Text messaging service could help reduce opioid relapses

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Researchers at the Washington University School of Medicine and Epharmix, a St. Louis-based digital health vendor, have developed an automated text messaging service that they believe can reduce opioid abuse and decrease the chances of patient relapse.

Using the service called EpxSubstanceUse, patients receive text messages asking them if they’re feeling alright or struggling with potential relapse. Patients who report they are struggling receive automated follow-up questions that are used to classify their risk for relapse, based on a three-tiered triage system that assesses patient risk as high, moderate or low.

In addition, patients are able to push a “panic button” if they feel they are slipping into relapse that requires immediate help from clinicians, who phone patients and provide counseling, as well as scheduling for in-person appointments and other resources.

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In a small study, 21 patients used the texting service as part of their treatment at Preferred Family Healthcare, a community-based organization in St. Louis that treats substance abuse. In the study, patients reporting that they used opioids in the last three days fell from 42 percent to 12 percent after three months.

“Data collected via the text messaging service revealed that at the time of enrollment, 42 percent of patients reported substance use in the past three days, 41 percent reported no use, and the remainder didn’t respond,” according to results of the study, published recently in NEJM Catalyst. “Substance use trended downward over the first three months, and by week 13, only 12 percent of patients reporting using, 50 percent reported no use, and 38 percent didn’t respond.”

Avik Som, an MD/PhD student at Washington University who has completed his doctorate in biomedical engineering and will receive his medical degree this month, helped develop EpxSubstanceUse as chief medical officer at Epharmix, which he founded with classmates in 2015.

“The system was primarily built for those patients who are trying to quit,” says Som. “We’re taking advantage of a 1980s technology that allows for widespread uses. Any cell phone that has any kind of SIM card will work.”

According to Som, the automated texting system could also result in decreased treatment costs. He contends that researchers calculated that per-patient costs for caregiver services specific to addiction-related care would drop 19 percent, from $926 annually to $753.

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