Text Message Service May Help Patients Recover from Opioid Addiction

Text messages proactively gauge patients' struggle with opioid addiction to prevent relapse.

Approximately 100 people die from an opioid overdose every day, according to the CDC. This alarming number has prompted health care providers to look for innovative strategies to fight the ongoing opioid epidemic.

A new text messaging service that automatically checks in on recovering patients may be a step in the right direction, according to a study published by NEJM Catalyst.

"There is an urgent need to address the opioid crisis in powerful new ways," said senior author Avik Som, MD, PhD student. "With the opioid epidemic, time is of the essence because of how quickly it's grown and the lives that are lost."

The service may decrease the likelihood of relapse among patients being treated for opioid addiction. Automated text messages ask patients how they are feeling or whether there is the possibility of a relapse, according to the study. Patients who are struggling can activate a panic button that immediately notifies a health care provider to call them for further assistance.

The service may also benefit patients by reducing the cost of care. The automated messages could reduce the frequency of individual phone calls and in-person appointments, according to the study. This may also prevent health care workers from becoming overwhelmed by their workload.

This text message therapy is meant to be used in conjunction with cognitive behavioral therapy and in-person treatment, according to the authors.

"This is not meant to replace important programs or face-to-face contact between patients and providers," Som said. "Rather, it is an additional tool that is affordable and immediate. It doesn't require costly, time-consuming measures such as opening substance-abuse centers, and training and hiring new staff.”

Out of the 21 participants, 43% of patients reported using opioids within the last 3 days at the time of enrollment, 43% of patients reported no use at the time of enrollment, and the remaining 14% did not respond.

Within 3 months, 50% of the patients reported no use, while the number of patients still using dropped to 10%, according to the authors.

The patients and caregivers reported feeling comfortable with the service, as texting is familiar and convenient. This may be a factor in the study’s positive results, according to the authors.

"Texting is convenient, immediate and nonjudgmental," Som said. "It has become an integral part of how we communicate in society. Patients reported feeling more connected to health-care providers."

The text messages let caregivers check in with patients by asking questions such as, “Have you used today?” or “Have you had any urges to use?”

If a patient reported fighting the urge to use, follow up questions were sent to help classify their risk as high, moderate, or low, and a health care provider was notified of their risk.

The authors noted that proactive treatment to prevent relapse is crucial to recovery.

"Health-care providers can be proactive," Som said. "It is so much more powerful to curb the temptation and break the cycle in advance of relapse rather than providing treatment only after the event has occurred."

The texting service also shows potential for significant cost reduction, according to the authors.

The patients in the study were receiving Medicaid benefits and had each accumulated more than $20,000 in substance abuse-related medical costs.

The researchers estimate that the text messaging service will reduce the cost of caregiver services for addiction-related care from $926 to $753 annually per patient—a 17% decrease—according to the study.

The text messaging service allowed health care providers to offer more efficient follow up care and target treatment towards the right patients, according to the authors.

The authors noted that further research is needed with a larger study group to determine whether the text messaging service could become a widely-used treatment method.

"In the midst of this national emergency, it is critical that patients and providers have clear, open channels of communication in order to mitigate the devastating impact of the opioid crisis," said research mentor Will Ross, MD.