Although drugs for opioid use disorder (OUD) are effective in reducing the use of illicit opioids, an increase in the use of co-morbid stimulants in people with TOU is of concern because it often acts against efficacy and contributes to premature discontinuation of treatment.
A recent study examined the association of contingency management, in which patients receive material incentives based on objectively verified behavior changes, with end-of-treatment outcomes for comorbid behavior problems.
The researchers, led by Stephen T. Higgins, PhD, Department of Psychiatry, University of Vermont, found evidence to support the dissemination of contingency management for use by clinicians to solve key clinical problems in patients. patients receiving drugs for opioid use disorder (MOUD), particularly for the abuse of comorbid psychomotor stimulants.
Researchers systematically searched the PubMed, Web of Science, and Cochrane Controlled Register of Trials (CENTRAL) databases to identify studies exploring contingency management in patients receiving MOUD.
Until May 6, 2020, the team searched using the terms good, contingency management, or financial incentives, where a total of 1443 reports for initial screening were included.
After selection for eligibility, a total of 213 reports were advanced for full text review to meet the criteria for a prospective experimental study of the management of monetary contingencies in patients receiving MOUD. They had a total of 74 studies remaining that met all the inclusion criteria.
Then, investigators extracted data from the studies for analysis. They noted that the main findings included the association of contingency management at the end of treatment evaluations with 6 clinical issues.
Clinical problems included use of stimulants, use of multiple substances, use of illicit opioids, smoking, attending treatment, and adherence to medication.
The team used random-effects meta-analysis models to calculate estimates of weighted mean effect size (Cohen d) in 3 categories assessing abstinence and 2 assessing treatment adherence outcomes.
The data show that the 74 studies included 10,444 adult participants receiving MOUD, with 60 studies eligible for meta-analyzes.
In addition, they observed that 22 studies tested the effectiveness of contingency management in increasing abstinence from psychomotor stimulant use and 18 (82%) reported significant abstinence at end of treatment assessment.
The team noted that contingency management was associated with end-of-treatment outcomes for the 6 issues examined separately in the medium to large range. The data show that the stimulants had a Cohen D score of 0.70 (95% CI, 0.49 – 0.92).
For 9 studies, the team found that contingency management had a medium to large effect size on abstinence in illicit opioid use (Cohen d = 0.58; 95% CI; 0, 30 – 0.86) and in 3 studies, it showed a medium to large effect on the increase in abstinence regarding cigarette consumption (Cohen d = 0.78; 95% CI: 0.43 – 1.14) .
Additionally, contingency management was associated with a small-to-average effect size on abstinence compared to controls in polysubstance use in 18 studies (Cohen d = 0.46; 95% CI: 0, 30 – 0.62). With therapy attendance, they noted a small to medium effect size on increasing therapy attendance (Cohen d = 0.43; 95% CI: 0.22 – 0.65).
With treatment adherence, all studies showed a mean to large overall effect size on treatment adherence (Cohen d = 0.75; 95% CI: 0.30 – 1.21).
Finally, in all categories of abstinence and adherence, contingency management had a medium to large effect size for abstinence (Cohen d = 0.58; 95% CI, 0.47 – 0 , 69) and adherence to treatment (Cohen d = 0.62; 95% CI 0.40-0.84) compared to the control.
In conclusion, investigators noted the association between contingency management and the treatment of various clinical problems that were common in patients receiving MOUD.
“The results support the position that policymakers, including CMS, should make a concerted effort to support widespread dissemination of contingency management to the many community clinics in the United States currently grappling with the challenges of the opioid crisis.” , particularly the concomitant use of psychomotor stimulants in patients taking MOUD, ”the investigators wrote.
The study, “Contingency management for patients receiving medication for an opioid use disorder: a systematic review and meta-analysis, ”Was published online in JAMA Psychiatry.