HIV-PASS (Pain and Sadness Support): Randomized Controlled Trial of a Behavioral Health Intervention for Interference Due to Pain in People Living With HIV, Chronic Pain, and Depression.

OBJECTIVE: This study aimed to determine whether HIV-Pain and Sadness Support (HIV-PASS), a collaborative behavioral health intervention based on behavioral activation, is associated with decreased pain-related interference with daily activities, depression, and other outcomes in people living with HIV. METHODS: We conducted a three-site clinical trial ( n = 187) in which we randomly assigned participants to receive either HIV-PASS or health education control condition. In both conditions, participants received seven intervention sessions, comprising an initial in-person joint meeting with the participant, their HIV primary care provider and a behavioral health specialist, and six, primarily telephone-based, meetings with the behavioral health specialist and participant. The intervention period lasted 3 months, and follow-up assessments were conducted for an additional 9 months. RESULTS: Compared with health education, HIV-PASS was associated with significantly lower pain-related interference with daily activities at the end of month 3 (our primary outcome; b = -1.31, 95% confidence interval = -2.28 to -0.34). We did not observe other differences between groups at 3 months in secondary outcomes that included worst or average pain in the past week, depression symptoms, anxiety, and perceived overall mental and physical health. There were no differences between groups on any outcomes at 12 months after enrollment. CONCLUSIONS: A targeted intervention can have positive effects on pain interference. At the end of intervention, effects we found were in a clinically significant range. However, effects diminished once the intervention period ended. TRIAL REGISTRATION: ClinicalTrials.gov NCT02766751.

Fine-Grained Intoxicated Gait Classification Using a Bilinear CNN.

Consuming excessive amounts of alcohol causes impaired mobility and judgment and driving accidents, resulting in more than 800 injuries and fatalities each day. Passive methods to detect intoxicated drivers beyond the safe driving limit can facilitate Just-In-Time alerts and reduce Driving Under the Influence (DUI) incidents. Popularly-owned smartphones are not only equipped with motion sensors (accelerometer and gyroscope) that can be employed for passively collecting gait (walk) data but also have the processing power to run computationally expensive machine learning models. In this paper, we advance the state-of-the-art by proposing a novel method that utilizes a Bi-linear Convolution Neural Network (BiCNN) for analyzing smartphone accelerometer and gyroscope data to determine whether a smartphone user is over the legal driving limit (0.08) from their gait. After segmenting the gait data into steps, we converted the smartphone motion sensor data to a Gramian Angular Field (GAF) image and then leveraged the BiCNN architecture for intoxication classification. Distinguishing GAF-encoded images of the gait of intoxicated vs. sober users is challenging as the differences between the classes (intoxicated vs. sober) are subtle, also known as a fine-grained image classification problem. The BiCNN neural network has previously produced state-of-the-art results on fine-grained image classification of natural images. To the best of our knowledge, our work is the first to innovatively utilize the BiCNN to classify GAF encoded images of smartphone gait data in order to detect intoxication. Prior work had explored using the BiCNN to classify natural images or explored other gait-related tasks but not intoxication Our complete intoxication classification pipeline consists of several important pre-processing steps carefully adapted to the BAC classification task, including step detection and segmentation, data normalization to account for inter-subject variability, data fusion, GAF image generation from time-series data, and a BiCNN classification model. In rigorous evaluation, our BiCNN model achieves an accuracy of 83.5%, outperforming the previous state-of-the-art and demonstrating the feasibility of our approach.

A Randomized Trial Comparing Brief Advice and Motivational Interviewing for Persons with HIV-HCV Co-infection Who Drink Alcohol.

