. A control group of patients receiving general risk information is compared to two intervention groups: one receiving the risk information sheet plus an individualized, visual probabilistic Opioid Risk Tool (ORT) and another receiving the risk information sheet plus a video narrative–enhanced probabilistic ORT. We will study the effect of probabilistic and narrative-enhanced opioid risk communication on the following: risk awareness and recall at 14 days postenrollment, reduced use or preferences for opioids after the emergency department episode, and alignment with patient preference and provider prescription. To assess these outcomes, we administer baseline patient surveys during acute care admission and follow-up surveys at predetermined times during the 3 months after discharge. Results: A total of 1302 patients were enrolled over 24 months. The mean age of the participants was 40 years (SD 14), 692 out of 1302 (53.15%) were female, 556 out of 1302 (42.70%) were White, 498 out of 1302 (38.25%) were Black, 1002 out of 1302 (76.96%) had back pain, and 334 out of 1302 (25.65%) were at medium or high risk. Demographics and ORT scores were equally distributed across arms. Conclusions: This study seeks to assess the potential clinical role of narrative-enhanced, risk-informed communication for acute pain management in acute care settings. This paper outlines the protocol used to implement the study and highlights crucial methodological, statistical, and stakeholder involvement as well as dissemination considerations. Trial Registration: ClinicalTrials.gov NCT03134092; https://clinicaltrials.gov/ct2/show/NCT03134092 International Registered Report Identifier (IRRID): DERR1-10.2196/19496 %M 32969832 %R 10.2196/19496 %U http://www.researchprotocols.org/2020/9/e19496/ %U https://doi.org/10.2196/19496 %U http://www.ncbi.nlm.nih.gov/pubmed/32969832 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18350 %T Social Media Text Mining Framework for Drug Abuse: Development and Validation Study With an Opioid Crisis Case Analysis %A Nasralah,Tareq %A El-Gayar,Omar %A Wang,Yong %+ Supply Chain and Information Management Group, D’Amore-McKim School of Business, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, United States, 1 617 373 4460, t.nasralah@northeastern.edu %K drug abuse %K social media %K infodemiology %K infoveillance %K text mining %K opioid crisis %D 2020 %7 13.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media are considered promising and viable sources of data for gaining insights into various disease conditions and patients’ attitudes, behaviors, and medications. They can be used to recognize communication and behavioral themes of problematic use of prescription drugs. However, mining and analyzing social media data have challenges and limitations related to topic deduction and data quality. As a result, we need a structured approach to analyze social media content related to drug abuse in a manner that can mitigate the challenges and limitations surrounding the use of such data. Objective: This study aimed to develop and evaluate a framework for mining and analyzing social media content related to drug abuse. The framework is designed to mitigate challenges and limitations related to topic deduction and data quality in social media data analytics for drug abuse. Methods: The proposed framework started with defining different terms related to the keywords, categories, and characteristics of the topic of interest. We then used the Crimson Hexagon platform to collect data based on a search query informed by a drug abuse ontology developed using the identified terms. We subsequently preprocessed the data and examined the quality using an evaluation matrix. Finally, a suitable data analysis approach could be used to analyze the collected data. Results: The framework was evaluated using the opioid epidemic as a drug abuse case analysis. We demonstrated the applicability of the proposed framework to identify public concerns toward the opioid epidemic and the most discussed topics on social media related to opioids. The results from the case analysis showed that the framework could improve the discovery and identification of topics in social media domains characterized by a plethora of highly diverse terms and lack of a commonly available dictionary or language by the community, such as in the case of opioid and drug abuse. Conclusions: The proposed framework addressed the challenges related to topic detection and data quality. We demonstrated the applicability of the proposed framework to identify the common concerns toward the opioid epidemic and the most discussed topics on social media related to opioids. %M 32788147 %R 10.2196/18350 %U https://www.jmir.org/2020/8/e18350 %U https://doi.org/10.2196/18350 %U http://www.ncbi.nlm.nih.gov/pubmed/32788147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17750 %T Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial %A Anthony,Chris A %A Rojas,Edward Octavio %A Keffala,Valerie %A Glass,Natalie Ann %A Shah,Apurva S %A Miller,Benjamin J %A Hogue,Matthew %A Willey,Michael C %A Karam,Matthew %A Marsh,John Lawrence %+ Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, United States, 1 319 356 8690, edward-rojas@uiowa.edu %K acceptance and commitment therapy %K opioid crisis %K patient-reported outcome measures %K postoperative pain %K orthopedics %K text messaging %K chatbot %K conversational agents %K mHealth %D 2020 %7 29.