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Hsu M, Jung OS, Kwan LT, Jegede O, Martin B, Malhotra A, Suzuki J. Access challenges to opioid use disorder treatment among individuals experiencing homelessness: Voices from the streets. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209216. [PMID: 37981243 DOI: 10.1016/j.josat.2023.209216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/25/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Achieving equitable access to medications for opioid use disorder (MOUD) such as buprenorphine is a pressing issue. Evidence suggests disparities in MOUD access based on race and socioeconomic status, further exacerbated by the COVID-19 pandemic. However, the drivers behind this access gap remain poorly understood. This study explores barriers to treatment access among individuals with opioid use disorder (OUD) experiencing homelessness. METHODS We interviewed 28 individuals in and around the Boston Public Health Commission (BPHC) Engagement Center, an area known for its high density of active substance use and homelessness. We asked about people's experiences, perceptions, and attitudes toward OUD treatment. We conducted a thematic analysis of our interview data. RESULTS Fifty-four percent of participants sampled were not prescribed MOUD. None of the participants reported having an active prescription of sublingual buprenorphine or buprenorphine/naloxone. White participants were more likely to have been prescribed buprenorphine in the past compared to participants of other races even in this socioeconomically homogeneous sample. Themes that emerged in our data included challenges to accessing MOUD due to reduced services during the COVID-19 pandemic, lost or stolen medications, fewer inpatient withdrawal management beds for women, transportation challenges, fear of adverse effects of MOUD, the perception that taking MOUD replaces one addiction for another, and community disapproval of MOUD. Participants also reported stigma and discrimination based on race, gender, and socioeconomic status. CONCLUSION Systems and individual-level factors contribute to the MOUD treatment gap across race and socioeconomic status. The COVID-19 pandemic posed additional access challenges. This study provides important, actionable insights about the barriers faced by a particularly vulnerable population of individuals with OUD experiencing homelessness.
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Affiliation(s)
- Michael Hsu
- Department of Psychiatry, Greater Los Angeles VA Medical Center, Los Angeles, CA, USA.
| | - Olivia S Jung
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Li Ting Kwan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Oluwole Jegede
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Bianca Martin
- Division of Addiction Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Aniket Malhotra
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Joji Suzuki
- Division of Addiction Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
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2
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Loverock A, Marshall T, Viste D, Safi F, Rioux W, Sedaghat N, Kennedy M, Ghosh SM. Electronic harm reduction interventions for drug overdose monitoring and prevention: A scoping review. Drug Alcohol Depend 2023; 250:110878. [PMID: 37441959 DOI: 10.1016/j.drugalcdep.2023.110878] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Novel strategies are required to address rising overdose deaths across the globe. We sought to identify the breadth and depth of the existing evidence around electronic harm reduction (e-harm reduction) interventions that aimed to reduce the harms associated with substance use. METHODS We conducted a scoping review according to the PRISMA-ScR and PRISMA for Searching guidelines. A health sciences librarian systematically searched seven health databases from inception until January 20, 2023. Citation chaining and reference lists of included studies were searched to identify additional articles. Two reviewers independently screened, extracted and charted the data. Additionally, we conducted a gray literature search and environmental scan to supplement the findings. RESULTS A total of 51 studies met the criteria for inclusion (30 peer-reviewed articles and 21 non-peer reviewed). Most peer-reviewed studies were conducted in Western countries (USA = 23, Canada = 3, Europe = 3, China = 1) and among adult samples (adult = 27, youth/adults =1, unspecified = 2). Study designs were predominantly quantitative (n = 24), with a minority using qualitative (n = 4) or mixed methods (n = 2). Most e-harm reduction interventions were harm reduction (n = 15), followed by education (n = 6), treatment (n = 2), and combined/other approaches (n = 7). Interventions utilized web-based/mobile applications (n = 15), telephone/telehealth (n = 10), and other technology (n = 5). CONCLUSIONS While e-harm reduction technology is promising, further research is required to establish the efficacy and effectiveness of these novel interventions.