Alcohol use contributes to the progression of liver disease in HIV-HCV co-infected persons, but alcohol interventions have never addressed low levels of alcohol use in this population. We enrolled 110 persons consuming at least 4 alcoholic drinks weekly in a clinical trial comparing two active 18-month long interventions, delivered every 3 months by phone, brief advice about drinking versus a motivational intervention. Final assessment was at 24 months. MI had larger reductions in alcohol use days than the BA arm at all follow-up assessments. The treatment by time effect was not significant for days of drinking (p = 0.470), mean drinks per day (p = 0.155), or for the continuous FIB-4 index (p = 0.175). Drinking declined in both conditions from baseline, but given the small sample, we do not have sufficient data to make any conclusion that one treatment is superior to the other.Trial Registry Trial registered at clinicaltrials.gov; Clinical Trial NCT02316184.

Sustained Sobriety: A Qualitative Study of Persons with HIV and Chronic Hepatitis C Coinfection and a History of Problematic Drinking.

For persons diagnosed with HIV and who are coinfected with hepatitis C virus (HCV), chronic liver disease is a leading cause of death and excessive consumption of alcohol can be a contributing factor. Little is known about the factors these individuals identify as key to achieving sustained sobriety. In this qualitative study, fourteen HIV/HCV coinfected persons who endorsed past problematic drinking were interviewed about their path to sustained sobriety. In open-ended interviews, participants often described their drinking in the context of polysubstance use and their decision to become sober as a singular response to a transcendent moment or a traumatic event. All articulated specific, concrete strategies for maintaining sobriety. The perceived effect of the HIV or HCV diagnosis on sobriety was inconsistent, and medical care as an influence on sobriety was rarely mentioned. Qualitative interviews may offer new insights on interventions and support strategies for heavy-drinking persons with HIV/HCV coinfection.

Examining Overdose and Homelessness as Predictors of Willingness to Use Supervised Injection Facilities by Services Provided Among Persons Who Inject Drugs.

BACKGROUND AND OBJECTIVES: Internationally, supervised injection facilities (SIFs) have demonstrated efficacy in reducing rates of overdose and promoting entry into treatment among persons who inject drugs (PWID); however, they remain unavailable in the United States. Early findings examining American PWID illustrate high overall willingness to use SIFs. The current study expands upon this research by examining PWID's likelihood to use SIFs based on services offered (eg, provides clean needles, linkage to treatment programs) and whether known risk factors (prior overdose, homelessness) influence PWID's willingness to use a SIF. METHODS: Participants (n = 184) were patients entering short-term inpatient opioid withdrawal management in Massachusetts between May 2018 and February 2019 who reported injection drug use in the prior 30 days. We examined PWID's likelihood to use a SIF if eight unique services were available, and compared if this differed by overdose history and homelessness status using ordered logistic regression and Pearson's χ2 -tests of independence. RESULTS: Participants (34.2 [±8.3 SD] years of age, 68.5% male, 85.9% white, 8.2% Hispanic) reported being most likely to use SIFs that provided safety from police intervention (86.7%), entry into withdrawal management (85.9%), or clean needles (83.2%). Drug works disposal and safety from police were particularly important for PWID with a history of overdose. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Overall, treatment-seeking PWIDs reported greater willingness to utilize SIFs if particular services were provided. These findings point to features of SIFs that may enhance treatment-seeking PWID's amenability to utilizing these services if such sites open in the United States. (Am J Addict 2021;30:21-25).

Motivation to Quit Drinking in Individuals Coinfected with HIV and Hepatitis C.

Alcohol consumption is common among individuals coinfected with HIV and hepatitis C (HCV) despite the uniquely harmful effects in this population. Limited research has examined factors that could influence drinking reduction or cessation among HIV/HCV coinfected persons; this study investigates motivation to quit. Participants were 110 alcohol-consuming HIV/HCV coinfected patients recruited from medical clinics. Participants self-reported 90-day drinking frequency and intensity; alcohol-related problems; reasons to quit drinking; reasons to drink; and motivation to quit drinking. Participants consumed alcohol on 54.1 (± 26.9) of the past 90 days. In a multivariate model that controlled for demographic variables, motivation to quit drinking was directly associated with alcohol-related problems (ßy·x = 0.35, p = .007) and reasons to quit drinking (ßy·x = 0.23, p = .021), and inversely associated with drinking for enhancement (ßy·x = - 0.36, p = .004). This study identified several factors associated with motivation to quit drinking in a sample of alcohol-consuming HIV/HCV patients.