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Acceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain. Objective: This study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries. Methods: Adult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups. Results: A total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone–based ACT intervention (P=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; P=.04). Conclusions: In this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference. Trial Registration: ClinicalTrials.gov NCT03991546; https://clinicaltrials.gov/ct2/show/NCT03991546 %M 32723723 %R 10.2196/17750 %U https://www.jmir.org/2020/7/e17750 %U https://doi.org/10.2196/17750 %U http://www.ncbi.nlm.nih.gov/pubmed/32723723 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16783 %T The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study %A Jongbloed,Kate %A Pearce,Margo E %A Thomas,Vicky %A Sharma,Richa %A Pooyak,Sherri %A Demerais,Lou %A Lester,Richard T %A Schechter,Martin T %A Spittal,Patricia M %A , %+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 875 2345 ext 5944, spittal@sm.hivnet.ubc.ca %K Indigenous %K mobile health %K mHealth %K text messaging %K substance use %K HIV/AIDS %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective: This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population. Methods: The Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth. Results: Less than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services. Conclusions: We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population. %M 32716311 %R 10.2196/16783 %U https://mhealth.jmir.org/2020/7/e16783 %U https://doi.org/10.2196/16783 %U http://www.ncbi.nlm.nih.gov/pubmed/32716311 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17693 %T Evaluation of Volume of News Reporting and Opioid-Related Deaths in the United States: Comparative Analysis Study of Geographic and Socioeconomic Differences %A Hswen,Yulin %A Zhang,Amanda %A Freifeld,Clark %A Brownstein,John S %+ University of California San Francisco, Department of Epidemiology and Biostatistics, Bakar Computational Health Sciences Institute, 505 Parnassus Ave, San Francisco, CA, 94143, United States, 1 6177751889, yhswen@gmail.com %K opioid epidemic %K news media %K geographic %K socioeconomic %K addiction %K overdose %D 2020 %7 10.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: News media coverage is a powerful influence on public attitude and government action. The digitization of news media covering the current opioid epidemic has changed the landscape of coverage and may have implications for how to effectively respond to the opioid crisis. Objective: This study aims to characterize the relationship between volume of online opioid news reporting and opioid-related deaths in the United States and how these measures differ across geographic and socioeconomic county-level factors. Methods: Online news reports from February 2018 to April 2019 on opioid-related events in the United States were extracted from Google News. News data were aggregated at the county level and compared against opioid-related death counts. Ordinary least squares regression was used to model opioid-related death rate and opioid news coverage with the inclusion of socioeconomic and geographic explanatory variables. Results: A total of 35,758 relevant news reports were collected representing 1789 counties. Regression analysis revealed that opioid-related death rate was positively associated with news reporting. However, opioid-related death rate and news reporting volume showed opposite correlations with educational attainment and rurality. When controlling for variation in death rate, counties in the Northeast were overrepresented by news coverage. Conclusions: Our results suggest that regional variation in the volume of opioid-related news reporting does not reflect regional variation in opioid-related death rate. Differences in the amount of media attention may influence perceptions of the severity of opioid epidemic. Future studies should investigate the influence of media reporting on public support and action on opioid issues. %M 32673248 %R 10.2196/17693 %U http://www.jmir.org/2020/7/e17693/ %U https://doi.org/10.2196/17693 %U http://www.ncbi.nlm.nih.gov/pubmed/32673248 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e17073 %T Online Conversation Monitoring to Understand the Opioid Epidemic: Epidemiological Surveillance Study %A Black,Joshua C %A Margolin,Zachary R %A Olson,Richard A %A Dart,Richard C %+ Rocky Mountain Poison and Drug Safety, 1391 N Speer Blvd #600, M/C 0180, Denver, CO, 80204, United States, 1 303 389 1652, joshua.black@rmpds.org %K epidemiological surveillance %K infoveillance %K infodemiology %K opioids %K social media %K misuse %K abuse %K addiction %K overdose %K death %D 2020 %7 29.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Between 2016 and 2017, the national mortality rate involving opioids continued its escalation; opioid deaths rose from 42,249 to 47,600, bringing the public health crisis to a new height. Considering that 69% of adults in the United States use online social media sites, a resource that builds a more complete understanding of prescription drug misuse and abuse could supplement traditional surveillance instruments. The Food and Drug Administration has identified 5 key risks and consequences of opioid drugs—misuse, abuse, addiction, overdose, and death. Identifying posts that discuss these key risks could lead to novel information that is not typically captured by traditional surveillance systems. Objective: The goal of this study was to describe the trends of online posts (frequency over time) involving abuse, misuse, addiction, overdose, and death in the United States and to describe