Aims: Will electronic monitoring of compliance with take-home medication receive acceptance by patients in substitution treatment and can abuse and diversion of buprenorphine be reduced in a cost-effective way?
Design: 2 open pilot-studies (A,B) and an open trial in progress (C) with dispensing of Suboxone® in a device for compliance monitoring. Measurements of effect on buprenorphine abuse before, during and after the 4-month intervention (C).
Setting: Kuopio University Hospital Drug Addiction Clinic (studies A,B,C) and for study C additionally all other local providers of opioid substitution treatment.
Participants: Outpatients on Suboxone® with take-home allowances.
Intervention: Study A: 12 Patients received 6 take-home doses/week in an electronic monitoring device (Pharma DDSi®, Stora Enso) for 4 weeks. Automatically registered time-cues were displayed on computer-screen and discussed with the patients on a weekly basis. Case-study B: 2 patients were also provided with a mobile phone for transmission of compliance-data in real-time. Study C: For 4 months all patients on Suboxone-treatment in the municipality of Kuopio (N=50) receive their weekly medication in a container (LääkekelloTM, Addoz Oy), which monitors compliance and also restricts the availability of the daily dose to 3 hours.
Measurements: Studies A,B: Variations in time of drug-taking, treatment-costs in comparison with standard supervised administration, patients’ information on abuse/diversion of their medication, technical questions, results (study B) from the Treatment Outcomes Profile (TOP, Finnish version). Study C: Longitudinal information on illegal buprenorphine in the community (drug-screens, TOP, questionnaires for clients of local needle-exchange service, information from local police, post mortem – findings in case of sudden death).
Findings and Conclusions: Patients’ acceptance of compliance-monitoring was good and treatment-costs were reduced by 39 % (study A). Variation in time-points of drug-taking was greatest in comorbid patients. The two monitoring-devices use different technical solutions, but neither one can eliminate abuse or diversion completely. Monitoring in real-time may have a place in special settings.