Examination of using alcohol to cope, depressive symptoms, and perceived social support in persons with HIV and Hepatitis C.

Depression is common among people living with HIV (PLWH) and some likely turn to alcohol to cope with this emotional distress. Using alcohol to cope is associated with increased alcohol use, persistent longitudinal alcohol use, and alcohol-related problems. This association is particularly concerning among PLWH who are co-infected with Hepatitis C (HCV) because alcohol adds to the damage already caused by HCV. Despite data showing the associated risks of using alcohol to cope, scant research has examined factors that might contribute to coping-based alcohol use in HIV-HCV patients, such as limited social support. Baseline data from a randomized trial of strategies to reduce alcohol use in co-infected HIV and HCV adult patients (n=110) were analyzed. Multiple linear regression models were used to estimate the association between using alcohol to cope, depression, and four aspects of social support, controlling for demographic variables. Results showed that using alcohol to cope was not significantly correlated with social support but was significantly correlated with depressive symptoms. In fact, depressive symptoms and severity of alcohol consumption accounted for nearly 45% of the variance related to coping-based alcohol use. These data highlight the central role of depression in the coping motives-alcohol use relationship among co-infected patients.

Worries About Discontinuing Buprenorphine Treatment: Scale Development and Clinical Correlates.

BACKGROUND AND OBJECTIVES: Despite the benefits of maintenance buprenorphine treatment for opioid use disorder (OUD), many individuals report an interest in discontinuing the medication, while also expressing worries about tapering. The purpose of this study was to develop a measure of worries about buprenorphine discontinuation ("Off Bupe") and determine the demographic and clinical characteristics associated with these worries. METHODS: Between May 2017 and May 2018, we surveyed adults in an outpatient primary care buprenorphine program (n = 138). Reliability and validity of the Off Bupe measure were examined. RESULTS: Participants averaged 39 years of age, 54% were male, average duration of buprenorphine was 189 weeks and 85.5% reported eventually wanting to discontinue buprenorphine, although fewer than 10% were actively tapering. We derived two scales, withdrawal symptom worry (10 items, ɑ = 0.94) and relapse worry (7 items, ɑ = 0.88). Worry about symptoms was positively associated with current buprenorphine dose (P = 0.016), physical discomfort avoidance (P < 0.001), and inversely associated with self-efficacy to quit buprenorphine (P < 0.001) and distress tolerance (P < 0.001). Worry about opioid relapse was associated positively with age (P = 0.019), current buprenorphine dose (P = 0.004), physical discomfort avoidance (P < 0.001), and impulsivity (P = 0.002), and inversely associated with self-efficacy to quit buprenorphine (P < 0.001). DISCUSSION AND CONCLUSIONS: Psychometric evaluation of the "Off Bupe" scale demonstrated its content and construct validity and internal reliability. SCIENTIFIC SIGNIFICANCE: The scale might help individuals with OUD and their providers identify concerns about discontinuing buprenorphine. (Am J Addict 2019;28:270-276).

Emerging Adults' Discussion of Substance Use and Sexual Behavior with Providers.

Emerging adulthood (ages 18-25) is a time of increased autonomy and associated with a high rate of risky substance use and sexual behavior. As emerging adults (EA) increasingly have more independence, they have the ability to make health decisions, including whether to see a provider (primary care (PCP) and/or gynecologist (GYN)) and whether to discuss substance use and sexual behavior. The current study aimed to determine: (1) factors associated with PCP and GYN health-care seeking by sexually active EA who use alcohol and/or marijuana; (2) gender differences in substance use and sexual risk topics initiated by providers; (3) whether PCPs compared to GYNs discuss different topics with women. Alcohol and/or marijuana-using, sexually active EA (n = 500) were recruited as part of a health behaviors study. Among participants, 39% did not see a PCP in the previous year. Women, White individuals, and EA with health insurance were most likely to attend a PCP appointment. Even among participants who saw a provider, many participants reported that providers did not initiate a discussion about substance use (approximately half discussed substance use) and sexual behavior (about half discussed STI history, two-thirds discussed condom use, and three-quarters discussed sexual partners). Among women with a PCP and GYN provider, discussions on substance use were more likely to be initiated by a PCP while sexual issues were more likely to be initiated by a GYN. Thus, even among sexually active, substance-using EA, central topics - specifically substance use and sexual behavior - are not routinely brought up by providers.