the types of websites that host these discussions. Internet posts that mentioned fentanyl, hydrocodone, oxycodone, or oxymorphone were examined. Methods: Posts that did not refer to personal experiences were removed, after which 3.1 million posts remained. A stratified sample of 61,000 was selected. Unstructured data were classified into 5 key risks by manually coding for key outcomes of misuse, abuse, addiction, overdose, and death. Sampling probabilities of the coded posts were used to estimate the total post volume for each key risk. Results: Addiction and misuse were the two most commonly discussed key risks for hydrocodone, oxycodone, and oxymorphone. For fentanyl, overdose and death were the most discussed key risks. Fentanyl had the highest estimated number of misuse-, overdose-, and death-related mentions (41,808, 42,659, and 94,169, respectively). Oxycodone had the highest estimated number of abuse- and addiction-related mentions (3548 and 12,679, respectively). The estimated volume of online posts for fentanyl increased by more than 10-fold in late 2017 and 2018. The odds of discussing fentanyl overdose (odds ratios [OR] 4.32, 95% CI 2.43-7.66) and death (OR 5.05, 95% CI 3.10-8.21) were higher for social media, while the odds of discussing fentanyl abuse (OR 0.10, 95% CI 0.04-0.22) and addiction (OR 0.24, 95% CI 0.15-0.38) were higher for blogs and forums. Conclusions: Of the 5 FDA-defined key risks, fentanyl overdose and death has dominated discussion in recent years, while discussion of oxycodone, hydrocodone, and oxymorphone has decreased. As drug-related deaths continue to increase, an understanding of the motivations, circumstances, and consequences of drug abuse would assist in developing policy responses. Furthermore, content was notably different based on media origin, and studies that exclusively use either social media sites (such as Twitter) or blogs and forums could miss important content. This study sets out sustainable, ongoing methodology for surveilling internet postings regarding these drugs. %M 32597786 %R 10.2196/17073 %U http://publichealth.jmir.org/2020/2/e17073/ %U https://doi.org/10.2196/17073 %U http://www.ncbi.nlm.nih.gov/pubmed/32597786 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e17574 %T Using Twitter to Surveil the Opioid Epidemic in North Carolina: An Exploratory Study %A Anwar,Mohd %A Khoury,Dalia %A Aldridge,Arnie P %A Parker,Stephanie J %A Conway,Kevin P %+ North Carolina A&T State University, 1601 East Market St, Greensboro, NC, 27401, United States, 1 (336) 334 7500, manwar@ncat.edu %K opioids %K surveillance %K social media %D 2020 %7 24.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Over the last two decades, deaths associated with opioids have escalated in number and geographic spread, impacting more and more individuals, families, and communities. Reflecting on the shifting nature of the opioid overdose crisis, Dasgupta, Beletsky, and Ciccarone offer a triphasic framework to explain that opioid overdose deaths (OODs) shifted from prescription opioids for pain (beginning in 2000), to heroin (2010 to 2015), and then to synthetic opioids (beginning in 2013). Given the rapidly shifting nature of OODs, timelier surveillance data are critical to inform strategies that combat the opioid crisis. Using easily accessible and near real-time social media data to improve public health surveillance efforts related to the opioid crisis is a promising area of research. Objective: This study explored the potential of using Twitter data to monitor the opioid epidemic. Specifically, this study investigated the extent to which the content of opioid-related tweets corresponds with the triphasic nature of the opioid crisis and correlates with OODs in North Carolina between 2009 and 2017. Methods: Opioid-related Twitter posts were obtained using Crimson Hexagon, and were classified as relating to prescription opioids, heroin, and synthetic opioids using natural language processing. This process resulted in a corpus of 100,777 posts consisting of tweets, retweets, mentions, and replies. Using a random sample of 10,000 posts from the corpus, we identified opioid-related terms by analyzing word frequency for each year. OODs were obtained from the Multiple Cause of Death database from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Least squares regression and Granger tests compared patterns of opioid-related posts with OODs. Results: The pattern of tweets related to prescription opioids, heroin, and synthetic opioids resembled the triphasic nature of OODs. For prescription opioids, tweet counts and OODs were statistically unrelated. Tweets mentioning heroin and synthetic opioids were significantly associated with heroin OODs and synthetic OODs in the same year (P=.01 and P<.001, respectively), as well as in the following year (P=.03 and P=.01, respectively). Moreover, heroin tweets in a given year predicted heroin deaths better than lagged heroin OODs alone (P=.03). Conclusions: Findings support using Twitter data as a timely indicator of opioid overdose mortality, especially for heroin. %M 32469322 %R 10.2196/17574 %U http://publichealth.jmir.org/2020/2/e17574/ %U https://doi.org/10.2196/17574 %U http://www.ncbi.nlm.nih.gov/pubmed/32469322 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e15752 %T Technologies for Opioid Use Disorder Management: Mobile App Search and Scoping Review %A Nuamah,Joseph %A Mehta,Ranjana %A Sasangohar,Farzan %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K mHealth %K apps %K wearable sensors %K substance abuse disorder %K mobile phone %D 2020 %7 5.