King's College London

Receiving over 50% of the nationally available funds, the Addictions Department will embark on three projects: Prison Release Engagement Trial, the use of virtual reality enhanced cue exposure treatment in people with cocaine dependence, and Buprenorphine Induction Low-Dose to Depot. 

The projects were awarded funding through the NIHR Invention for Innovation (i4i) Addiction: Innovation for Treatment and Recovery Awards. The new research builds on feasibility funding awarded through phase 1 of the Reducing Drugs Deaths Challenge in 2023.

The three projects will engage different aspects of digital technologies to break new ground in facilitating the uptake, engagement, and accessibility of treatment within populations that have been largely overlooked by existing efforts. While there are effective treatments for opioid and cocaine addiction, bringing them to people who need them the most is a task complicated by many barriers.

Release Engagement Trial (PRET)

The Prison Release Engagement Trial (PRET) receives a grant of £1.9m. PRET is a randomised trial of app-coordinated daily bot contact to improve prison-release continuity of care. PRET will harness new Artificial Intelligence (AI) technology to bring care and support via a smartphone app, therefore improving continuity of care for post-release prisoners working to stay drug free.

Contingency Management (CM) is a behavioural therapy that rewards individuals for positive behaviours. CM has been shown in earlier research to improve engagement and adherence in treatments for opioid use disorder. Working with the expertise of Contingency Management Innovations (CMI), PRET will develop an app, adding a new interactive layer of support to continuity of care. The trial will work with six busy prisons across England, with the support and guidance of the Ministry of Justice and colleagues in the Department of Health prison healthcare.

Use of virtual reality enhanced cue exposure treatment

The second study aims to investigate the potential use of virtual reality (VR) enhanced cue exposure treatment (CET) combined with a wearable device in improving treatment outcomes, preventing relapse, and aiding recovery for individuals with cocaine dependence. This research involves collaboration between five UK universities: Addictions Department, IoPPN Virtual Lab, and Department of Biostatistics and Health Informatics at King’s College London, Centre for Addiction and Mental Health Research at the University of Hull, University of Kent, University of Birmingham, and University of Southampton.

A key challenge in recovery from cocaine dependence is that a person’s craving for the drug can be trigged by cues within their environment including situations and objects. This is known as classical conditioning, and this study aims to reduce the risk of relapse by using novel technologies including VR to reduce cravings. The effectiveness of current talking therapies for cocaine dependence is limited by poor service user engagement and a high rate of relapse soon after the treatment ends.

Existing treatments have little impact on people experiencing an intense craving for cocaine, and this study attempts to offer alternative options. However, previous research on people with alcohol dependence has shown than repeated exposure to cues for alcohol within a safe, treatment environment can significantly reduce levels of craving and relapse, therefore this study will explore CET within cocaine dependence.

This research plans to use virtual reality to develop more realistic CET environments which are tailored to the individual’s experiences and therefore have a greater impact on reducing craving than previously available methods. Cocaine craving and relapse to use are associated with physiological changes to the body that this study will measure by asking individuals to wear a novel watch-like device that can measure physiological changes in relation to cues in their everyday environment. This will enable research to identify in real time when they experience an episode of craving or start using cocaine again, to understand what real-life scenarios or circumstances have triggered these events.

Throughout this study, people with cocaine dependence and service users will be engaged, both in the design of the research and in developing accessible briefings on the findings.

Buprenorphine Induction Low-Dose to Depot

The third study, receiving £1.6m in funding, is the Buprenorphine Induction Low-Dose to Depot, BUILD2Depot, study, which will also work with the expertise of Contingency Management Innovations (CMI) and other industry partners. This study will explore making switching from methadone to buprenorphine long-acting injection easier for people with opioid dependence.

Methadone and buprenorphine are both medications which help people with opioid dependence stop using heroin. Emerging research suggests that buprenorphine has some benefits over methadone, primarily that it is safer for people with lung or heart disease and is easier to reduce and stop when patients want to discontinue treatment. Buprenorphine long-acting injection, which is an injection given just under the skin, has the advantage that rather than attending their pharmacy every day to take their medication in front of the pharmacist, people only need to attend their drug service weekly or monthly for their injection.

One of the barriers to getting from methadone to buprenorphine is that they work differently, and people can experience a sudden shift from a large dose of one to the large dose of the other as unpleasant withdrawal. A new approach has been tried where very low doses of buprenorphine are given and increased slowly over a week – referred to as ‘low dose induction’, however, this has not been studied in depth and using this technique to switch to the long-acting injection has been reported for only two patients.

This study will investigate how best to use ‘low dose induction’ to make the switch. Stage One will involve intensive monitoring during frequent visits to a clinical research unit, during which the patient’s withdrawal symptoms will be measured to understand when the risk of withdrawal is greatest. Blood oxygen and breathing rate will also be measured, as both methadone and buprenorphine can affect people’s breathing. The protocol will be developed in collaboration with patients and obtain detailed feedback from those going through the switch. This will allow researchers to understand more about how to conduct the transition in a way that ensures comfort and safety.

In Stage Two, insights and feedback from Stage One will be used to develop a protocol for, and assess the safety and comfort of, low dose induction in a manner feasible in the real world, with less frequent clinic visits, using the monitoring that worked in Stage One.

The NIHR funding forms part of the government’s Addiction Healthcare Goals. These are being delivered by OLS and form a part of the Department of Health and Social Care’s ambition to deliver a world-class treatment and recovery system for people experiencing drug and alcohol addictions.