Offering financial incentives following the conclusion of treatment for opioid-use disorder has been found to be associated with decreased use of stimulants and cigarettes and improvements in medication adherence and therapy attendance, according to the results of a study published in JAMA Psychiatry.
Medication treatment for opioid-use disorder is effective, but using psychomotor stimulants undermines treatment benefits and contributes to relapse. Contingency management — offering financial or other incentives to people undergoing treatment for opioid-use disorder to motivate them to avoid stimulants — may be an effective way to treat comorbid substance use.
Researchers searched PubMed, Web of Science, and Cochrane Controlled Register of Trials (CENTRAL) databases to identify studies that examined contingency management involving patients undergoing medication treatment for opioid-use disorder. They searched studies from the databases’ inceptions to May 6, 2020. Out of 1143 possible studies, 74 met the inclusion criteria.
Of the 22 studies that tested contingency management for increasing abstinence from psychomotor stimulant use, 82% reported significant increases in abstinence at the end-of-treatment assessment.
Of the 23 studies that tested contingency management for increasing abstinence from multiple substances, 70% reported increased abstinence. The analysis also showed increased abstinence from illicit opioids in patients entered into a contingency management program. Contingency management also helped patients improve therapy attendance (small to medium effect size) and treatment adherence.
The authors note the analysis included a small number of studies that discussed abstinence after the contingency program ended, which represents a limitation of the study. In addition, studies analyzed used varying definitions of “abstinence.”
The authors conclude that “the results support a position that policy makers including [Centers for Medicare & Medicaid Services] should make concerted efforts to support broad dissemination of contingency management to the many community clinics throughout the US currently struggling with the challenges of the opioid crisis, especially concomitant psychomotor stimulant use among patients taking [medication for opioid-use disorder].”
Bolívar HA, Klemperer EM, Coleman SRM, DeSarno M, Skelly JM, Higgins ST. Contingency management for patients receiving medication for opioid use disorder: a systematic review and meta-analysis. JAMA Psychiatry. 2021;78(10):1092-1102. doi:10.1001/jamapsychiatry.2021.1969