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in technology engender the investigation of technological solutions to opioid use disorder (OUD). However, in comparison to chronic disease management, the application of mobile health (mHealth) to OUD has been limited. Objective: The overarching aim of our research was to design OUD management technologies that utilize wearable sensors to provide continuous monitoring capabilities. The objectives of this study were to (1) document the currently available opioid-related mHealth apps, (2) review past and existing technology solutions that address OUD, and (3) discuss opportunities for technological withdrawal management solutions. Methods: We used a two-phase parallel search approach: (1) an app search to determine the availability of opioid-related mHealth apps and (2) a scoping review of relevant literature to identify relevant technologies and mHealth apps used to address OUD. Results: The app search revealed a steady rise in app development, with most apps being clinician-facing. Most of the apps were designed to aid in opioid dose conversion. Despite the availability of these apps, the scoping review found no study that investigated the efficacy of mHealth apps to address OUD. Conclusions: Our findings highlight a general gap in technological solutions of OUD management and the potential for mHealth apps and wearable sensors to address OUD. %M 32501273 %R 10.2196/15752 %U https://mhealth.jmir.org/2020/6/e15752 %U https://doi.org/10.2196/15752 %U http://www.ncbi.nlm.nih.gov/pubmed/32501273 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e17688 %T Online Interventions for the Selective Prevention of Illicit Drug Use in Young Drug Users: Exploratory Study %A Tomazic,Tina %A Jerkovic,Olivera Stanojevic %+ Institute of Media Communications, Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroska 46, Maribor, 2000, Slovenia, 386 41704302, tina.tomazic@um.si %K web-based %K intervention %K prevention %K internet %D 2020 %7 22.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies have a major impact on the daily lives of young people and are also used to seek information on and help with drug-related issues online. Objective: The aim of this article was to analyze current online interventions for young drug users in Slovenia, with the purpose of contributing to the development of guidelines and key recommendations for effective online interventions. Methods: This study was part of the project Click for Support. We performed a keyword search, received input from national experts in the field of drug prevention, and conducted an assessment of recognized national online interventions through workshop-based discussions with the target group of 20 young drug users. Results: The current online intervention services in Slovenia are satisfactory but are still not sufficiently recognized. The most important issues for young drug users were the design and functionality of the online intervention, presence of a clear structure, possibility of using it on smartphones, comprehensive and quick professional feedback, and data security. Playful elements and the ability to share (experiences) with other or former users were also recognized as important. Conclusions: With effective online interventions, we can include more young drug users, facilitate access to a more affordable service, provide quick professional feedback on patterns of consumption, increase knowledge about the effects and consequences of drugs, and support the reduction or cessation of drug use. From the public health perspective, it is challenging to provide drug interventions broadly to the target group and, hence, decrease inequities. %M 32319962 %R 10.2196/17688 %U http://www.jmir.org/2020/4/e17688/ %U https://doi.org/10.2196/17688 %U http://www.ncbi.nlm.nih.gov/pubmed/32319962 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 3 %P e16199 %T Discrepancies in Written Versus Calculated Durations in Opioid Prescriptions: Pre-Post Study %A Slovis,Benjamin H %A Kairys,John %A Babula,Bracken %A Girondo,Melanie %A Martino,Cara %A Roke,Lindsey M %A Riggio,Jeffrey %+ Office of the Chief Medical Information Officer, Thomas Jefferson University, 833 Chestnut St, 10th Floor, Philadelphia, PA, 19107, United States, 1 215 955 7975, Benjamin.Slovis@jefferson.edu %K informatics %K electronic health record %K opioids %K prescription %K duration %D 2020 %7 31.3.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The United States is in the midst of an opioid epidemic. Long-term use of opioid medications is associated with an increased risk of dependence. The US Centers for Disease Control and Prevention makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment. Objective: The purpose of this study was to determine if opioid prescription quantities written at our institution exceed intended duration of treatment and whether enhancements to our electronic health record system improved any discrepancies. Methods: We examined the opioid prescriptions written at our institution for a 22-month period. We examined the duration of treatment documented in the prescription itself and calculated a duration based on the quantity of tablets and doses per day. We determined whether requiring documentation of the prescription duration affected these outcomes. Results: We reviewed 72,314 opioid prescriptions, of which 16.96% had a calculated duration that was greater than what was documented in the prescription. Making the duration a required field significantly reduced this discrepancy (17.95% vs 16.21%, P<.001) but did not eliminate it. Conclusions: Health information technology vendors