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Affiliation(s)
- Alexandra Loverock
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, Alberta T6G 1C9, Canada.
| | - Tyler Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Dylan Viste
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Fahad Safi
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
| | - Will Rioux
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
| | - Navid Sedaghat
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
| | | | - S Monty Ghosh
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada; Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
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3
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Charron E, White A, Carlston K, Abdullah W, Baylis JD, Pierce S, Businelle MS, Gordon AJ, Krans EE, Smid MC, Cochran G. Prospective acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder: A multisite qualitative study. Front Psychiatry 2023; 14:1137071. [PMID: 37139320 PMCID: PMC10149825 DOI: 10.3389/fpsyt.2023.1137071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Background While medications for opioid use disorder (MOUD) effectively treat OUD during pregnancy and the postpartum period, poor treatment retention is common. Digital phenotyping, or passive sensing data captured from personal mobile devices, namely smartphones, provides an opportunity to understand behaviors, psychological states, and social influences contributing to perinatal MOUD non-retention. Given this novel area of investigation, we conducted a qualitative study to determine the acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder (PPP-OUD). Methods This study was guided by the Theoretical Framework of Acceptability (TFA). Within a clinical trial testing a behavioral health intervention for PPP-OUD, we used purposeful criterion sampling to recruit 11 participants who delivered a child in the past 12 months and received OUD treatment during pregnancy or the postpartum period. Data were collected through phone interviews using a structured interview guide based on four TFA constructs (affective attitude, burden, ethicality, self-efficacy). We used framework analysis to code, chart, and identify key patterns within the data. Results Participants generally expressed positive attitudes about digital phenotyping and high self-efficacy and low anticipated burden to participate in studies that collect smartphone-based passive sensing data. Nonetheless, concerns were noted related to data privacy/security and sharing location information. Differences in participant assessments of burden were related to length of time required and level of remuneration to participate in a study. Interviewees voiced broad support for participating in a digital phenotyping study with known/trusted individuals but expressed concerns about third-party data sharing and government monitoring. Conclusion Digital phenotyping methods were acceptable to PPP-OUD. Enhancements in acceptability include allowing participants to maintain control over which data are shared, limiting frequency of research contacts, aligning compensation with participant burden, and outlining data privacy/security protections on study materials.
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Affiliation(s)
- Elizabeth Charron
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Tulsa, OK, United States
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Ashley White
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Kristi Carlston
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Walitta Abdullah
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jacob D Baylis
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Stephanie Pierce
- Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adam J Gordon
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
- Center for Perinatal Addiction Research, Education and Evidence-based Solutions (Magee CARES), Magee-Womens Research Institute, Pittsburgh, PA, United States
| | - Marcela C Smid
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, United States
| | - Gerald Cochran
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
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Lombardi AR, Arya R, Rosen JG, Thompson E, Welwean R, Tardif J, Rich JD, Park JN. Overdose Detection Technologies to Reduce Solitary Overdose Deaths: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1230. [PMID: 36673987 PMCID: PMC9859116 DOI: 10.3390/ijerph20021230] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 05/06/2023]
Abstract
Drug overdoses were a leading cause of injury and death in the United States in 2021. Solitary drug use and solitary overdose deaths have remained persistent challenges warranting additional attention throughout the overdose epidemic. The goal of this narrative review is to describe recent global innovations in overdose detection technologies (ODT) enabling rapid responses to overdose events, especially for people who use drugs alone. We found that only a small number of technologies designed to assist in overdose detection and response are currently commercially available, though several are in the early stages of development. Research, development, and scale-up of practical, cost-effective ODTs remains a public health imperative. Equipping places where people live, learn, work, worship, and play with the necessary tools to detect and prevent overdose deaths could complement ongoing overdose prevention efforts.
