Tracking the use of opioids has never been more important than during the ongoing drug epidemic. That’s why Brigham and Women’s Hospital has turned to digital pills—gelatin capsules containing ingestible sensors and medication—to help track patterns of opioid usage among patients.
The Boston hospital claims to be among the first healthcare organizations to explore the application of this new technology. Specifically, BWH leveraged the etectRx ID-Cap system in a pilot study of 15 patients who received prescriptions to take oxycodone digital pills as needed following treatment in the emergency department for acute fractures.
According to Peter Chai, MD, a faculty member in the Division of Medical Toxicology within the BWH Department of Emergency Medicine, the Commonwealth of Massachusetts is experiencing an epidemic of opioid-related overdose and a death rate that has surpassed the national average.
“Opioids are really the only medication, when you think about it, that as physicians we place all the onus of dosing on the patients,” says Chai. “It’s up to them to gauge how much pain they’re in and whether or not they need to take an opioid.”
Patients in the pilot study were directed to use oxycodone—one to two 5-millegram oxycodone digital pills every six to eight hours—as needed for pain. However, to their surprise, Chai and his colleagues found in their study that most patients stopped taking their prescription opioid after only a brief period, even among patients with fractures that required surgical management.
The digital tracking system—which uses a radiofrequency emitter—documented that most oxycodone doses were ingested by patients within the first three days after discharge from the ED, and that on average they took only six pills despite being prescribed 21 total capsules.
“The reality is that we’re potentially prescribing too much, as the study showed,” according to Chai. “We know that opioids are definitely a source for diversion and non-medical use. So, let’s be smart about prescribing the right amount that controls pain and no more opioids than are needed.”
BWH’s clinicians published results of their pilot study in the current issue of Anesthesia & Analgesia.
“Understanding patterns of actual opioid ingestion after acute painful conditions can help clinicians counsel patients on safe opioid use, and allow timely recognition and intervention when escalating opioid self-dosing occurs, to prevent tolerance and addiction,” state the authors. “Our data from digital pills that can detect patterns of opioid use are a novel and important step toward responsible and evidence-based opioid prescribing.”
In related news, the Food and Drug Administration earlier this month approved the first drug in the U.S. with a digital ingestion tracking system. Abilify MyCite, used to treat schizophrenia, utilizes an ingestible sensor embedded in the pill that records the medication was taken by sending a message to a wearable patch, which transmits the information to a mobile app so patients can track it on their smartphones. Patients can also allow their caregivers and physicians access to the information via a web-based portal.
“As an investigational tool, the digital pill provides a direct measure of opioid ingestion and changes in medication-taking behavior,” said senior author Edward Boyer, MD, of the Division of Medical Toxicology within the BWH Department of Emergency Medicine. “This technology may also make it possible for physicians to monitor adherence, identify escalating opioid use patterns that may suggest the development of tolerance or addiction and intervene for a specific medical condition or patient population.”
“Another study that we’re looking at is—now that we’ve gotten this rich data in terms of opioid ingestion, how do you develop the interface in an EHR?” Chai adds. “We have to have a way in which we can display this quickly and easily to clinicians.”
Besides the use of opioids, he concludes that digital pills have other applications. According to Chai, other studies at BWH are underway to determine the feasibility of the technology for medication adherence for patients with depression as well as those patients with HIV.
The latter study is aimed at improving medication adherence in men who have sex with men (MSM) with a history of substance abuse. Funded by a grant from Harvard University's Center for AIDS Research, the study will seek to test the usability and acceptance of etectRx's ID-Cap system taken with the drug Truvada in Pre-Exposure Prophylaxis therapy. Taken once daily, the FDA-approved medication has been shown to prevent new HIV infection in MSM.
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