should develop tools that, by default, accurately represent prescription durations and/or modify doses and quantities dispensed based on provider-entered durations. This would potentially reduce unintended prolonged opioid use and reduce the potential for long-term dependence. %M 32229472 %R 10.2196/16199 %U https://medinform.jmir.org/2020/3/e16199 %U https://doi.org/10.2196/16199 %U http://www.ncbi.nlm.nih.gov/pubmed/32229472 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e16191 %T Exploring Substance Use Tweets of Youth in the United States: Mixed Methods Study %A Stevens,Robin C %A Brawner,Bridgette M %A Kranzler,Elissa %A Giorgi,Salvatore %A Lazarus,Elizabeth %A Abera,Maramawit %A Huang,Sarah %A Ungar,Lyle %+ Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Fagin Hall, Philadelphia, PA, United States, 1 2158984063, robin2@nursing.upenn.edu %K social media %K illicit drug %K youth %K adolescent %D 2020 %7 26.3.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Substance use by youth remains a significant public health concern. Social media provides the opportunity to discuss and display substance use–related beliefs and behaviors, suggesting that the act of posting drug-related content, or viewing posted content, may influence substance use in youth. This aligns with empirically supported theories, which posit that behavior is influenced by perceptions of normative behavior. Nevertheless, few studies have explored the content of posts by youth related to substance use. Objective: This study aimed to identify the beliefs and behaviors of youth related to substance use by characterizing the content of youths’ drug-related tweets. Using a sequential explanatory mixed methods approach, we sampled drug-relevant tweets and qualitatively examined their content. Methods: We used natural language processing to determine the frequency of drug-related words in public tweets (from 2011 to 2015) among youth Twitter users geolocated to Pennsylvania. We limited our sample by age (13-24 years), yielding approximately 23 million tweets from 20,112 users. We developed a list of drug-related keywords and phrases and selected a random sample of tweets with the most commonly used keywords to identify themes (n=249). Results: We identified two broad classes of emergent themes: functional themes and relational themes. Functional themes included posts that explicated a function of drugs in one’s life, with subthemes indicative of pride, longing, coping, and reminiscing as they relate to drug use and effects. Relational themes emphasized a relational nature of substance use, capturing substance use as a part of social relationships, with subthemes indicative of drug-related identity and companionship. We also identified topical areas in tweets related to drug use, including reference to polysubstance use, pop culture, and antidrug content. Across the tweets, the themes of pride (63/249, 25.3%) and longing (39/249, 15.7%) were the most popular. Most tweets that expressed pride (46/63, 73%) were explicitly related to marijuana. Nearly half of the tweets on coping (17/36, 47%) were related to prescription drugs. Very few of the tweets contained antidrug content (9/249, 3.6%). Conclusions: Data integration indicates that drugs are typically discussed in a positive manner, with content largely reflective of functional and relational patterns of use. The dissemination of this information, coupled with the relative absence of antidrug content, may influence youth such that they perceive drug use as normative and justified. Strategies to address the underlying causes of drug use (eg, coping with stressors) and engage antidrug messaging on social media may reduce normative perceptions and associated behaviors among youth. The findings of this study warrant research to further examine the effects of this content on beliefs and behaviors and to identify ways to leverage social media to decrease substance use in this population. %M 32213472 %R 10.2196/16191 %U http://publichealth.jmir.org/2020/1/e16191/ %U https://doi.org/10.2196/16191 %U http://www.ncbi.nlm.nih.gov/pubmed/32213472 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e16038 %T How Motivations for Using Buprenorphine Products Differ From Using Opioid Analgesics: Evidence from an Observational Study of Internet Discussions Among Recreational Users %A Butler,Stephen F %A Oyedele,Natasha K %A Dailey Govoni,Taryn %A Green,Jody L %+ Inflexxion, 3070 Bristol Street, Suite 350, Costa Mesa, CA, 92626, United States, 1 6033057068, sfbutler@inflexxion.com %K buprenorphine-naloxone combination %K buprenorphine %K motivation %K controlled substance diversion %K addiction, opioid %K opioid medication-assisted treatment %D 2020 %7 25.3.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Opioid use disorder (OUD) poses medical and societal concerns. Although most individuals with OUD in the United States are not in drug abuse treatment, buprenorphine is considered a safe and effective OUD treatment, which reduces illicit opioid use, mortality, and other drug-related harms. However, as buprenorphine prescriptions increase, so does evidence of misused, abused, or diverted buprenorphine. Users’ motivations for extratreatment use of buprenorphine (ie, misuse or abuse of one’s own prescription or use of diverted medication) may be different from the motivations involved in analgesic opioid products. Previous research is based on small sample sizes and use surveys, and none directly compare the motivations for using buprenorphine products (ie, tablet or film) with other opioid products having known abuse potential. Objective: The aim