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Affiliation(s)
| | - Ritikraj Arya
- Division of Biology and Medicine, Brown University, Providence, RI 02912, USA
| | - Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Erin Thompson
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI 02903, USA
| | - Ralph Welwean
- School of Public Health, Brown University, Providence, RI 02912, USA
| | - Jessica Tardif
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI 02903, USA
| | - Josiah D. Rich
- School of Public Health, Brown University, Providence, RI 02912, USA
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI 02903, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Ju Nyeong Park
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI 02903, USA
- School of Public Health, Brown University, Providence, RI 02912, USA
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI 02903, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
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5
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Rosenthal A, Ebrahimi C, Wedemeyer F, Romanczuk-Seiferth N, Beck A. The Treatment of Substance Use Disorders: Recent Developments and New Perspectives. Neuropsychobiology 2022; 81:451-472. [PMID: 35724634 DOI: 10.1159/000525268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Abstract
Substance-related disorders are complex psychiatric disorders that are characterized by continued consumption in spite of harmful consequences. Addiction affects various brain networks critically involved in learning, reward, and motivation, as well as inhibitory control. Currently applied therapeutic approaches aim at modification of behavior that ultimately leads to decrease of consumption or abstinence in individuals with substance use disorders. However, traditional treatment methods might benefit from recent neurobiological and cognitive neuroscientific research findings. Novel cognitive-behavioral approaches in the treatment of addictive behavior aim at enhancement of strategies to cope with stressful conditions as well as craving-inducing cues and target erroneous learning mechanisms, including cognitive bias modification, reconsolidation-based interventions, mindfulness-based interventions, virtual-reality-based cue exposure therapy as well as pharmacological augmentation strategies. This review discusses therapeutic strategies that target dysregulated neurocognitive processes associated with the development and maintenance of disordered substance use and may hold promise as effective treatments for substance-related disorders.
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Affiliation(s)
- Annika Rosenthal
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Ebrahimi
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friederike Wedemeyer
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nina Romanczuk-Seiferth
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne Beck
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Health and Medical University, Campus Potsdam, Faculty of Health, Potsdam, Germany
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6
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Hsu M, Martin B, Ahmed S, Torous J, Suzuki J. Smartphone Ownership, Smartphone Utilization, and Interest in Using Mental Health Apps to Address Substance Use Disorders: Literature Review and Cross-sectional Survey Study Across Two Sites. JMIR Form Res 2022; 6:e38684. [PMID: 35797102 PMCID: PMC9305402 DOI: 10.2196/38684] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/10/2022] [Accepted: 06/21/2022] [Indexed: 01/25/2023] Open
Abstract
Background In recent years, there has been increasing interest in implementing digital technologies to diagnose, monitor, and intervene in substance use disorders. Smartphones are now a vehicle for facilitating telepsychiatry visits, measuring health metrics, and communicating with health care professionals. In light of the COVID-19 pandemic and the movement toward web-based and hybrid clinic visits and meetings, it has become especially salient to assess phone ownership among individuals with substance use disorders and their comfort in navigating phone functionality and using phones for mental health purposes. Objective The aims of this study were to summarize the current literature around smartphone ownership, smartphone utilization, and the acceptability of using smartphones for mental health purposes and assess these variables across two disparate substance use treatment sites. Methods We performed a focused literature review via a search of two academic databases (PubMed and Google Scholar) for publications since 2007 on the topics of smartphone ownership, smartphone utilization, and the acceptability of using mobile apps for mental health purposes among the substance use population. Additionally, we conducted a cross-sectional survey study that included 51 participants across two sites in New England—an inpatient detoxification unit that predominantly treats patients with alcohol use disorder and an outpatient methadone maintenance treatment clinic. Results Prior studies indicated that mobile phone ownership among the substance use population between 2013 and 2019 ranged from 83% to 94%, while smartphone ownership ranged from 57% to 94%. The results from our study across the two sites indicated 96% (49/51) mobile phone ownership and 92% (47/51) smartphone ownership among the substance use population. Although most (43/49, 88%) patients across both sites reported currently using apps on their phone, a minority (19/48, 40%) reported previously using any apps for mental health purposes. More than half of the participants reported feeling at least neutrally comfortable with a mental health app gathering information regarding appointment reminders (32/48, 67%), medication reminders (33/48, 69%), and symptom surveys (26/45, 58%). Most patients were concerned about privacy (34/51, 67%) and felt uncomfortable with an app gathering location (29/47, 62%) and social (27/47, 57%) information for health care purposes. Conclusions The majority of respondents reported owning a mobile phone (49/51, 96%) and smartphone (47/51, 92%), consistent with prior studies. Many respondents felt comfortable with mental health apps gathering most forms of personal information and with communicating with their clinician about their mental health. The differential results from the two sites, namely greater concerns about the cost of mental health apps among the methadone maintenance treatment cohort and less experience with downloading apps among the older inpatient detoxification cohort, may indicate that clinicians should tailor technological interventions based on local demographics and practice sites and that there is likely not a one-size-fits-all digital psychiatry solution.
