(PS1-9) Contingency Management in Opioid Use Disorder Treatment: Three-month Outcomes

Medications for opioid use disorder like buprenorphine are effective interventions, but around half of individuals discontinue treatment within the first month (Morgan et al., 2018). This study sought to examine the efficacy of contingency management (incentives) for the first 3 months of buprenorphine treatment attendance and adherence (urine samples positive for buprenorphine and negative for other opioids).

New patients at an urban, outpatient opioid clinic were randomized to either treatment as usual (TAU, n=32), consisting of regular clinic procedures, or contingency management (CM, n=33), consisting of regular procedures plus incentives remotely delivered on a reloadable debit card. Participants earned $50 for attending their first follow-up appointment and up to $25 for attending and adhering to subsequent appointments, with a bonus that increased by $10 for every third consecutive adherent sample. Attendance and adherence were monitored remotely through medical records. Patients attended appointments at a frequency determined by their provider, so participant outcomes for the 12 weeks of the study were extrapolated based on scheduled visit attendance (i.e., the surrounding appointments’ attendance and adherence informed the coding for the week[s] in between).

Participants were 35.4% female, 46.2% Black, and had an average age of 41.11 (SD±10.31). Of the sample, 75.0% were unemployed and 33.8% had an annual income of less than $10,000.

On average, the CM group attended 6.03 (SD±4.92) weeks and were adherent for 3.94 (SD±4.98) of them, compared to 3.25 (SD±3.82) weeks attended, 1.81 (SD±3.21) of which were adherent for TAU. A significant regression was found for both the number of attended weeks (F[1,63]=6.45, p=0.01), predicting 2.78 more weeks in the CM group than TAU, as well as number of adherent weeks (F[1,63]=4.16, p=0.04), predicting 2.13 more weeks in the CM group.

The average longest streak of attendance was 5.39 (SD±4.87) weeks and the longest streak of adherence was 3.42 SD±4.85) for CM, compared to 2.87 (SD±3.60) weeks and 1.41 (SD±2.50) weeks, respectively, for TAU. Similarly, a significant regression was found for both the longest attendance streak (F[1,63]=5.60, p=0.02), predicting 2.52 more weeks in the CM group than TAU, as well as longest adherence streak (F[1,63]=4.41, p=0.04), predicting 2.02 more weeks in the CM group.

Of the CM group, 27.3% attended all 12 weeks and 21.2% were adherent during all 12 weeks, compared to 9.4% and 0.0% for TAU.

Results suggest that CM is effective at increasing buprenorphine attendance and adherence in the first 3 months of treatment. Participants receiving incentives demonstrated both greater engagement overall as well as consecutive instances of attendance and adherence. Contingency management appears to be a viable method to increase early engagement with efficacious, life-saving opioid treatment.