Acceptability of the use of cellular telephone and computer pictures/video for “pill counts” in buprenorphine maintenance treatment

Christopher Welsh, MD

doi:10.5055/jom.2016.0334

Authors

Christopher Welsh, MD

DOI:

https://doi.org/10.5055/jom.2016.0334

Keywords:

pill counts, controlled substances, misuse, diversion

Abstract

Objective: As part of a comprehensive plan to attempt to minimize the diversion of prescribed controlled substances, many professional organization and licensing boards are recommending the use of “pill counts.” This study sought to evaluate acceptability of the use of cellular phone and computer pictures/video for “pill counts” by patients in buprenorphine maintenance treatment.

Setting and intervention: Patients prescribed buprenorphine/naloxone were asked a series of questions related to the type(s) of electronic communication to which they had access as well as their willingness to use these for the purpose of performing a “pill/film count.”

Results: Of the 80 patients, 4 (5 percent) did not have a phone at all. Only 28 (35 percent) had a “smart phone” with some sort of data plan and Internet access. Forty (50 percent) of the patients had a phone with no camera and 10 (12.5 percent) had a phone with a camera but no video capability. All patients said that they would be willing to periodically use the video or camera on their phone or computer to have buprenorphine/naloxone pills or film counted as long as the communication was protected from electronic tampering.

Conclusions: With the advent of applications for smart phones that allow for Health Insurance Portability and Accountability Act of 1996-compliant picture/video communication, a number of things can now be done that can enhance patient care as well as reduce the chances of misuse/diversion of prescribed medications. This could be used in settings where a larger proportion of controlled substances are prescribed including medication assisted therapy for opioid use disorders and pain management programs.

Author Biography

Christopher Welsh, MD

Associate Professor, Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, Baltimore, Maryland

References

Centers for Disease Control and Prevention: Injury Prevention and Control: Prescription Drug Overdose. Available at http://www.cdc.gov/drugoverdose/data/index.html. Accessed February 10, 2016.

Centers for Disease Control and Prevention: Medication Safety Program. Available at http://www.cdc.gov/MedicationSafety/program_focus_activities.html. Accessed February 10, 2016.

Centers for Disease Control and Prevention: CDC Grand Rounds: Prescription drug overdoses-a U.S. epidemic. MMWR Morb Mortal Wkly Rep. 2012; 61(1): 10-13.

Epidemic: Responding to America's Prescription Drug Abuse Crisis 2011. Available at https://www.whitehouse.gov/sites/default/files/ondcp/issues-content/prescription-drugs/rx_abuse_plan_0.pdf. Accessed February 10, 2016.

Paulozzi LJ, Weisler RH, Patkar AA: A national epidemic of unintentional prescription opioid overdose deaths: How physicians can help control it. J Clin Psychiatry. 2011; 72(5): 589-592.

Dowell D, Haegerich T, Chou R: CDC guideline for prescribing opioids for chronic pain-United States, 2016. J Am Med Assoc. 2016; E1-E21.

Cantrill SV, Brown MD, Carlisle RJ, et al.: Clinical policy: Critical issues in the prescribing of opioids for adult patients in the emergency department. Ann Emerg Med. 2012; 60(4): 499-525.

Passik SD, Kirsh KL: Assessing aberrant drug-taking behaviors in the patient with chronic pain. Curr Pain Headache Rep. 2004; 8: 289-294.

Manchikanti L, Abdi S, Atluri S, et al.: American Society of Interventional Pain Physicians(ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2. Guidance. Pain Physician. 2012; 15: S67-S116.

Cortez NG, Cohen IG, Kesselheim AS: FDA regulation of mobile health technologies. N Engl J Med. 2014; 371(4): 372-379.

Reponen J, Ilkko E, Jyrkinen L, et al.: Initial experience with a wireless personal digital assistant as a teleradiology terminal for reporting emergency computerized tomography scans. J Telemed Telecare. 2000; 6: 45-49.

Blaivas M, Lyon M, Duggal S: Ultrasound image transmission via camera phones for overreading. Am J Emerg Med. 2005; 23: 433-438.

Braun RP, Vecchietti JL, Thomas L, et al.: Telemedical wound care using a new generation of mobile phones: A feasibility study. Arch Dermatol. 2005; 141: 254-258.

Archibold HA, Guha AR, Shyamsundar S, et al.: The use of multi-media messaging in the referral of musculoskeletal limb injuries to a tertiary trauma unit: A 1 month evaluation. Injury. 2005; 36: 260-266.

Jayaraman C, Kennedy P, Dutu G, et al.: Use of mobile phone cameras for after-hours triage in primary care. J Telemed Telecare. 2008; 14: 271-274.

McLean R, Jury C, Bazeos A, et al.: Application of camera phones in telehaematology. J Telemed Telecare. 2009; 15: 339-343.

Trankler U, Hagen O, Horsch A: Video quality of 3G videophones for telephone cardiopulmonary resuscitation. J Telemed Telecare. 2008; 14: 396-400.

Nieves JE, Godleski LS, Stack KM, et al.: Videophones for intensive case management of psychiatric outpatients. J Telemed Telecare. 2009; 15: 51-54.

Kim D, Yoo SK, Park I, et al.: A mobile telemedicine system for remote consultation in cases of acute stroke. J Telemed Telecare. 2009; 15: 102-107.

Bolle SR, Scholl J, Gilbert M: Can video mobile phones improve CPR quality when used for dispatcher assistance during simulated cardiac arrest? Acta Anaesthesiol Scand. 2009; 53: 116-120.

Lim TH, Choi HJ, Kang BS: Feasibility of dynamic cardiac ultrasound transmission via mobile phone for basic emergency teleconsultation. J Telemed Telecare. 2010; 16: 281-285.

Rudd P, Byyny RL, Zachary V, et al.: The natural history of medication compliance in a drug trial: Limitations of pill counts. Din Pharmacol Ther. 1989; 46: 169-176.

Kalichman SC, Amaral CM, Cherry C, et al.: Monitoring medication adherence by unannounced pill counts conducted by telephone: Reliability and criterion-related validity. HIV Clin Trials. 2008; 9(5): 298-308.

Skrajner MJ, Camp CJ, Haberman JL, et al.: Use of videophone technology to address medication adherence issues in persons with HIV. HIV/AIDS. 2009; 1: 23-30.

Galloway GP, Coyle JR, Guillen JE, et al.: A simple, novel method for assessing medication adherence; capsule photographs taken with cellular telephones. J Addict Med. 2011; 5(3): 170-174.

Viscomi CM, Covington M, Christenson C: Pill counts and pill rental: Unintended entrepreneurial opportunities. Clin J Pain. 2013; 29(7): 623-624.

Souppaya M, Scarfone K: Guidelines for managing the security of mobile devices in the enterprise. 2013. Available at http://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-124r1.pdf. Accessed February 10, 2016.