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Affiliation(s)
- Michael Hsu
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
| | - Bianca Martin
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
| | - Saeed Ahmed
- West Ridge Center, Rutland Regional Medical Center, Rutland, VT, United States
| | - John Torous
- Digital Psychiatry Division, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
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7
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Hesse BW, Aronoff‐Spencer E, Ahern DK, Mullett TW, Gibbons C, Chih M, Hubenko A, Koop B. “Don't drop the patient:” Health information in a postpandemic world. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Bradford W. Hesse
- National Cancer Institute (Retired) Health Communications and Research Branch Kailua‐Kona Hawaii USA
| | - Eliah Aronoff‐Spencer
- Department of Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego La Jolla California USA
| | - David K. Ahern
- Department of Psychiatry, School of Medicine, Brigham and Women's Hospital Boston Massachusetts USA
| | | | - Chris Gibbons
- Department of Medicine, School of Medicine, Johns Hopkins University Baltimore Maryland USA
| | - Ming‐Yuan Chih
- Markey Cancer Center, University of Kentucky Lexington Kentucky USA
| | - Alexandra Hubenko
- Department of Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego La Jolla California USA
| | - Barbara Koop
- Philips, Usability – Design Practice and Centre of Excellence Amsterdam Netherlands
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8
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Marsch LA, Chen CH, Adams SR, Asyyed A, Does MB, Hassanpour S, Hichborn E, Jackson-Morris M, Jacobson NC, Jones HK, Kotz D, Lambert-Harris CA, Li Z, McLeman B, Mishra V, Stanger C, Subramaniam G, Wu W, Campbell CI. The Feasibility and Utility of Harnessing Digital Health to Understand Clinical Trajectories in Medication Treatment for Opioid Use Disorder: D-TECT Study Design and Methodological Considerations. Front Psychiatry 2022; 13:871916. [PMID: 35573377 PMCID: PMC9098973 DOI: 10.3389/fpsyt.2022.871916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Across the U.S., the prevalence of opioid use disorder (OUD) and the rates of opioid overdoses have risen precipitously in recent years. Several effective medications for OUD (MOUD) exist and have been shown to be life-saving. A large volume of research has identified a confluence of factors that predict attrition and continued substance use during substance use disorder treatment. However, much of this literature has examined a small set of potential moderators or mediators of outcomes in MOUD treatment and may lead to over-simplified accounts of treatment non-adherence. Digital health methodologies offer great promise for capturing intensive, longitudinal ecologically-valid data from individuals in MOUD treatment to extend our understanding of factors that impact treatment engagement and outcomes. Methods This paper describes the protocol (including the study design and methodological considerations) from a novel study supported by the National Drug Abuse Treatment Clinical Trials Network at the National Institute on Drug Abuse (NIDA). This study (D-TECT) primarily seeks to evaluate the feasibility of collecting ecological momentary assessment (EMA), smartphone and smartwatch sensor data, and social media data among patients in outpatient MOUD treatment. It secondarily seeks to examine the utility of EMA, digital sensing, and social media data (separately and compared to one another) in predicting MOUD treatment retention, opioid use events, and medication adherence [as captured in electronic health records (EHR) and EMA data]. To our knowledge, this is the first project to include all three sources of digitally derived data (EMA, digital sensing, and social media) in understanding the clinical trajectories of patients in MOUD treatment. These multiple data streams will allow us to understand the relative and combined utility of collecting digital data from these diverse data sources. The inclusion of EHR data allows us to focus on the utility of digital health data in predicting objectively measured clinical outcomes. Discussion Results may be useful in elucidating novel relations between digital data sources and OUD treatment outcomes. It may also inform approaches to enhancing outcomes measurement in clinical trials by allowing for the assessment of dynamic interactions between individuals' daily lives and their MOUD treatment response. Clinical Trial Registration Identifier: NCT04535583.
