Patients Being Treated for Opioid and Substance Use Disorders can Receive Cognitive Behavioral Therapy Remotely – On Their Phone

Center for Addiction Medicine at University of Maryland Medical Center's Midtown Campus Offers Prescription Mobile Apps to Help People Maintain Their Sobriety

People receiving outpatient treatment for opioid and substance use disorders at the University of Maryland Medical Center's Midtown Campus are now receiving cognitive behavioral therapy using a prescription digital therapeutic (PDT) application on their smartphone. The mobile app enables them to access evidence-based behavioral therapy when and where they need it and allows medical providers to track their progress.

"We are excited to be able to provide counseling to our patients in an alternative way," said Marian Currens, CRNP, Director of the University of Maryland Center for Addiction Medicine (CAM) at the UMMC Midtown Campus. "We live in a digital age and having this technology makes perfect sense. We are not doing away with face-to-face counseling or telehealth visits. This is another tool in the toolkit to help patients get through their struggles with addiction."

"With this mobile medical app, people can manage and learn about their addiction at their own pace on their own time," Currens said.

The COVID-19 pandemic has exacerbated drug and alcohol abuse. More than 2,500 Marylanders died of opioid overdoses in 2020, more than any year on record, with a majority of the deaths related to the synthetic opioid fentanyl, Maryland Department of Health officials reported. That total includes a record 453 people who died of prescription opioid overdoses. The Centers for Disease Control reported recently that drug overdose deaths in the U.S. topped 100,000 annually for the first time during the pandemic.

"Fentanyl has taken over the illicit substance industry," said Edwin Juma, DNP, who treats patients in the CAM program, adding that the man-made drug is being added to prescription drugs and marijuana and users often don't realize it. He and Currens said the drug is readily accessible and more potent and economical than heroin, which they no longer see much of in Baltimore.

Juma noted that having this mobile application to augment cognitive behavioral therapy has been particularly important during the pandemic because people have found it difficult to regularly attend in-person and telehealth counseling sessions. The pandemic has strained outpatient services at the clinic, which has scaled back the number of hours of required outpatient therapy for many patients.

Patients use the software to complete a recommended four lessons a week, answer questions to quizzes and report substance use, cravings and triggers. The applications, reSET and reSET-O, developed by Pear Therapeutics, allow users to win rewards, such as coupons for Starbucks or Amazon, as a way to create positive reinforcement and promote engagement.

"It's not just the rewards that are good, which would make people want to do it. The information is great," said Keisha, who has been using reSET-O along with medication and twice-weekly Zoom counseling meetings to deal with her addiction to the narcotic painkiller Percocet. "The real reward is the information you are gaining."

Keisha, who said she became addicted to Percocet when she was undergoing treatment for cancer, said the mobile app "absolutely helps" and is easy to use. "It builds your self-esteem. It builds your confidence. It helps you become the best you can be." She is taking classes to become a medical assistant and would like to work with hospice patients.

"The app is very educational and provides a lot of details," said Bryan, who has been using reSET to battle alcohol abuse. "It helps you avoid the temptations and helps with your coping skills and to avoid using." As part of his treatment, Bryan also receives injections of Vivitrol, which reduces cravings for alcohol and the "buzz" from drinking, and attends Alcoholics Anonymous meetings three days a week.

"I am doing good – 11 months clean," said Bryan, who was referred for outpatient therapy at UMMC Midtown by a residential treatment program in Baltimore. So far, he has earned several hundred dollars in rewards for completing lessons and quizzes on the mobile app, which he says covers non-drug-related topics such as saving money and sexually transmitted diseases. He said the lessons are written in terms he can understand.

The mobile app includes a check-in process where the user is asked, "Have you used today?" and then is prompted to rank their craving on a scale of 1-10 and to identify the possible triggers: hungry, lonely, tired, angry, social pressure and pain.

Pear Therapeutics has published research indicating that its mobile app reSET-O is positively associated with patients refraining from using opioids and staying longer in medication-assisted treatment programs.

reSET is a 12-week PDT for patients with substance use disorder, and reSET-O is a 12-week PDT for patients with opioid use disorder who are being treated with buprenorphine, an opioid used as an alternative to methadone. Patients can only receive the prescription software as part of medication-assisted treatment in an outpatient program overseen by a clinician. Clinicians can refill the prescriptions multiple times. Both applications are authorized by the U.S. Food and Drug Administration for patients with substance or opioid use disorders in outpatient treatment.

The Center for Addiction Medicine at UMMC Midtown began offering reSET and reSET-O to patients in late April 2021; 60 patients have been prescribed the apps, with 29 completing the 12-week program, including 16 who refilled their prescriptions. The majority of the prescriptions were for reSET-O. There are 19 patients currently participating in the program.

"This platform also provides a dashboard so that clinicians can track whether a patient is experiencing cravings and completing lessons, which provides us with additional insight into the progress they are making," Juma said.

About the University of Maryland Medical Center

The University of Maryland Medical Center (UMMC) is comprised of two hospital campuses in Baltimore: the 800-bed flagship institution of the 13-hospital University of Maryland Medical System (UMMS) and the 200-bed UMMC Midtown Campus. Both campuses are academic medical centers for training physicians and health professionals and for pursuing research and innovation to improve health. UMMC's downtown campus is a national and regional referral center for trauma, cancer care, neurosciences, advanced cardiovascular care, and women's and children's health, and has one of the largest solid organ transplant programs in the country. All physicians on staff at the downtown campus are clinical faculty physicians of the University of Maryland School of Medicine. The UMMC Midtown Campus medical staff is predominately faculty physicians specializing in a wide spectrum of medical and surgical subspecialties, primary care for adults and children and behavioral health. UMMC Midtown has been a teaching hospital for 140 years and is located one mile away from the downtown campus. For more information, visit www.umm.edu.

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