A longitudinal evaluation of the role of alcohol self-concept in alcohol use, motives, negative affect, and alcohol-related problems among emerging adults.

BACKGROUND AND OBJECTIVES: Emerging adulthood is a time of identity formation, and is also the most common time period for individuals to consume alcohol. Alcohol self-concept (or drinking identity) has been associated cross-sectionally with rates of alcohol use and use-related problems. Additionally, there is preliminary evidence that alcohol self-concept is related to negative affect and to alcohol use motives. However, less research has evaluated the longitudinal nature of these variables, particularly in a community sample. The current study evaluated relationships between self-concept, alcohol-related variables, and negative affect among emerging adults. Additionally, the study explored self-concept as a mediator between motives and alcohol use and problems. METHODS: Community-recruited participants (n = 226, 55.3% male) involved in a health behaviors study were assessed over the course of 12 months. RESULTS: Results substantiated both the cross-sectional and longitudinal relationships between these variables. Self-concept, rates of use, and problems decreased over the course of time. Decreases in motives for alcohol use (including coping and enhancement motives) were related to subsequent decreases in alcohol self-concept, which in turn were associated with decreases in use and use-related problems. Alcohol self-concept mediated the longitudinal relationship between coping motives and use as well as use-related problems. DISCUSSION AND CONCLUSIONS: Results from this study underscore the importance of motivation for alcohol use and internalization of alcohol identity in predicting changes in behavior across emerging adulthood and suggest future avenues of research. SCIENTIFIC SIGNIFICANCE: Alcohol self-concept may be a risk factor and intervention target. (Am J Addict 2018;27:501-508).

The overlap of sleep disturbance and depression in primary care patients treated with buprenorphine.

BACKGROUND: Sleep disturbance is common among patients receiving long-term opioid therapies, such as methadone maintenance. However, little is known about sleep disturbances in patients receiving medication treatment with buprenorphine. We sought to determine the frequency of subjective sleep disturbance in a sample of patients receiving medication treatment and to examine clinical factors related to sleep disturbance. METHODS: Participants were 328 persons receiving buprenorphine at 3 primary care sites. Sleep difficulty was assessed 2 questions adapted from the Patient Health Questionnaire-9 (PHQ-9) item assessing sleep. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD)-10 and PHQ-2. In addition, information was gathered on participant demographics and treatment characteristics. Demographics, buprenorphine treatment history, and depressive symptoms were compared for those with and without self-reported sleep difficulty. Logistic regression was used to estimate the adjusted association of sleep disturbance with these correlates. RESULTS: Seventy-one percent of persons receiving medication treatment with buprenorphine in the present study reported sleep difficulty. Persons reporting sleep disturbance reported shorter time in buprenorphine treatment and more depressed mood compared with those without sleep difficulty (p < .01). Men were significantly less likely to report disturbed sleep than women (odds ratio [OR] = 0.57, 95% confidence interval [CI]: 0.33, 0.98). Sleep disturbance was not associated significantly with age, ethnicity, educational attainment, or buprenorphine dose. CONCLUSIONS: Sleep disturbance is common in patients receiving medication treatment with buprenorphine and is associated with more depressive symptoms as well as a shorter duration of medication treatment. Future research, using subjective and objective sleep measures, is warranted to understand whether sleep disturbance is mitigated by longer buprenorphine treatment and whether difficulty sleeping predicts buprenorphine discontinuation among patients seeking treatment for opioid dependence.