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Affiliation(s)
- Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Ching-Hua Chen
- Center for Computational Health, International Business Machines (IBM) Research, Yorktown Heights, NY, United States
| | - Sara R. Adams
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States
| | - Asma Asyyed
- The Permanente Medical Group, Northern California, Addiction Medicine and Recovery Services, Oakland, CA, United States
| | - Monique B. Does
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States
| | - Saeed Hassanpour
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Emily Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Nicholas C. Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Heather K. Jones
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States
| | - David Kotz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Chantal A. Lambert-Harris
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Zhiguo Li
- Center for Computational Health, International Business Machines (IBM) Research, Yorktown Heights, NY, United States
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Varun Mishra
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Geetha Subramaniam
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, United States
| | - Weiyi Wu
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Cynthia I. Campbell
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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9
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Wu X, Du J, Jiang H, Zhao M. Application of Digital Medicine in Addiction. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (SCIENCE) 2022; 27:144-152. [PMID: 34866856 PMCID: PMC8627382 DOI: 10.1007/s12204-021-2391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/20/2021] [Indexed: 10/29/2022]
Affiliation(s)
- Xiaojun Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030 China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030 China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030 China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030 China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 201108 China
- CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, 200031 China
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10
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Hesse BW, Kwasnicka D, Ahern DK. Emerging digital technologies in cancer treatment, prevention, and control. Transl Behav Med 2021; 11:2009-2017. [PMID: 34850933 PMCID: PMC8824462 DOI: 10.1093/tbm/ibab033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The very first issue of the journal of Translational Behavioral Medicine (TBM) was dedicated, in part, to the theme of Health Information Technology as a platform for evidence implementation. The topic was timely: legislation in the USA was passed with the intent of stimulating the adoption of electronic health records; mobile smartphones, tablets, and other devices were gaining traction in the consumer market, while members within the Society of Behavioral Medicine were gaining scientific understanding on how to use these tools to effect healthy behavior change. For the anniversary issue of TBM, we evaluated the progress and problems associated with deploying digital health technologies to support cancer treatment, prevention, and control over the last decade. We conducted a narrative review of published literature to identify the role that emerging digital technologies may take in achieving national and international objectives in the decade to come. We tracked our evaluation of the literature across three phases in the cancer control continuum: (a) prevention, (b) early detection/screening, and (c) treatment/survivorship. From our targeted review and analyses, we noted that significant progress had been made in the adoption of digital health technologies in the cancer space over the past decade but that significant work remains to be done to integrate these technologies effectively into the cancer control systems needed to improve outcomes equitably across populations. The challenge for the next 10 years is inherently translational.
