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Prescription opioid abuse is any intentional use of opioids outside of a physician’s prescription for a bona fide medical condition (Finley et al., 2017; Lossio-Ventura, Song, Sainlaire, Dykes, & Hernandez-Boussard, 2022; Sarker, DeRoos, & Perrone, 2020; Sinha, Jensen, Mullin, & Elkin, 2017). It can lead to addiction, higher healthcare costs, and serious harm to patients (Azadfard, Huecker, & Leaming, 2022; Blendon & Benson, 2018). This abuse requires detoxification and hospitalization very similar to a chronic condition. The number of people in the US with opioid abuse exceeds 2 million and the total cost is approximately $100B per year (NIH, 2019). According to NIH, about half of the drug overdose deaths in the US are due to opioids (NIH, 2019) and resulted in 80,816 deaths in 2021 (CDC, 2022). Opioid abuse is a major challenge for patients and family members, healthcare professionals, employers, regulators, and society. There is a need for smart interventions at multiple levels before patients develop opioid addiction and require major treatment (Singh & Varshney, 2019a, 2020; Varshney & Singh, 2020b, 2020c). These smart interventions can lead to better outcomes for patients and reduce the need for healthcare resources.
Each patient has a certain chance of abusing opioids (single vs multiple prescriptions) based on their history, genetic makeup, current environment, medical condition, and type of opioid prescribed. Some of the patients will have low, some moderate and some will have a high level of opioid abuse. This is also time-dependent, and patients can change from low to moderate to high or high to moderate. This has some chance of leading to addiction, which will require expensive inpatient treatment. This abuse should be considered a chronic disease and different patients will require outpatient treatment for different durations of time. A different set of actions will be needed (a) at the source (for healthcare professionals) managing the prescriptions, (b) patient-level during consumption of opioids, and (c) after the patient has developed an addiction. In this paper, we focus on patient-level interventions, which are proactive and with some probabilities will be effective for some patients in preventing them from developing an opioid addiction. To design smart interventions, we present a design approach. Using multiple constraints and considering the environmental context, we have developed three smart interventions. The interventions are (a) mobile reminders (Voelker, 2019), (b) electronic monitoring of opioids (Jungquist et al., 2019), and (c) composite intervention (monitoring, reminders and support from other patients) (Schuman-Olivier et al., 2018; Varshney, 2015). The mobile reminders will be sent to the patient to provide educational and motivational support to avoid overconsumption of opioids. Electronic monitoring will keep track of the prescribed opioids. This involves designing wireless monitoring systems for collecting and analyzing opioid consumption data. The composite intervention will include reminder, monitoring and motivational support from other patients. This intervention can reduce the consumption of prescription opioids by monitoring and reminding patients about taking and/or not taking certain doses within certain windows of time. The interventions can be implemented using both simple and sophisticated mobile apps, sensors, mobile devices, and smart medication boxes. This could proactively stop patients from becoming dependent on opioids or developing an addiction.