Pilot Randomized Trial of Collaborative Behavioral Treatment for Chronic Pain and Depression in Persons Living with HIV/AIDS.

In this pilot study, we assessed feasibility and acceptability of a behavior therapy intervention for pain and depressive symptoms in persons living with HIV/AIDS (PLWH). We randomly assigned 23 participants to HIV-PASS (HIV-Pain and Sadness Study) or a health education control arm for 3 months. On average, participants attended more than 5 sessions (of 7 possible) in both arms. Qualitative data suggest HIV-PASS participants understood key messages and made concrete behavioral changes. HIV-PASS was associated with effects in the expected direction for three of four outcomes, including the primary outcome (pain-related interference with functioning). Findings suggest that HIV-PASS is promising.

Chronic pain and depression among primary care patients treated with buprenorphine.

BACKGROUND: Pain and depression are each prevalent among opioid dependent patients receiving maintenance buprenorphine, but their interaction has not been studied in primary care patients. OBJECTIVE: We set out to examine the relationship between chronic pain, depression, and ongoing substance use, among persons maintained on buprenorphine in primary care settings. DESIGN: Between September 2012 and December 2013, we interviewed buprenorphine patients at three practice sites. PARTICIPANTS: Opioid dependent persons at two private internal medicine offices and a federally qualified health center participated in the study. MAIN MEASURES: Pain was measured in terms of chronicity, with chronic pain being defined as pain lasting at least 6 months; and in terms of severity, as measured by self-reported pain in the past week, measured on a 0-100 scale. We defined mild chronic pain as pain severity between 0 and 39 and lasting at least 6 months, and moderate/severe chronic pain as severity ≥ 40 and lasting at least 6 months. To assess depression, we used the Center for Epidemiologic Studies Depression (CESD) ten-item symptom scale and the two-item Patient Health Questionnaire (PHQ-2). KEY RESULTS: Among 328 participants, 169 reported no chronic pain, 56 reported mild chronic pain, and 103 reported moderate/severe chronic pain. Participants with moderate/severe chronic pain commonly used non-opioid pain medications (56.3%) and antidepressants (44.7%), yet also used marijuana, alcohol, or cocaine (40.8%) to help relieve pain. Mean CESD scores were 7.1 (±6.8), 8.3 (±6.0), and 13.6 (±7.6) in the no chronic, mild, and moderate/severe pain groups, respectively. Controlling for covariates, higher CESD scores were associated with a higher likelihood of moderate/severe chronic pain relative to both no chronic pain (OR = 1.09, p < 0.001) and mild chronic pain (OR = 1.06, p = 0.04). CONCLUSION: Many buprenorphine patients are receiving over-the-counter or prescribed pain medications, as well as antidepressants, and yet continue to have significant and disabling pain and depressive symptoms. There is a clear need to address the pain-depression nexus in novel ways.

Differential risk factors for HIV drug and sex risk-taking among non-treatment-seeking hospitalized injection drug users.

Injection drug users (IDUs) are at increased risk of contracting HIV. From a clinical trial assessing an intervention to enhance the linkage of hospitalized patients to opioid treatment after discharge, we conducted multivariate analysis of baseline data from hospitalized IDUs with a history of opioid dependence (n = 104) to identify differences in factors predicting HIV drug and sex risk behaviors. Factors significantly associated with HIV drug risk were being non-Hispanic Caucasian and recent cocaine use. Being female, binge drinking, and poorer mental health were significantly associated with higher sex risk. Because factors predicting HIV sex risk behaviors differ from those predicting HIV drug risk, interventions aimed at specific HIV risks should have different behavioral and substance use targets.

The unique challenges facing HIV-positive patients who smoke cigarettes: HIV viremia, ART adherence, engagement in HIV care, and concurrent substance use.