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Affiliation(s)
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia and Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
| | - David K Ahern
- Digital Behavioral Health and Informatics Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02215, USA
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Mosher Henke R. Knowing Well, Being Well: well-being born of understanding: Shifts in Health Behaviors Amid the COVID-19 Pandemic. Am J Health Promot 2021; 35:1162-1183. [DOI: 10.1177/08901171211055310a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Satre DD, Meacham MC, Asarnow LD, Fisher WS, Fortuna LR, Iturralde E. Opportunities to Integrate Mobile App-Based Interventions Into Mental Health and Substance Use Disorder Treatment Services in the Wake of COVID-19. Am J Health Promot 2021; 35:1178-1183. [PMID: 34652971 DOI: 10.1177/08901171211055314] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has heightened concerns about the impact of depression, anxiety, alcohol, and drug use on public health. Mobile apps to address these problems were increasingly popular even before the pandemic, and may help reach people who otherwise have limited treatment access. In this review, we describe pandemic-related substance use and mental health problems, the growing evidence for mobile app efficacy, how health systems can integrate apps into patient care, and future research directions. If equity in access and effective implementation can be addressed, mobile apps are likely to play an important role in mental health and substance use disorder treatment.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Meredith C Meacham
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Lauren D Asarnow
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Weston S Fisher
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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13
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Berhe O, Gerhardt S, Schmahl C. Clinical Outcomes of Severe Forms of Early Social Stress. Curr Top Behav Neurosci 2021; 54:417-438. [PMID: 34628586 DOI: 10.1007/7854_2021_261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Early social stress, particularly severe but nevertheless frequent forms such as abuse and neglect, are among the major risk factors for the development of mental disorders. However, we only have very limited knowledge of the psychobiological disease mechanisms underlying the influence of early life stress and stress-related disorders during this vulnerable phase of life. Early stress can have long-lasting adverse effects on the brain and other somatic systems, e.g. through influences on brain development. In adulthood, the prior experience of abuse or neglect can result in complex clinical profiles. Besides conditions such as mood and anxiety disorders as well as posttraumatic stress disorder, substance use disorders (SUD) are among the most prevalent sequelae of early social stress. Current social stress further influences the development and maintenance of these disorders, e.g., by increasing the risk of relapses. In this chapter, we will first give an overview of currently used methods to assess the phenomenology and pathophysiology of stress-related disorders and then focus on the phenomenological and neurobiological background of the interaction between early social stress and SUD. We will give an overview of important insights from neuroimaging studies and will also highlight recent findings from studies using digital tools such as ecological momentary assessment or virtual reality to capture the influence of early social stress as well as current social stress in everyday life of persons with SUD.
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Affiliation(s)
- Oksana Berhe
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Sarah Gerhardt
- Department of Addictive Behaviour and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany.
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14
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Hélène K, Gourret Baumgart J, El Hage W, Deloyer J, Maes C, Lebas MC, Marazziti D, Thome J, Fond-Harmant L, Denis F. Uses of digital technologies in the time of Covid-19: opportunities and challenges for professionals in psychiatry and mental health care. JMIR Hum Factors 2021; 9:e30359. [PMID: 34736224 PMCID: PMC8820762 DOI: 10.2196/30359] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/06/2021] [Accepted: 10/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Covid-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. OBJECTIVE As part of a research project that was co-funded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, we carried out a systematic literature review to investigate how such uses of digital technologies have been developing. METHODS The present systematic review was conducted following the PRISMA guidelines. The search was carried out in MEDLINE (PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts, and then on full texts, 61 articles were included. RESULTS The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up an experience of remote care, and thus better identify the possibilities and limits of these digital technologies. CONCLUSIONS The new uses of such technologies essentially consist in a transition from the classic consultation model towards teleconsultation and makes less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular so as to promote the autonomy and empowerment of mental health service users. CLINICALTRIAL
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Affiliation(s)
- Kane Hélène
- Laboratoire éducation, éthique, santé, Université de Tours, Boulevard Tonnellé, Tours, FR