of the study was to describe and compare the motivation-to-use buprenorphine products, including buprenorphine/naloxone (BNX) sublingual film and oxycodone extended-release (ER), as discussed in online forums. Methods: Web-based posts from 2012 to 2016 were collected from online forums using the Web Informed Services internet monitoring archive. A random sample of posts was coded for motivation to use. These posts were coded into the following motivation categories: (1) use to avoid withdrawal, (2) pain relief, (3) tapering from other drugs, (4) opioid addiction treatment, (5) recreational use (ie, to get high), and (6) other use. Oxycodone ER, an opioid analgesic with known abuse potential, was selected as a comparator. Results: Among all posts, 0.81% (30,576/3,788,922) discussed motivation to use one of the target products. The examination of query-selected posts revealed significantly greater discussion of buprenorphine products than oxycodone ER (P<.001). The posts mentioning buprenorphine products were more likely than oxycodone ER to discuss treatment for OUD, tapering down use, and/or withdrawal management (P<.001). Buprenorphine-related posts discussed recreational use (375/1020, 36.76%), although much less often than in oxycodone ER posts (425/508, 83.7%). Despite some differences, the overall pattern of motivation to use was similar for BNX sublingual film and other buprenorphine products. Conclusions: An analysis of spontaneous, Web-based discussion among recreational substance users who post on online drug forums supports the contention that motivation-to-use patterns associated with buprenorphine products are different from those reported for oxycodone ER. Although the findings presented here are not expected to reflect the actual use of the target products, they may represent the interests and motivations of those posting on the online forums. Buprenorphine-related posts were more likely to discuss treatment for OUD, tapering, and withdrawal management than oxycodone ER. Although the findings are consistent with a purported link between the limited availability of medication-assisted therapies for substance use disorders and use of diverted buprenorphine products for self-treatment, recreational use was a motivation expressed in more than one-third of buprenorphine posts. %M 32209533 %R 10.2196/16038 %U http://publichealth.jmir.org/2020/1/e16038/ %U https://doi.org/10.2196/16038 %U http://www.ncbi.nlm.nih.gov/pubmed/32209533 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e15861 %T Promoting Reproducible Research for Characterizing Nonmedical Use of Medications Through Data Annotation: Description of a Twitter Corpus and Guidelines %A O'Connor,Karen %A Sarker,Abeed %A Perrone,Jeanmarie %A Gonzalez Hernandez,Graciela %+ Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19095, United States, 1 2155738089, karoc@pennmedicine.upenn.edu %K prescription drug misuse %K social media %K substance abuse detection %K natural language processing %K machine learning %K infodemiology %K infoveillance %D 2020 %7 26.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media data are being increasingly used for population-level health research because it provides near real-time access to large volumes of consumer-generated data. Recently, a number of studies have explored the possibility of using social media data, such as from Twitter, for monitoring prescription medication abuse. However, there is a paucity of annotated data or guidelines for data characterization that discuss how information related to abuse-prone medications is presented on Twitter. Objective: This study discusses the creation of an annotated corpus suitable for training supervised classification algorithms for the automatic classification of medication abuse–related chatter. The annotation strategies used for improving interannotator agreement (IAA), a detailed annotation guideline, and machine learning experiments that illustrate the utility of the annotated corpus are also described. Methods: We employed an iterative annotation strategy, with interannotator discussions held and updates made to the annotation guidelines at each iteration to improve IAA for the manual annotation task. Using the grounded theory approach, we first characterized tweets into fine-grained categories and then grouped them into 4 broad classes—abuse or misuse, personal consumption, mention, and unrelated. After the completion of manual annotations, we experimented with several machine learning algorithms to illustrate the utility of the corpus and generate baseline performance metrics for automatic classification on these data. Results: Our final annotated set consisted of 16,443 tweets mentioning at least 20 abuse-prone medications including opioids, benzodiazepines, atypical antipsychotics, central nervous system stimulants, and gamma-aminobutyric acid analogs. Our final overall IAA was 0.86 (Cohen kappa), which represents high agreement. The manual annotation process revealed the variety of ways in which prescription medication misuse or abuse is discussed on Twitter, including expressions indicating coingestion, nonmedical use, nonstandard route of intake, and consumption above the prescribed doses. Among machine learning classifiers, support vector machines obtained the highest automatic classification accuracy of 73.00% (95% CI 71.4-74.5) over the test set (n=3271). Conclusions: Our manual analysis and annotations of a large number of tweets have revealed types of information posted on Twitter about a set of abuse-prone prescription medications and their distributions. In the interests of