Applying Web Technology to Buprenorphine Treatment

The partial opioid agonist, buprenorphine, was recently approved by the FDA for the
treatment of opioid-dependence and will be available via physician prescription, enabling a
greatly needed expansion of access to opioid treatment services. However, physicians,
because of considerable demands on their time, will likely be unable to provide or
coordinate referral for opioid-dependent patients to receive supplemental educational
interventions that are critical to the success of their treatment. To address this
challenge, we are developing an interactive, web-based patient education system for
opioid-dependent individuals in office-based buprenorphine treatment. In this system, we
plan to provide patients with educational interventions of demonstrated efficacy (e.g.,
information about buprenorphine, HIV/AIDS education, relapse prevention skills training). In
Phase I, we demonstrated the scientific, technical and commercial merit and feasibility of
this web-based patient education system by developing several modules of the program as well
as the appropriate technology for the program to be delivered in an office-based setting. We
subsequently assessed these modules in the context of feedback sessions conducted with
opioid-dependent individuals in a lab designed to mimic the technical constraints of a
physician's office. Results demonstrated that this system represents a viable approach to
patient education in office-based buprenorphine treatment. During Phase II, we plan to
complete our research and development efforts on this project. We will complete all
educational modules of the system. We will also develop a "customization program" that
patients can use to help them identify the optimal order in which they may access the
program modules while in treatment. Additionally, we will establish an electronic reporting
system that will provide physicians prescribing buprenorphine with patient activity reports,
enabling them to track and document patient progress through the system and ensure that
patients are compliant with ancillary educational interventions. Additionally, we plan to
conduct a randomized, controlled trial to evaluate the efficacy and cost-effectiveness of
this patient education system delivered via the Internet compared to the delivery of patient
educational services by community-based treatment facilities outside of the office-based
setting. This system will provide patients, physicians and the larger community with
assurance that patients in office-based buprenorphine treatment are receiving ancillary
services along with their medication, thereby improving their likelihood for a successful
treatment outcome.

Inclusion Criteria:

- Opioid dependence

- Adults ( >/= 18 years)

- In first month of office-based buprenorphine maintenance treatment

Exclusion Criteria:

- In buprenorphine-assisted taper