Optimizing Retention, Duration and Discontinuation Strategies for Opioid Use Disorder Pharmacotherapy (RDD)

Exclusion Criteria

• •1. Serious medical, psychiatric, or co-occurring substance use disorder or concomitant medication that, in the opinion of the study medical clinician, makes the patient not appropriate for outpatient treatment with buprenorphine or XR-NTX, but instead requires a higher or different level of care. Examples include:
• •1. Disabling or terminal medical illness (e.g., uncompensated heart failure, cirrhosis or end-stage liver disease) as assessed by medical history, review of systems, physical exam and/or laboratory assessments;
• •2. Severe, untreated or inadequately treated psychiatric condition (e.g., active psychosis, uncontrolled bipolar disorder) as assessed by history and/or clinical interview, requiring a different level of care (e.g., hospitalization);
• •3. Current severe alcohol, benzodiazepine, or other depressant or sedative hypnotic use, requiring a different level of care (e.g., hospitalization);
• •2. Suicidal or homicidal ideation or behavior requiring a different level of care (e.g., hospitalization);
• •3. Known allergy or sensitivity to preferred medication or its components;
• •4. Maintenance on methadone at the time of signing consent;
• •5. For those preferring XR-NTX, presence of pain of sufficient severity as to require ongoing pain management with opioids;
• •6. For those preferring XR-NTX, body habitus that, in the judgment of the study physician, precludes safe intramuscular injection of XR-NTX (e.g., BMI\>40, excess fat tissue over the buttocks, emaciation);
• •7. If female, currently pregnant or breastfeeding or planning on conception;
• •8. Are currently in jail, prison or other overnight facility as required by court of law or have pending legal action that could prevent participation in study activities;
• •9. Have used the reSET-O or CHESS Connections mHealth apps in the 3 months prior to consent;
• •10. Other major reasons that might prevent an individual from participating in the study (e.g., a planned move out of the area).
• •1. Serious medical or psychiatric disorder or concomitant medication that, in the opinion of the study medical clinician, would make study participation hazardous to the participant or compromise study findings or would prevent the participant from completing the study. Examples include:
• •1. Disabling or terminal medical illness (e.g., uncompensated heart failure, cirrhosis or end-stage liver disease) as assessed by medical history, review of systems, physical exam and/or laboratory assessments;
• •2. Severe, untreated, or inadequately treated psychiatric condition (e.g., active psychosis, uncontrolled bipolar disorder) as assessed by history and/or clinical interview, requiring a different level of care (e.g., hospitalization);
• •2. Suicidal or homicidal ideation or behavior requiring a different level of care (e.g., hospitalization);
• •3. For participants entering the study taking buprenorphine, presence of pain requiring or likely requiring ongoing pain management with buprenorphine or other opioids;
• •4. If female, currently pregnant or breastfeeding or planning on conception;
• •5. Use of opioids (other than buprenorphine), cocaine, methamphetamine, or non-prescribed benzodiazepines in the past 12 weeks;
• •6. Meets current DSM-5 criteria for any current alcohol use disorder;
• •7. Are currently in jail, prison or other overnight facility as required by court of law or have pending legal action that could prevent participation in study activities;
• •8. Have used the Connections mHealth app in the 3 months prior to consent (other than Connections in the Retention Phase);
• •9. Other major reasons that might prevent an individual from participating in the study (e.g., a planned move out of the area.