reproducible and community-driven research, we have made our detailed annotation guidelines and the training data for the classification experiments publicly available, and the test data will be used in future shared tasks. %M 32130117 %R 10.2196/15861 %U http://www.jmir.org/2020/2/e15861/ %U https://doi.org/10.2196/15861 %U http://www.ncbi.nlm.nih.gov/pubmed/32130117 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e15645 %T The Detection of Opioid Misuse and Heroin Use From Paramedic Response Documentation: Machine Learning for Improved Surveillance %A Prieto,José Tomás %A Scott,Kenneth %A McEwen,Dean %A Podewils,Laura J %A Al-Tayyib,Alia %A Robinson,James %A Edwards,David %A Foldy,Seth %A Shlay,Judith C %A Davidson,Arthur J %+ Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, United States, 1 3036024487, josetomasprieto@gmail.com %K naloxone %K emergency medical services %K natural language processing %K heroin %K substance-related disorders %K opioid crisis %K artificial intelligence %D 2020 %7 3.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Timely, precise, and localized surveillance of nonfatal events is needed to improve response and prevention of opioid-related problems in an evolving opioid crisis in the United States. Records of naloxone administration found in prehospital emergency medical services (EMS) data have helped estimate opioid overdose incidence, including nonhospital, field-treated cases. However, as naloxone is often used by EMS personnel in unconsciousness of unknown cause, attributing naloxone administration to opioid misuse and heroin use (OM) may misclassify events. Better methods are needed to identify OM. Objective: This study aimed to develop and test a natural language processing method that would improve identification of potential OM from paramedic documentation. Methods: First, we searched Denver Health paramedic trip reports from August 2017 to April 2018 for keywords naloxone, heroin, and both combined, and we reviewed narratives of identified reports to determine whether they constituted true cases of OM. Then, we used this human classification as reference standard and trained 4 machine learning models (random forest, k-nearest neighbors, support vector machines, and L1-regularized logistic regression). We selected the algorithm that produced the highest area under the receiver operating curve (AUC) for model assessment. Finally, we compared positive predictive value (PPV) of the highest performing machine learning algorithm with PPV of searches of keywords naloxone, heroin, and combination of both in the binary classification of OM in unseen September 2018 data. Results: In total, 54,359 trip reports were filed from August 2017 to April 2018. Approximately 1.09% (594/54,359) indicated naloxone administration. Among trip reports with reviewer agreement regarding OM in the narrative, 57.6% (292/516) were considered to include information revealing OM. Approximately 1.63% (884/54,359) of all trip reports mentioned heroin in the narrative. Among trip reports with reviewer agreement, 95.5% (784/821) were considered to include information revealing OM. Combined results accounted for 2.39% (1298/54,359) of trip reports. Among trip reports with reviewer agreement, 77.79% (907/1166) were considered to include information consistent with OM. The reference standard used to train and test machine learning models included details of 1166 trip reports. L1-regularized logistic regression was the highest performing algorithm (AUC=0.94; 95% CI 0.91-0.97) in identifying OM. Tested on 5983 unseen reports from September 2018, the keyword naloxone inaccurately identified and underestimated probable OM trip report cases (63 cases; PPV=0.68). The keyword heroin yielded more cases with improved performance (129 cases; PPV=0.99). Combined keyword and L1-regularized logistic regression classifier further improved performance (146 cases; PPV=0.99). Conclusions: A machine learning application enhanced the effectiveness of finding OM among documented paramedic field responses. This approach to refining OM surveillance may lead to improved first-responder and public health responses toward prevention of overdoses and other opioid-related problems in US communities. %M 31899451 %R 10.2196/15645 %U https://www.jmir.org/2020/1/e15645 %U https://doi.org/10.2196/15645 %U http://www.ncbi.nlm.nih.gov/pubmed/31899451 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 4 %P e15794 %T Identifying Opioid Use Disorder in the Emergency Department: Multi-System Electronic Health Record–Based Computable Phenotype Derivation and Validation Study %A Chartash,David %A Paek,Hyung %A Dziura,James D %A Ross,Bill K %A Nogee,Daniel P %A Boccio,Eric %A Hines,Cory %A Schott,Aaron M %A Jeffery,Molly M %A Patel,Mehul D %A Platts-Mills,Timothy F %A Ahmed,Osama %A Brandt,Cynthia %A Couturier,Katherine %A Melnick,Edward %+ Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave, Suite 260, New Haven, CT, 06519, United States, 1 2037855174, edward.melnick@yale.edu %K electronic health records %K emergency medicine %K algorithms %K phenotype %K opioid-related disorders %D 2019 %7 31.10.