Evidence suggests that smoking may have negative associations with HIV health outcomes. The smoking rate in our sample of people living with HIV (N = 333) was triple that of the general population (57 v. 19 %). Regression analyses revealed that (smokers v. non-smokers) reported lower medication adherence (unstandardized beta = 9.01) and were more likely to have a detectable viral load (OR = 2.85, 95 % CI [1.53-5.30]). Smokers attended fewer routine medical visits (ß = -0.16) and were more likely to report recent hospitalization (OR = 1.89, 95 % CI [0.99, 3.57]). Smokers ranked "health" as less important to their quality of life (ß = -0.13) and were more likely to report problematic alcohol (OR = 2.40, 95 % CI [1.35, 4.30]), cocaine (OR = 2.87, 95 % CI [1.48-5.58]), heroin (OR = 4.75, 95 % CI [1.01, 22.30]), or marijuana use (OR = 3.08, 95 % CI [1.76-5.38]). Findings underscore the need for integrated behavioral smoking cessation interventions and routine tobacco screenings in HIV primary care.

Chronic Pain in HIV-Infected Patients: Relationship to Depression, Substance Use, and Mental Health and Pain Treatment.

OBJECTIVE: As the advent of highly active antiretroviral therapy, HIV has become a chronic disease for most individuals in developed countries. Chronic pain is a common occurrence for HIV-infected patients and has an impact on quality of life and antiretroviral adherence. The objective of this study was to examine relationships between chronic pain and depression, substance use, mental health treatment, and pain treatment in HIV-infected patients. DESIGN: Cross-sectional study. SETTING: Three primary care sites where HIV+ patients receive treatment. SUBJECTS: Two hundred and thirty eight HIV-infected primary care patients. METHODS: We collected self-report and chart-review information on demographics, HIV clinical status, chronic pain, depression, substance use, mental health treatment, and pain treatment. We collected data between October 2012 and November 2013. RESULTS: Of the patients enrolled in this study, 107 reported no chronic pain, 24 reported mild chronic pain, and 107 reported moderate-severe chronic pain. Participants in the moderate-severe pain group were more likely to have high levels of depressive symptoms than those in the no chronic pain group. Similarly, there was a significant relationship between chronic pain status and interference with life activities due to pain. Participants with moderate-severe chronic pain were more likely to be taking an antidepressant medication than those with mild chronic pain, and more likely to be taking a prescription opioid than the other two groups. We did not find a significant relationship between problematic substance use and chronic pain status. CONCLUSIONS: Despite pharmacologic treatment, moderate-severe chronic pain and elevated depression symptoms are common among HIV-infected patients and frequently co-occur.

Study protocol for the Treating Opioid Patients' Pain and Sadness (TOPPS) study - A randomized control trial to lower depression and chronic pain interference, and increase care retention among persons receiving buprenorphine.

BACKGROUND: Persons receiving prescription buprenorphine for opioid use disorder experience high rates of comorbid conditions such as chronic pain and depression, which present barriers to buprenorphine care retention. This paper describes the protocol of the TOPPS (Treating Opioid Patients' Pain and Sadness) study, which compares a values-based, behavioral activation intervention with a health education contact-control condition, with the aim of decreasing chronic pain and depression, and increasing buprenorphine care retention for persons with opioid use disorder. METHODS: This randomized controlled trial (RCT) enrolls and randomizes up to 250 participants currently being treated with buprenorphine to receive three months of either TOPPS, a six-session phone-based behavioral intervention, or a health education (HE) control condition. We compare the TOPPS intervention to HE on the following outcomes: 1) pain interference and pain severity over the 3-month treatment phrase; 2) depressive symptoms over the 3-month treatment phase; and 3) sustained improvements in pain interference, depressive symptoms, and buprenorphine treatment retention over the 12-month study period. We also examine mechanisms by which the intervention may reduce pain interference. DISCUSSION: This RCT explores a novel intervention to address chronic pain and depression for individuals receiving buprenorphine in office-based settings. TOPPS may lead to improved pain, depression, and substance use outcomes, and can utilize providers available within buprenorphine programs, broadening the disseminability of this intervention and heightening its public health impact. CLINICAL TRIAL: #NCT03698669.