| | - Jade Gourret Baumgart
- Laboratoire éducation, éthique, santé, Université de Tours, Boulevard Tonnellé, Tours, FR
| | - Wissam El Hage
- Centre d'Investigation Clinique, Institut national de la santé et de la recherche médicale (INSERM), Tours, FR.,Centre Hospitalier Régional Universitaire Tours (CHRU), Tours, FR
| | - Jocelyn Deloyer
- Centre Neuro Psychiatrique St. Martin (CNP St. Martin), Dave Namur, BE
| | - Christine Maes
- Centre Neuro Psychiatrique St. Martin (CNP St. Martin), Dave Namur, BE
| | - Marie-Clotilde Lebas
- Département des Sciences de la Santé Publique et de la Motricité, Haute Ecole de la Province de Namur (HEPN), Namur, BE
| | - Donatella Marazziti
- Department of Experimental and Clinical Medicine, Section of Psychiatry, University of Pisa, Pisa, IT.,Unicamillus, University of Rome and Brain Research Foundation, Lucca, IT
| | - Johannes Thome
- Department of Psychiatry, University of Rostock, Rostock, DE
| | - Laurence Fond-Harmant
- Agence de Coopération Scientifique Europe-Afrique-Luxembourg (ASCAL), Luxembourg, LU.,Education et Pratiques en Santé, Paris 13, Université Sorbonne Paris Nord, Paris, FR
| | - Frédéric Denis
- Laboratoire éducation, éthique, santé, Université de Tours, Boulevard Tonnellé, Tours, FR
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15
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Liu S, Heinzel S, Dolan RJ. Digital Phenotyping and Mobile Sensing in Addiction Psychiatry. PHARMACOPSYCHIATRY 2021; 54:287-288. [PMID: 34407554 DOI: 10.1055/a-1559-4003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Shuyan Liu
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin (Campus Charité Mitte), Berlin, Germany
| | - Stephan Heinzel
- 2Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Raymond J Dolan
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin (Campus Charité Mitte), Berlin, Germany.,Max Planck Centre for Computational Psychiatry and Ageing Research & Wellcome Centre for Human Neuroimaging, University College London, London, England.,State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
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16
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Martinez-Martin N, Greely HT, Cho MK. Ethical Development of Digital Phenotyping Tools for Mental Health Applications: Delphi Study. JMIR Mhealth Uhealth 2021; 9:e27343. [PMID: 34319252 PMCID: PMC8367187 DOI: 10.2196/27343] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/06/2021] [Accepted: 05/21/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Digital phenotyping (also known as personal sensing, intelligent sensing, or body computing) involves the collection of biometric and personal data in situ from digital devices, such as smartphones, wearables, or social media, to measure behavior or other health indicators. The collected data are analyzed to generate moment-by-moment quantification of a person's mental state and potentially predict future mental states. Digital phenotyping projects incorporate data from multiple sources, such as electronic health records, biometric scans, or genetic testing. As digital phenotyping tools can be used to study and predict behavior, they are of increasing interest for a range of consumer, government, and health care applications. In clinical care, digital phenotyping is expected to improve mental health diagnoses and treatment. At the same time, mental health applications of digital phenotyping present significant areas of ethical concern, particularly in terms of privacy and data protection, consent, bias, and accountability. OBJECTIVE This study aims to develop consensus statements regarding key areas of ethical guidance for mental health applications of digital phenotyping in the United States. METHODS We used a modified Delphi technique to identify the emerging ethical challenges posed by digital phenotyping for mental health applications and to formulate guidance for addressing these challenges. Experts in digital phenotyping, data science, mental health, law, and ethics participated as panelists in the study. The panel arrived at consensus recommendations through an iterative process involving interviews and surveys. The panelists focused primarily on clinical applications for digital phenotyping for mental health but also included recommendations regarding transparency and data protection to address potential areas of misuse of digital phenotyping data outside of the health care domain. RESULTS The findings of this study showed strong agreement related to these ethical issues in the development of mental health applications of digital phenotyping: privacy, transparency, consent, accountability, and fairness. Consensus regarding the recommendation statements was strongest when the guidance was stated broadly enough to accommodate a range of potential applications. The privacy and data protection issues that the Delphi participants found particularly critical to address related to the perceived inadequacies of current regulations and frameworks for protecting sensitive personal information and the potential for sale and analysis of personal data outside of health systems. CONCLUSIONS The Delphi study found agreement on a number of ethical issues to prioritize in the development of digital phenotyping for mental health applications. The Delphi consensus statements identified general recommendations and principles regarding the ethical application of digital phenotyping to mental health. As digital phenotyping for mental health is implemented in clinical care, there remains a need for empirical research and consultation with relevant stakeholders to further understand and address relevant ethical issues.