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Deploying accurate computable phenotypes in pragmatic trials requires a trade-off between precise and clinically sensical variable selection. In particular, evaluating the medical encounter to assess a pattern leading to clinically significant impairment or distress indicative of disease is a difficult modeling challenge for the emergency department. Objective: This study aimed to derive and validate an electronic health record–based computable phenotype to identify emergency department patients with opioid use disorder using physician chart review as a reference standard. Methods: A two-algorithm computable phenotype was developed and evaluated using structured clinical data across 13 emergency departments in two large health care systems. Algorithm 1 combined clinician and billing codes. Algorithm 2 used chief complaint structured data suggestive of opioid use disorder. To evaluate the algorithms in both internal and external validation phases, two emergency medicine physicians, with a third acting as adjudicator, reviewed a pragmatic sample of 231 charts: 125 internal validation (75 positive and 50 negative), 106 external validation (56 positive and 50 negative). Results: Cohen kappa, measuring agreement between reviewers, for the internal and external validation cohorts was 0.95 and 0.93, respectively. In the internal validation phase, Algorithm 1 had a positive predictive value (PPV) of 0.96 (95% CI 0.863-0.995) and a negative predictive value (NPV) of 0.98 (95% CI 0.893-0.999), and Algorithm 2 had a PPV of 0.8 (95% CI 0.593-0.932) and an NPV of 1.0 (one-sided 97.5% CI 0.863-1). In the external validation phase, the phenotype had a PPV of 0.95 (95% CI 0.851-0.989) and an NPV of 0.92 (95% CI 0.807-0.978). Conclusions: This phenotype detected emergency department patients with opioid use disorder with high predictive values and reliability. Its algorithms were transportable across health care systems and have potential value for both clinical and research purposes. %M 31674913 %R 10.2196/15794 %U http://medinform.jmir.org/2019/4/e15794/ %U https://doi.org/10.2196/15794 %U http://www.ncbi.nlm.nih.gov/pubmed/31674913 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e13593 %T Using Web-Based Pin-Drop Maps to Capture Activity Spaces Among Young Adults Who Use Drugs in Rural Areas: Cross-Sectional Survey %A Cooper,Hannah Luke Fenimore %A Crawford,Natalie D %A Haardörfer,Regine %A Prood,Nadya %A Jones-Harrell,Carla %A Ibragimov,Umedjon %A Ballard,April M %A Young,April M %+ College of Public Health, University of Kentucky, 111 Washington Avenue, Office 211C, Lexington, KY, 40536, United States, 1 859 218 2090, april.young@uky.edu %K rural %K substance use disorder %K Web-based data collection %K geospatial methods %K risk environment %K activity spaces %D 2019 %7 18.10.2019 %9 Review %J JMIR Public Health Surveill %G English %X Background: Epicenters of harmful drug use are expanding to US rural areas, with rural young adults bearing a disproportionate burden. A large body of work suggests that place characteristics (eg, spatial access to health services) shape vulnerability to drug-related harms among urban residents. Research on the role of place characteristics in shaping these harms among rural residents is nascent, as are methods of gathering place-based data. Objective: We (1) analyzed whether young rural adults who used drugs answered self-administered Web-based mapping items about locations where they engaged in risk behaviors and (2) determined the precision of mapped locations. Methods: Eligible individuals had to report recently using opioids to get high; be aged between 18 and 35 years; and live in the 5-county rural Appalachian Kentucky study area. We used targeted outreach and peer-referral methods to recruit participants. The survey asked participants to drop a pin in interactive maps to mark where they completed the survey, and where they had slept most; used drugs most; and had sex most in the past 6 months. Precision was assessed by (1) determining whether mapped locations were within 100 m of a structure and (2) calculating the Euclidean distance between the pin-drop home location and the street address where participants reported sleeping most often. Measures of central tendency and dispersion were calculated for all variables; distributions of missingness for mapping items and for the Euclidean distance variable were explored across participant characteristics. Results: Of the 151 participants, 88.7% (134/151) completed all mapping items, and ≥92.1% (>139/151) dropped a pin at each of the 4 locations queried. Missingness did not vary across most participant characteristics, except that lower percentages of full-time workers and peer-recruited participants mapped some locations. Two-thirds of the pin-drop sex and drug use locations were less than 100 m from a structure, as were 92.1% (139/151) of pin-drop home locations. The median distance between the pin-drop and street-address home locations was 2.0 miles (25th percentile=0.8 miles; 75th percentile=5.5 miles); distances were shorter for high-school graduates, staff-recruited participants, and participants reporting no technical difficulties completing the survey. Conclusions: Missingness for mapping items was low and unlikely to introduce bias, given that it varied across few participant characteristics. Precision results were mixed. In a rural study area of 1378 square miles, most pin-drop home addresses were near a structure; it is unsurprising that fewer drug and sex locations were near structures because most participants reported engaging in these activities outside at times. The error in pin-drop home locations, however, might be too large for some purposes. We offer several recommendations to strengthen future research, including gathering metadata on the extent to which participants zoom in on each map and recruiting participants via trusted staff. %M 31628787 %R 10.2196/13593 %U https://publichealth.jmir.org/2019/4/e13593 %U https://doi.org/10.2196/13593 %U http://www.ncbi.nlm.nih.gov/pubmed/31628787