Novel remote electronic medication supply model for opioid-dependent outpatients with polypharmacy--first long-term case study

Harm Reduct J. 2017 Aug 16;14(1):56. doi: 10.1186/s12954-017-0182-x.


Background: Patients with substance use disorders grow older thanks to effective treatments. Together with a high prevalence of comorbidities, psychological problems, and low social support, these patients are at high risk for medication non-adherence. Established treatment facilities face challenges to accommodate these complex patients within their setting. Electronic medication management aids (e-MMAs) might be appropriate to simultaneously monitor and improve adherence for these patients.

Case presentation: We report the first long-term experiences with a novel remote electronic medication supply model for two opioid-dependent patients with HIV. John (beginning dementia, 52 years, 6 tablets daily at 12 am) and Mary (frequent drug holidays, 48 years, 5-6 tablets daily at 8 pm) suffered from disease progression due to non-adherence. We electronically monitored adherence and clinical outcomes during 659 (John) and 953 (Mary) days between July 2013 and April 2016. Both patients retrieved over 90% of the pouches within 75 min of the scheduled time. Technical problems occurred in 4% (John) and 7.2% (Mary) of retrievals, but on-site support was seldom required. Viral loads fell below detection limits during the entire observation period.

Conclusions: Continuous medication supply and persistence with treatment of over 1.7 years, timing adherence of more than 90%, and suppressed HIV viral load are first results supporting the feasibility of the novel supply model for patients on opioid-assisted treatment and polypharmacy.

Keywords: Interprofessional collaboration; Medication adherence; Medication management aid; Old age; Substance use disorders.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-HIV Agents / therapeutic use
  • Electronic Prescribing*
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / virology
  • Humans
  • Longitudinal Studies
  • Male
  • Medication Adherence
  • Medication Therapy Management / organization & administration*
  • Middle Aged
  • Opioid-Related Disorders / drug therapy*
  • Polypharmacy*
  • Treatment Outcome
  • Viral Load


  • Anti-HIV Agents