Self-efficacy and motivation to quit marijuana use among young women.

BACKGROUND AND OBJECTIVES: Assessing motivation to quit substance use is recommended as part of brief interventions. The purpose of this study was to determine correlates of desire to quit marijuana use among young adult women enrolled in a brief motivational intervention trial. METHODS: Participants were 332 female marijuana users, aged 18-24, who rated their current desire to quit using a single item change ladder. We hypothesized self-efficacy and prior quit attempts will interact in this population to increase motivation to quit. RESULTS: Participants had a mean age of 20.5 years, 67.7% were non-Hispanic Caucasian, and 60% had some desire to quit marijuana use. Using multivariate linear regression, quit desire was significantly lower among Caucasians (b = -.256; 95% CI -.489; -.037) and more frequent marijuana users (b = -.268; 95% CI -.372; -.166), and higher among those with previous quit attempts (b = .454; 95% CI .235; .671), and greater marijuana problem severity (b = .408; 95% CI .302; .514). Greater refusal self-efficacy was associated with greater quit desire among participants with previous quit attempts, but not among those without prior quit attempts (b = .241; 95% CI .050; .440). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Understanding the factors relating to quit desire among marijuana users may allow clinicians to tailor counseling so as to increase readiness to quit and decrease use and its associated consequences.

User-centered preferences for a gait-informed alcohol intoxication app.

Background: mHealth technology can be used as a potential intervention for alcohol-related consequences. Applications designed to monitor alcohol use and relay information to the user may help to reduce risky behavior. Acceptability of such applications needs to be assessed. Methods: Survey data from 139 participants (29.8 years on average, 58% female) completing a single-session study for developing an application to detect blood alcohol concentration (BAC) from gait was analyzed to examine user preferences. Participants reported on their interest in an application for monitoring BAC from gait. Participants also reported on their preference for controlling features of the application. Acceptability and feasibility data were collected. Data were examined for the entire sample as well as differences in preference by age and gender were examined. Results: The majority of the sample indicated that they were interested in using an mHealth application to infer BAC from their gait. Users were interested in being able to control features of the application, such as monitoring BAC and reporting information to other individuals. Adults, as compared to emerging adults, preferred the ability to turn off the BAC-monitoring feature of the app. Females reported a preference for an app that does not allow the user to turn off notifications for BAC as well as safety features of the app. Conclusions: Results of the survey data indicate general interest in mHealth technology that monitors BAC from passive input. These results suggest that such an app may be accepted and used as an intervention for monitoring alcohol levels, which could mediate drinking and alcohol-related consequences.

Retention in care for persons with opioid use disorder transitioning from sublingual to injectable buprenorphine.

INTRODUCTION: In the current overdose epidemic, effective treatments for opioid use disorders (OUD), including innovations in medication delivery such as extended-release formulations, have the potential to improve treatment access and reduce treatment discontinuation. This study assessed treatment retention in a primary care-based, extended-release buprenorphine program. METHODS: The study recruited individuals (n = 92) who transitioned from sublingual buprenorphine to extended-release buprenorphine (BUP-XR) in 2018-2019. The study defined the primary outcome, treatment retention, as three or more consecutive, monthly BUP-XR injections following the transition to BUP-XR in this retrospective chart review. RESULTS: Participants' mean age was 38 years old and 67% were male. The average duration of sublingual buprenorphine prior to transition was 17.1 (±28.1) months. Three months after transition, 48% of extended-release buprenorphine patients had discontinued BUP-XR treatment. Persons with chronic pain were more likely, and those who had used heroin in the past month less likely to continue BUP-XR. Mean months on sublingual buprenorphine prior to BUP-XR initiation was 24.3 (±32.5) months for people who received 3+ post-induction injections compared to only 8.9 (±19.5) months for those who did not (p = .009). CONCLUSIONS: Extended-release buprenorphine discontinuation was high in a real-world setting. Retention continues to represent a major obstacle to treatment effectiveness, and programs need interventions with even newer MOUD formulations.