Digital Pills Track Patient Dosing and Combat Opioid Addiction

“Drugs don’t work in patients who don’t take them.”

Former Surgeon General C. Everett Koop

Medication adherence presents a unique challenge for pharmacists.

We educate and inform, but ultimately we rely on our patients to take their medication correctly.

In the case of opioids-or prescription painkillers-the dilemma is amplified by medications prescribed on an as-needed basis, which means that decisions regarding frequency and dosage are left to the patient’s discretion. Additionally, a 2016 study on the issue reports a wide variation in how doctors prescribe opioids because of the lack of data regarding patient usage.

Edward Boyer and Peter Chai-emergency medical physicians and medical toxicologists-partnered with EtectRx to change that. They’ve developed an ingestible gel capsule with a wireless sensor designed to fit over a patient’s regular pills. Once the patient swallows the pill, the stomach acids dissolve the gel, which then emits a radio signal. The patient wears a reader, about the size of an iPod, which picks up the signal and forwards it to the provider’s smartphone app via Bluetooth technology.

The pair began the effort by studying emergency room patients with acute fractures. Physicians gave patients a brief, hands-on training session and sent them home with the digital pill system and oxycodone, prescribed as needed for 1 week.

Study results indicated that most patients required only brief use of opioids following an acute fracture. Participants experienced the greatest pain in the first 48 hours after the injury and gradually self-tapered their opioid dosage after 72 hours. The majority were able to control pain beyond 72 hours with acetaminophen and ibuprofen.

This study has 3 important implications for medical providers:

1. Combat dangerous escalation of medications.

The obvious application in this study is the pill’s ability to detect dangerous escalation of opioid use so that providers can intervene immediately to address the behavior.

A study by the National Institute on Drug Abuse reported that more than 90 Americans die daily from opioid overdose. Almost one-third of patients who take opioids for chronic pain misuse them, and 4% to 6% of those patients will eventually transition to heroin.

The issue has become a national health crisis, prompting the National Institutes of Health to seek better ways to prevent opioid abuse and safer ways to manage patient pain.

This is where the new technology comes in: If the patient is experiencing more pain than expected following treatment, the potential causes are numerous. Are there unexpected complications? Is the patient developing a tolerance to the medication? Regardless of the causes, providers can intervene quickly to address the patient’s needs and prevent dangerous behavior.

One participant in Boyer and Chai’s study reported that the digital pills helped him be more aware of how much oxycodone he was ingesting.

2. Identify non-adherence to prescriptions.

A 2014 study of medication adherence reports that results vary by disease, patient characteristics, and insurance coverage, and that the range falls somewhere between 25% and 50% nonadherence.

A 2003 study by the World Health Organization reports that medication adherence is one of the most impactful factors on the health of the population. The study reported that poor medication adherence leads to increased morbidity and death, and results in costs of about $100 billion annually.

The digital pill can counteract those numbers by helping providers monitor patient adherence to prescriptions. In fact, the study team is poised to study adherence to antidepressants because these medications often require several weeks to achieve clinical response. The result is that typically, nonadherence early in the course of therapy is frequent, and often results in failure of treatment.

The first digital pill was approved by the US Food and Drug Administration for use with Abilify, an antipsychotic drug used to treat patients with schizophrenia and bipolar disorder. The technology helps patients prevent the severe side effects of non-adherence, and provides the option to share usage information with caregivers, providers, or family members.

3. Reach at-risk populations.

The study reports that research based in emergency departments is unique in its ability to sample lower socioeconomic populations.

Given that lower socioeconomic status is one of the main barriers to medication adherence, study authors reported that the ability to monitor medication as patients move throughout their normal daily routines—even among the homeless and indigent — is powerful. The study reports that 90 million American adults have inadequate health literacy, so the ability to intervene in the case of non-adherence could lower hospitalization rates, and consequently, costs.

The study authors also believe that the technology’s greatest applications may eventually be high-risk patients, such as the elderly, who may forget to take their medications, or patients with high-risk conditions for whom non-compliance can be deadly.

The Future of the Technology

As with other emerging technology, the digital pill has its own limitations, the greatest of which is that patients must agree to be part of such a program. Additionally, the gel in its current form sometimes lacks sufficient signal strength to reliably transmit information to the provider.

Those familiar with the technology hope that the concept will develop enough that it can be integrated into daily life, as with an Apple Watch or a smartphone.

On a personal level, patient concerns about the privacy of their information may prove to be a barrier to such treatment.

It’s a thought-provoking concept, though, and another example of how pharmacists can put their skills to use in less direct ways. In an ever-changing job market, pharmacists who are willing to evolve may find tremendous success and fulfillment by looking beyond the traditional pharmacy roles.

I’ve made it my personal mission to help pharmacists find work they love -- whether it’s finding more fulfilling pharmacy work, creating a side-hustle, or transitioning out of pharmacy into something completely new.

If you’re exasperated by pharmacy and you’d like to dip your toe into something new, share your email address with me and I’ll help you identify the avenues available to you outside of pharmacy.

Like other industries, pharmacy must evolve and grow if it is to survive. This is only the beginning.