What is the recommended approach for Medication-Assisted Treatment (MAT) via text-based platforms for patients with opioid use disorder?

Text-Based Medication-Assisted Treatment for Opioid Use Disorder

For patients with opioid use disorder, text-based platforms should be used to supplement, not replace, evidence-based medication-assisted treatment (MAT) with buprenorphine or methadone in combination with behavioral therapies. 1

Core Components of MAT for Opioid Use Disorder

Medication Options

1. First-line medications:

   • Buprenorphine (partial opioid agonist)
   • Methadone (full opioid agonist)
   • Both have strong evidence for reducing mortality, opioid use, and disease transmission 1

2. Alternative option:

   • Naltrexone (opioid antagonist) - requires complete opioid detoxification (7-10 days opioid-free) before initiation 2
   • Less studied than agonist therapies but can reduce opioid use and craving in patients who successfully initiate treatment 3

Implementation of Text-Based Support

Text-based platforms should be structured to:

1. Facilitate clinical monitoring:

   • Medication adherence tracking
   • Symptom assessment
   • Early identification of relapse risk

2. Provide secure provider-patient communication:

   • Medical concerns (52% of patient messages in studies) 4
   • Appointment scheduling
   • Medication questions
   • Crisis intervention

3. Enable peer support:

   • Anonymous community message boards where patients share:
     • Emotional states (45% of posts)
     • Offer support to others (47% of posts)
     • Request support (8% of posts) 4

4. Deliver contingency management:

   • Digital rewards for medication adherence and negative drug screens
   • Smartphone-smartcard platforms have shown higher rates of drug abstinence and clinic attendance 5

Clinical Algorithm for Text-Based MAT Implementation

1. Assessment phase:

   • Diagnose opioid use disorder using DSM-5 criteria
   • Evaluate patient's digital literacy and access to technology
   • Determine appropriate medication based on:
     • Patient preference
     • Treatment history
     • Concurrent substance use
     • Pregnancy status (buprenorphine or methadone recommended for pregnant women) 1

2. Initiation phase:

   • Begin appropriate medication therapy following standard protocols
   • Introduce text-based platform during in-person visit
   • Provide training on app features and security measures
   • Set clear expectations about response times and emergency procedures

3. Maintenance phase:

   • Regular in-person visits (frequency based on stability)
   • Text-based check-ins between visits
   • Digital urine drug testing reminders
   • Secure messaging for non-urgent concerns

4. Relapse prevention:

   • Automated supportive messages during high-risk periods
   • Digital cognitive behavioral therapy modules
   • Crisis resources readily accessible
   • Peer support connections

Important Caveats and Pitfalls

• Text-based platforms cannot replace in-person care: Initial assessment, medication induction, and periodic face-to-face visits remain essential 1

• Privacy and security concerns: Ensure HIPAA compliance and patient education about secure communication

• Digital divide issues: Not all patients have equal access to smartphones or reliable internet

• Provider workload: Establish clear boundaries for response times and emergency protocols to prevent provider burnout

• Continuity of care: Text-based platforms should integrate with existing electronic health records and treatment plans 6

• Regulatory compliance: Ensure adherence to federal and state regulations regarding telehealth and controlled substance prescribing

• Overdose prevention: Include digital access to naloxone training and resources 7

The evidence strongly supports that medication-assisted treatment should be continued indefinitely, as discontinuation significantly increases relapse risk 3. Text-based platforms should be designed to support long-term engagement with treatment rather than as a short-term intervention.