Opioid misuse can, and should, be characterized as an epidemic and public health crisis. Opioid misuse, use disorders, and overdoses are costly in terms of morbidity, mortality, and humanitarian and economic costs. Managing the use of opioids in the postoperative period is an essential point of intervention in combating the opioid crisis. To address this critical issue, Continuous Precision Medicine (CPM; Research Triangle Park, NC) has developed a mobile application that tracks a patient's pain and usage of both opiates and non-steroidal anti-inflammatory (NSAID) medications to manage that pain. Participants (N = 8) of this feasibility study were patients undergoing outpatient surgeries in an urban area of the Southeastern United States. Seven of eight (87.5%) patients using the mobile application began to delay the next opioid dose and took less than the recommended dosage within 24 hours post-operation, took less than half of the prescribed opioids, and consumed less than 2/3 of the recommended opioids to manage their pain, thereby decreasing their plasma concentration and reducing the risk of habit-forming behaviors. Across seven of the patients, 180 oxycodone pills were prescribed, and only 39 pills (21%) were taken, leaving 141 pills in the community. Preliminary results suggest that the CPM mobile application is feasible and acceptable for both patients and practitioners and provides traceability for the clinicians and make better-informed decisions regarding patient care.

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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, use disorders, and overdoses are costly in terms of morbidity, mortality, and humanitarian and economic burden. Opioid misuse costs the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) more than $1.13 billion annually. Adjusted annual healthcare costs for diagnosed opioid abuse patients are higher than those for patients without diagnosed abuse, and prevalence of diagnosed opioid abuse is almost 7 times higher for those in the Veteran's Administration than in commercial health plans, translating to a significant economic burden for this population. OBJECTIVE The overarching purpose of this single-arm prospective pilot study was to explore whether deploying a mobile application (CPMRx) to track postoperative pain and medication use is feasible in a VA Medical Center. In support of this goal, we had four complementary specific aims: (1) to determine the technological and logistical feasibility of the mobile application, (2) to assess acceptability of the mobile application to participants, (3) to measure demand for and engagement with the mobile application, and (4) to explore potential utility of the mobile application to patients and providers. METHODS Participants (n = 10) were Veterans undergoing total knee arthroplasty within the Veterans Health Administration. 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 application for patients, which includes a behavioral health intervention, and a clinical decision support tool for healthcare providers, which provides feedback about pain and medication use trends. Veterans self-managed their pain while using the CPMRx mobile app during their at-home recovery following surgery. RESULTS Overall, quantitative measures of acceptability were high. The average rating for the amount of time required to use the application was 4.9 and the average rating for ease of use was 4.4. 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 application entries of 34.1 during the postoperative period. There were no reported technological or logistical issues with the mobile application. Participants took an average of 25.13 opioid tablets to manage their postoperative pain. CONCLUSIONS Results of this study revealed that use of a mobile application 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 utility of the mobile application to provide actionable insights to clinicians if adopted more widely.

The nationwide increase in opioid use has led to an epidemic in the United States, resulting in an increase of opioid-related overdose deaths and opioid analgesic prescriptions over the last two decades. The risk of long-term opioid use post-surgery increases when patients are treated with opioid analgesics compared to their counterparts. Guidelines state that opioid analgesics are not always necessary and should be prescribed for the lowest effective dose only as long as pain is expected to be severe; however, over-prescription is common with general populations showing that half the amount of prescribed opioids do not get used by patients. Obstetric delivery is one of the most common procedures experienced among women who are pregnant. Recent evidence shows that many variations exist in opioid prescription rates during postpartum across states, ranging from 7% to 53% with differences in dosages for greater than 280 morphine milligram equivalents following uncomplicated vaginal delivery, indicating opportunities to develop guidelines on postpartum opioid use but also to improve prescription safety as well as to prevent an unnecessary increase in prescription opioid misuse among postpartum women. Telemedicine for monitoring substance use is increasingly common for substance use treatment programs and electronic technology is also being explored to screen and deliver brief interventions to treat substance use, drinking, and smoking in maternal populations. Given the myriad psychosocial risk factors associated with the postpartum period and the introduction of opioids to many opiate-naïve patients during this time, obstetric delivery may be an optimal time for upstream opioid misuse prevention using mobile technology. The objective of this commentary is to describe the prevalence of maternal opioid use and importance of addressing it with a study to prevent development of maternal opioid misuse.