Building a Contextually Triggered Just-in-Time Intervention for Opioid UseDisorder: Stakeholder Evaluation and User Centered Design

Abstract The opioid epidemic represents a major public health crisis in the U.S. Although medications such as buprenorphine are the current gold standard treatment for individuals diagnosed with opioid use disorder (OUD), a significant proportion of patients return to illicit opioid use and/or discontinue treatment prematurely. Moreover, the co-occurrence of a psychiatric condition is one important contributor to poor treatment outcomes. Recognizing and responding adaptively to substance-related and personal cues that can trigger both craving and substance use behaviors is a crucial behavioral strategy for managing or overcoming OUD. Digital technologies, especially personal smartphones, represent promising platforms to transcend traditional barriers to care, and smartphone sensors can be used to objectively, yet passively, assess aspects of cue exposure (e.g., geographic proximity to personalized locations where an individual typically obtains or uses opiates, psychological distress) which can be leveraged to deploy tailored, just-in-time supportive interventions to promote recovery and psychological well- being. The focus of this application – the Vira Mobile App - is a digitally enhanced behavior change platform that has primarily been used in the management of mental health symptoms. Given the relevance of both substance-related and personal cues in the maintenance and relapse of addictive behaviors in OUD, one promising approach to the development of just-in- time adaptive interventions is to use mobile sensing to anticipate and avoid exposure to cues, and to facilitate the use of coping skills in the presence of cues. Therefore, in this Phase 1 SBIR application, we will conduct technical development and formative, user centered research on extending the capabilities of the Vira platform to provide just-in-time intervention for two types of cues that play a role in the maintenance and relapse in OUD – 1) personalized geographic locations that are associated with obtaining and using drugs, and 2) emotional distress. As such, the aims of this Phase 1 SBIR application are to develop, adapt, and refine the Vira platform for use as a scalable, adjunctive treatment for OUD.