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Affiliation(s)
- Nicole Martinez-Martin
- Center for Biomedical Ethics, School of Medicine, Stanford University, Stanford, CA, United States
| | | | - Mildred K Cho
- Center for Biomedical Ethics, School of Medicine, Stanford University, Stanford, CA, United States
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17
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Perra N. Non-pharmaceutical interventions during the COVID-19 pandemic: A review. PHYSICS REPORTS 2021; 913:1-52. [PMID: 33612922 PMCID: PMC7881715 DOI: 10.1016/j.physrep.2021.02.001] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/08/2021] [Indexed: 05/06/2023]
Abstract
Infectious diseases and human behavior are intertwined. On one side, our movements and interactions are the engines of transmission. On the other, the unfolding of viruses might induce changes to our daily activities. While intuitive, our understanding of such feedback loop is still limited. Before COVID-19 the literature on the subject was mainly theoretical and largely missed validation. The main issue was the lack of empirical data capturing behavioral change induced by diseases. Things have dramatically changed in 2020. Non-pharmaceutical interventions (NPIs) have been the key weapon against the SARS-CoV-2 virus and affected virtually any societal process. Travel bans, events cancellation, social distancing, curfews, and lockdowns have become unfortunately very familiar. The scale of the emergency, the ease of survey as well as crowdsourcing deployment guaranteed by the latest technology, several Data for Good programs developed by tech giants, major mobile phone providers, and other companies have allowed unprecedented access to data describing behavioral changes induced by the pandemic. Here, I review some of the vast literature written on the subject of NPIs during the COVID-19 pandemic. In doing so, I analyze 348 articles written by more than 2518 authors in the first 12 months of the emergency. While the large majority of the sample was obtained by querying PubMed, it includes also a hand-curated list. Considering the focus, and methodology I have classified the sample into seven main categories: epidemic models, surveys, comments/perspectives, papers aiming to quantify the effects of NPIs, reviews, articles using data proxies to measure NPIs, and publicly available datasets describing NPIs. I summarize the methodology, data used, findings of the articles in each category and provide an outlook highlighting future challenges as well as opportunities.
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Affiliation(s)
- Nicola Perra
- Networks and Urban Systems Centre, University of Greenwich, London, UK
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18
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Nguyen T, Buxton JA. Pathways between COVID-19 public health responses and increasing overdose risks: A rapid review and conceptual framework. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 93:103236. [PMID: 33838990 PMCID: PMC8545050 DOI: 10.1016/j.drugpo.2021.103236] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022]
Abstract
Background Emerging evidence indicates that illicit drug overdoses are increasing throughout the COVID-19 pandemic. There is a paucity of evidence on the causative pathways for this trend, but expert opinions, commentaries, and some reviews offer theoretical underpinnings. Methods In this rapid review, we collate the available published evidence, expert opinions, commentaries, and reviews on the unintended pathways between COVID-19 public health responses and increasing illicit drug overdoses. Using tenets of thematic analyses and grounded theory, we also offer a visual conceptual framework for these unintended pathways. Results Our framework focuses on five particular public health responses, namely social isolation/physical distancing/quarantine; staff/resource reallocations and reductions; closures of businesses and other places of employment; border closures and transportation restrictions; and the early release of people from prisons. As argued in the literature reviewed here, these public health responses have unintentionally created increased overdose risks by producing high risk use scenarios; increased risks of relapsing; disrupted addictions services and treatment; an increasingly toxic supply of drugs; and the risk of using with lowered tolerance. Conclusions Health care systems should respond to these pathways to mitigate the unintended consequences. Furthermore, the COVID-19 pandemic may represent an opportunity to enact proactive, progressive, and innovative solutions to an overdose crisis that will surely outlast the current pandemic.
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Affiliation(s)
- Tribesty Nguyen
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Jane A Buxton
- British Columbia Centre for Disease Control, 655W 12th Ave, Vancouver, BC V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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