title: A pilot study about the feasibility and cost-effectiveness of electronic compliance monitoring in substitution treatment with buprenorphine-naloxone combination.
abstract: OBJECTIVE
  The purpose of the study was to investigate whether or not compliance monitoring by microchip could offer a feasible method for reducing abuse and/or diversion of medication from unsupervised substitution treatment for opioid addiction.
  
  
  METHODS
  Naturalistic, 4-week pilot study in out patients.
  
  
  METHODS
  All our patients (N = 12) on buprenorphine-naloxone combination (Suboxone) received their medication for 6 days in a compliance-monitoring device (PharmaDDSi, StoraEnso), which registers date and time of tablet removal. Patients were instructed to take all tablets as one dose. Time cues were displayed and discussed with the patients during their weekly visits for supervised drug administration and counseling.
  
  
  METHODS
  Regularity of registered time cues, treatment costs in comparison with routine treatment, patients' answers from a questionnaire on acceptability, and effect on drug diversion.
  
  
  RESULTS
  Six patients showed good compliance, in two patients irregularities were minor, but in two others lack of adherence to treatment instructions was detected. Patients with several comorbid psychiatric diagnoses showed on an average the longest intervals between removal of first and last tablet of the daily dose. One-fourth of the patients reported that compliance monitoring had helped to avoid diversion. Total cost savings during the 4-week period was a reduction of 39 percent, which was mainly due to fewer visits to the clinic.
  
  
  CONCLUSIONS
  Compliance monitoring by PharmaDDSI with weekly feedback was well accepted and subjectively increased compliance with substitution treatment. Future studies will show whether a technical solution for compliance monitoring in real time can help to reduce drug abuse and noncompliance in substitution treatment and other opioid treatments.
authors.affiliation: Kuopio Univeristy Hospital, Finland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Tacke
authors.forename: Hanna
authors.initials: H
authors.lastname: Uosukainen
authors.forename: Marjo
authors.initials: M
authors.lastname: Kananen
authors.forename: Kirsi
authors.initials: K
authors.lastname: Kontra
authors.forename: Hannu
authors.initials: H
authors.lastname: Pentikänen
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002047:Buprenorphine / Q000008:administration & dosage*; D000069479:Buprenorphine, Naloxone Drug Combination; D003362:Cost-Benefit Analysis; D003376:Counseling; D004334:Drug Administration Schedule; D004360:Drug Therapy, Computer-Assisted / Q000191:economics* / Q000379:methods; D004582:Electronics, Medical / Q000191:economics*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine