Evaluation of a Mobile Application to Decrease Opioid Misuse and Habit-Forming Behaviors Following Prescription: Preliminary Results and Future Directions

Abstract

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.

A Mobile App for Postoperative Pain Management Among Older Veterans Undergoing Total Knee Arthroplasty: Mixed Methods Feasibility and Acceptability Pilot Study

“…Overall, participants rated ease of use and amount of time required as highly acceptable, with no logistical or technological issues being reported. This is congruent with our prior findings across several studies, including those involving young soldiers undergoing third molar extraction [ 24 , 25 ], adults undergoing tonsillectomy [ 26 ], and women undergoing cesarean section [ 27 , 28 ]. This study was the first to include a report by a patient of difficulty using the mobile app, which does warrant discussion.…”

“…We have used a public health research pipeline approach for designing, evaluating, and implementing behavioral health interventions, and the CPMRx mobile app has been shown to be feasible and acceptable for supporting postoperative pain management across several patient populations and surgery types, including young adults undergoing third molar extraction (dental clinic, Womack Army Medical Center) [ 24 , 25 ], adults undergoing tonsillectomy (ear, nose, and throat, WakeMed Hospital) [ 26 ], and women undergoing cesarean section (obstetrics and gynecology, Temple University Health) [ 27 , 28 ]. The effectiveness of the mobile app and clinical decision support tool has also been validated.…”

The Postpartum Period as a Point of Prevention for Opioid Misuse: A Commentary

“…Electronic technology is also being explored to screen and deliver brief interventions to treat substance use, drinking, and smoking in maternal populations (Ondersma et al, 2012;Ondersma et al, 2015Ondersma et al, , 2018Washio et al, 2017). As described in the study above (Morgan et al, 2019), simply tracking their pain level and getting encouragement and motivation to delay pain medication intake might also help immediate postpartum women to prevent an unnecessary increase in prescription opioid misuse post-delivery. 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, and use of mobile technology may increase user and provider engagement to properly manage pain medication.…”

“…A recent study in the United States (Morgan, Walther, & Lane, 2019) used a mobile application technology to track pain and usage of opiates and non-steroidal anti-inflammatory medications (NSAID) that manage pain. The mobile applica-tion uses elements of gamification to encourage patients to delay medications when appropriate and to decrease dosages as able.…”

Evaluation of a mobile application to decrease opioid misuse in patients undergoing cesarean section: A Randomized Controlled Trial

“…We have used a public health research pipeline approach for designing, evaluating, and implementing behavioral health interventions, and the CPMRx mobile app has been shown to be feasible and acceptable for supporting postoperative pain management across several patient populations and surgery types, including young adults undergoing third molar extraction (Dental Clinic, Womack Army Medical Center, Ft. Bragg, NC) [16,17], adults undergoing tonsillectomy (ENT, WakeMed Hospital, Raleigh, NC), and women undergoing cesarean section (OB/GYN, Temple University Health, Philadelphia, PA) [18].…”