Pilot Testing of the emPath Platform to Improve Medication for Opioid Use Disorder (MOUD) Linkage and Retention Among Adults With Opioid Use Disorder in Durham, North Carolina

This emPath pilot program will test the V1.0 app's core features (field-first app registration with access via personal device or a tablet stationed at community outreach sites, a secure telemedicine video visit portal designed for drop-in visits during outreach sessions, a secure in-app patient-provider messaging feature) combined with outreach staff facilitation at Project MAPS Durham mobile and fixed-site outreach sessions, to complete these aims:

Aim 1: Pilot the emPath prototype platform to initiate and maintain participants receiving community-based outreach services on all-virtual delivery of medications for opioid-use disorder (MOUD) using a low barrier care strategy.

Investigators will enroll up to 50 people with opioid use disorder for participation in the pilot program using a pilot feasibility-implementation trial. The primary feasibility outcome of interest is retention in care, defined by at least one virtual visit conducted before and after the expected 6-month time-point from enrollment.

Aim 2: Elucidate implementation determinants for the emPath pilot program. Study investigators will perform semi-structured qualitative interviews with up to 20 people who use drugs (PWUD) participants and 10 outreach staff participants to evaluate program implementation, as guided by Forney's conceptual framework for care access (PWUD) and the Consolidated Framework for Implementation Research (staff).

Researchers will use descriptive statistics to describe the baseline characteristics of the sample, including sociodemographics and substance use patterns (e.g., R). Retention defined as telemedicine visit attendance at baseline and before and after the 3 and/or 6-month follow-up time-point (whichever later timepoint is available based on when the participant was recruited) will be summarized with descriptive statistics following analysis of abstracted app paradata and electronic medical record data. As an exploratory question, there will be comparison of retention-in-care and secondary outcomes (e.g., participants who reported personal smartphone ownership at baseline vs not), as well as several baseline demographics (e.g., active injection drug use, housing status, criminal legal involvement in last year). Survey measures for implementation evaluation will be analyzed using descriptive statistics.

Side effects of buprenorphine/naloxone (Suboxone®) are rare and include headache, nausea, constipation, sweating, trouble sleeping, and numbness or pain in the mouth where a patient places the medication. More serious risks include breathing problems, especially if this medication is combined with alcohol, benzodiazepines (like Xanax or Valium), or other sedating drugs. Providers will regularly assess for these side effects during visits per standard of care. Participants will receive buprenorphine/naloxone medication (sublingual) at no added cost to themselves, in addition to related provider services during visits. Currently buprenorphine/naloxone (sublingual tablet formulation) is offered free of cost through a subsidy program for uninsured patients in Durham County, and also carries no associated co-pay for insured patients with Medicaid or Medicare (participants with other forms of insurance may be charged a co-pay). Long-acting injectable formulations will not be offered for this pilot study.

Inclusion criteria

for Outreach program PWOUD (n=50):

• Age 18 or older
• Screen positive for moderate to high risk opioid use by WHO-ASSIST
• Not currently prescribed any form of MOUD
• Able to speak and understand English
• Able and willing to provide informed consent

Inclusion criteria

for Outreach Staff (n=10):

• Age 18 or older
• Employed by the preceding 1 month or longer at time of enrollment
• Able and willing to provide informed consent