title: Digital Pills to Measure Opioid Ingestion Patterns in Emergency Department Patients With Acute Fracture Pain: A Pilot Study.
abstract: Nonadherence to prescribed regimens for opioid analgesic agents contributes to increasing opioid abuse and overdose death. Opioids are frequently prescribed on an as-needed basis, placing the responsibility to determine opioid dose and frequency with the patient. There is wide variability in physician prescribing patterns because of the lack of data describing how patients actually use as-needed opioid analgesics. Digital pill systems have a radiofrequency emitter that directly measures medication ingestion events, and they provide an opportunity to discover the dose, timing, and duration of opioid therapy.
  
  
  
  The purpose of this study was to determine the feasibility of a novel digital pill system to measure as-needed opioid ingestion patterns in patients discharged from the emergency department (ED) after an acute bony fracture.
  
  
  
  We used a digital pill with individuals who presented to a teaching hospital ED with an acute extremity fracture. The digital pill consisted of a digital radiofrequency emitter within a standard gelatin capsule that encapsulated an oxycodone tablet. When ingested, the gastric chloride ion gradient activated the digital pill, transmitting a radiofrequency signal that was received by a hip-worn receiver, which then transmitted the ingestion data to a cloud-based server. After a brief, hands-on training session in the ED, study participants were discharged home and used the digital pill system to ingest oxycodone prescribed as needed for pain for one week. We conducted pill counts to verify digital pill data and open-ended interviews with participants at their follow-up appointment with orthopedics or at one week after enrollment in the study to determine the knowledge, attitudes, beliefs, and practices regarding digital pills. We analyzed open-ended interviews using applied thematic analysis.
  
  
  
  We recruited 10 study participants and recorded 96 ingestion events (87.3%, 96/110 accuracy). Study participants reported being able to operate all aspects of the digital pill system after their training. Two participants stopped using the digital pill, reporting they were in too much pain to focus on the novel technology. The digital pill system detected multiple simultaneous ingestion events by the digital pill system. Participants ingested a mean 8 (SD 5) digital pills during the study period and four participants continued on opioids at the end of the study period. After interacting with the digital pill system in the real world, participants found the system highly acceptable (80%, 8/10) and reported a willingness to continue to use a digital pill to improve medication adherence monitoring (90%, 9/10).
  
  
  
  The digital pill is a feasible method to measure real-time opioid ingestion patterns in individuals with acute pain and to develop real-time interventions if opioid abuse is detected. Deploying digital pills is possible through the ED with a short instructional course. Patients who used the digital pill accepted the technology.
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Peter R
authors.identifier: 0000-0003-0955-4117
authors.initials: PR
authors.lastname: Chai
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Stephanie
authors.identifier: 0000-0003-1798-9006
authors.initials: S
authors.lastname: Carreiro
authors.affiliation: University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Brendan J
authors.identifier: 0000-0003-2107-1767
authors.initials: BJ
authors.lastname: Innes
authors.affiliation: Behavioral and Preventative Medicine, The Miriam Hospital, Brown School of Public Health, Providence, RI, United States.
authors.forename: Rochelle K
authors.identifier: 0000-0003-1598-667X
authors.initials: RK
authors.lastname: Rosen
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Conall
authors.identifier: 0000-0002-5639-5043
authors.initials: C
authors.lastname: O'Cleirigh
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
authors.forename: Kenneth H
authors.identifier: 0000-0001-7460-733X
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Edward W
authors.identifier: 0000-0002-3454-1310
authors.initials: EW
authors.lastname: Boyer
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D015374:Biosensing Techniques; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011846:Radio Waves
chemical_list: D000701:Analgesics, Opioid; D010098:Oxycodone
keywords: digital health; digital pills; emergency medicine; medication adherence; opioid; pain management