Prediction of Return to Opioid Use During Immediate Community Reintegration

Nearly 400,000 people with an opioid use disorder (OUD) receive OUD treatment each year, or 19.7% of all people with an OUD. Community reintegration following residential OUD treatment is a critically vulnerable time, with most inpatients returning to use within 30 days. Given the extremely brief window of opportunity for prevention intervention, evaluating time-sensitive proximal predictors of return to opioid use during community reintegration is essential. Risk for return to use fluctuates substantially—even within timescales of hours—with some people displaying higher variability than others. Identifying predictors of return to opioid use thus requires methods that can track return to use closely over time, rather than relying on retrospective or cross-sectional assessments. Ecological monitoring tools can accurately record severity and variability of return to opioid use in daily life, proximally to when they occur. Yet, application of this work during the extremely high-risk period of community reintegration is scarce. The proposed study will assess time-varying, longitudinal changes in post-traumatic stress disorder (PTSD) symptoms on risk for return to opioid use during community reintegration. Further, the influence of physiology (heart rate variability [HRV] and electrodermal response [EDA]) on risk for return to opioid use—including when coupled with PTSD symptoms—will be explored. These findings will inform evidence-based tools to prevent and/or delay return to opioid use during community integration.

This study advances research by using ecological momentary assessment (EMA) and a wearable biosensor (Empatica) to test proximal relations between PTSD symptoms and return to opioid use—and the influence of physiology—in the 30 days immediately following residential OUD treatment (N=150). EMA and biometrics capture data frequently (or, for the Empatica E4, continuously), naturalistically, and in near real-time, allowing for explication of within-person, proximal relations, as well as contextual factors underlying risk. Aim 1 determines the influence of PTSD on return to opioid use during immediate community reintegration of OUD inpatients. Aim 2 evaluates the utility of passively collected physiology to detect return to opioid use during immediate community reintegration of OUD inpatients.

The proposed research fills important gaps regarding time-sensitive proximal predictors of return to opioid use during the high-risk and understudied period of community reintegration. This work is important, timely, and innovative. Developing evidence-based tools to prevent and delay return to opioid use during community reintegration has important implications for the health of individuals in our nation.