Text Messaging + Contingency Management for Opioid Use Disorder

Overseen By Hannah Dart, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pennsylvania

Must be taking: Buprenorphine

Disqualifiers: Under 18, No OUD, No phone, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 15

Duration: 4 weeks

1808 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to explore new ways to support individuals with opioid use disorder (OUD) after they leave the emergency department. Researchers are testing whether daily text check-ins and rewards for staying engaged in treatment (known as Contingency Management) help keep patients on track. Participants will be divided into four groups to determine which support methods work best. This trial is open to individuals diagnosed with OUD, who have received a buprenorphine prescription, can read English, and have a mobile phone for texts. As an unphased trial, it offers participants the chance to contribute to innovative approaches that could enhance support for OUD recovery.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on supporting continued treatment for opioid use disorder, particularly with buprenorphine.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that contingency management (CM) is generally safe and effective for treating opioid use disorder. Studies indicate that CM can help individuals abstain from opioids without major side effects. For instance, one review found that CM significantly increased the number of people who stopped using opioids, with no major safety issues reported.

Text message check-ins are also considered safe. Research shows that using text messages to support opioid recovery is effective and poses little risk. One study found that these check-ins can help individuals stay engaged in their treatment without causing significant side effects.

Both CM and text message check-ins have been used successfully in similar situations and are generally safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using text messaging and contingency management for opioid use disorder because they offer a fresh, tech-driven approach. Traditional treatments often rely on medication-assisted therapy and counseling, but this method incorporates regular text check-ins and rewards for treatment engagement. The innovative use of technology means patients receive support and motivation directly to their phones, making it more accessible and convenient. Plus, incentives for staying engaged can boost motivation, potentially leading to better outcomes. This combination of digital interaction and positive reinforcement could revolutionize how support is delivered to those struggling with opioid use.

What evidence suggests that this trial's treatments could be effective for opioid use disorder?

Research has shown that giving rewards for staying off drugs, known as contingency management, effectively reduces drug use in people with opioid use disorder (OUD). In this trial, some participants will receive augmented usual care combined with contingency management. Studies have also found that regular text message check-ins help people recovering from OUD by keeping them engaged in their treatment. Another group in this trial will receive augmented usual care with both text-message check-ins and contingency management. Using these check-ins alongside contingency management leads to even better treatment results. This approach helps people adhere to their recovery plans, providing extra support to traditional methods. ^{4 6 7 8 9}

Who Is on the Research Team?

Kit Delgado, MD, MS

Principal Investigator

University of Pennsylvania

Are You a Good Fit for This Trial?

This trial is for adults over 18 with Opioid Use Disorder (OUD) who are being discharged from the Emergency Department with a prescription for Buprenorphine. Participants must be able to read English and have a mobile phone that can receive text messages.

Inclusion Criteria

Inclusion Criteria: To be considered eligible, participants must be 18 or older, have a diagnosis code for OUD or screen positive for OUD, Discharged with Buprenorphine RX , English reading ability, Have a mobile phone capable of receiving text messages

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive augmented usual care with options for text-message check-ins and contingency management for 30 days

4 weeks

Daily text-message check-ins

Follow-up

Participants are monitored for engagement in addiction treatment and health outcomes

6 months

Follow-up surveys at day 15, day 30, month 3, and month 6

What Are the Treatments Tested in This Trial?

Interventions

• Contingency Management
• Text Message Check-ins

Trial Overview

The study tests if daily text message check-ins and contingency management (a reward system for positive behavior) can help people stay engaged in addiction treatment after leaving the hospital. Patients will be randomly placed into one of four groups to see how these methods work.

How Is the Trial Designed?

Group I: Augmented Usual care + Contingency Management (CM) Active Control 1 Intervention

AUC: Standard Way to Health Care text line. Patients can call or text the on-call substance use navigators (SUN) from 9a-9p, 7 days a week. Participants across all arms will receive an intake survey, and follow-up surveys at day 15, day 30, month 3, and month 6. CM: Patients will also receive incentives for engagement with treatment.

Group II: Augmented usual care + text-message check-ins + contingency management Active Control 2 Interventions

AUC: Standard Way to Health Care text line. Patients can call or text the on-call substance use navigators (SUN) from 9a-9p, 7 days a week. Text check-in: Patients will also receive incentives for engagement with treatment and Participants across all arms will receive an intake survey, and follow-up surveys at day 15, day 30, month 3, and month 6. CM: Patients will also receive incentives for engagement with treatment.

Group III: Augmented Usual Care (AUC) Active Control 1 Intervention

AUC: Standard Way to Health Care text line. Patients can call or text the on-call substance use navigators (SUN) from 9a-9p, 7 days a week. Participants across all arms will receive an intake survey, and follow-up surveys at day 15, day 30, month 3, and month 6.

Group IV: Augmented usual care + text-message check-ins Active Control 1 Intervention

AUC: Standard Way to Health Care text line. Patients can call or text the on-call substance use navigators (SUN) from 9a-9p, 7 days a week. Text check-in: Patients will also receive incentives for engagement with treatment and Participants across all arms will receive an intake survey, and follow-up surveys at day 15, day 30, month 3, and month 6.

Who Is Running the Clinical Trial?

University of Pennsylvania

Lead Sponsor

Trials

2,118

Recruited

45,270,000+

Patient-Centered Outcomes Research Institute

Collaborator

Trials

592

Recruited

27,110,000+

Published Research Related to This Trial

Contingency management (CM) is an effective behavior-modification method for treating substance-use disorders (SUDs), and this review analyzed 31 studies to explore its advancements and applications.

Emerging technologies, such as mobile delivery systems and new biomarkers, can enhance CM's effectiveness by personalizing interventions and making them accessible to underserved populations, particularly in hard-to-reach areas.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies. McPherson, SM., Burduli, E., Smith, CL., et al.[2020]

Clients in a community-based methadone treatment program who received stars for attending counseling and providing clean urines showed increased attendance and better outcomes, especially in the high-reward condition, where they earned more stars for prizes.

Overall, the use of a star-based recognition system and contingent rewards led to significantly higher attendance rates and fewer positive drug tests, demonstrating its effectiveness in supporting recovery behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A simple reinforcement system for methadone clients in a community-based treatment program. Rowan-Szal, G., Joe, GW., Chatham, LR., et al.[2019]

Telehealth-based contingency management (CM) for stimulant use disorder has shown preliminary feasibility and acceptability, allowing participants to successfully engage in treatment and verify abstinence through self-administered oral fluid testing.

Improvements are needed in the remote interpretation of toxicology test results to ensure accurate detection of abstinence, which is critical for delivering therapeutic incentives effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telehealth-Based Contingency Management Targeting Stimulant Abstinence: A Case Series from the COVID-19 Pandemic. Forster, SE., Torres, TM., Steinhauer, SR., et al.[2023]

The integrated smartphone-smartcard platform significantly improved counseling appointment attendance and drug abstinence rates among 85 adults with opioid use disorder over a four-month period, showing a 9.6%-18.0% increase in attendance and an odds ratio of 4.84 for drug abstinence compared to matched controls.

Participants overwhelmingly found the platform acceptable, indicating that this technology could help overcome barriers to the adoption of contingency management (CM) interventions in treatment settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A smartphone-smartcard platform for contingency management in an inner-city substance use disorder outpatient program. DeFulio, A., Rzeszutek, MJ., