Journal of Pain Research (May 2024)

Electronic Real-Time Monitoring Reveals Limited Adherence to Long-Term Opioid Prescriptions in Pain Patients

  • Houghton DC,
  • Merritt CR,
  • Miller SN,
  • Mitchell JM,
  • Parker D,
  • Hommel JD,
  • Cunningham KA,
  • Wilkes DM

Journal volume & issue
Vol. Volume 17
pp. 1815 – 1827

Abstract

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David C Houghton,1,2 Christina R Merritt,1,3 Sierra N Miller,1 Jasmine M Mitchell,4 David Parker,1 Jonathan D Hommel,1,3 Kathryn A Cunningham,1– 3,* Denise M Wilkes1,5,* 1Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA; 2Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA; 3Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA; 4Department of Family and Community Medicine, UT McGovern Medical School, Houston, TX, USA; 5Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA*These authors contributed equally to this workCorrespondence: David C Houghton, Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, 301 University Blvd, Texas, Galveston, TX 77555, USA, Tel +1 (409)747-9785, Email [email protected]: Pain management physicians are increasingly focused on limiting prescription opioid abuse, yet existing tools for monitoring adherence have limited accuracy. Medication event monitoring system (MEMS) is an emerging technology for tracking medication usage in real-time but has not been tested in chronic pain patients on long-term opioid regimens.Objective: We conducted a pilot clinical trial to investigate the utility of MEMS for monitoring opioid adherence and compared to traditional methods including self-report diaries, urine drug screen (UDS), and physicians’ opinions.Methods: Opioid-maintained chronic pain patients were recruited from a pain management clinic. Participants (n=28) were randomly assigned to either receive MEMS bottles containing their opioid medication for a 90-day period or to continue using standard medication bottles. MEMS bottles were configured to record and timestamp all bottle openings and the number of pills that were removed from the bottle (via measurement of weight change).Results: Participants who received MEMS demonstrated highly heterogenous dosing patterns, with a substantial number of patients rapidly removing excessive amounts of medication and/or “stockpiling” medication. By comparison, physicians rated all participants as either “totally compliant” or “mostly compliant”. UDS results did not reveal any illicit drug use, but 25% of participants (n=7) tested negative for their prescribed opioid metabolite. MEMS data did not correlate with physician-rated adherence (P=0.24) and UDS results (P=0.77). MEMS data consistently revealed greater non-adherence than self-report data (P< 0.001).Conclusion: These results highlight the limits in our understanding of naturalistic patterns of daily opioid use in chronic pain patients as well as support the use of MEMS for detecting potential misuse as compared to routine adherence monitoring methods. Future research directions include the need to determine how MEMS could be used to improve patient outcomes, minimize harm, and aid in clinical decision-making.Trial Registration: This study was preregistered on ClinicalTrials.gov (NCT03752411).Keywords: medication event monitoring systems, chronic pain, medication adherence

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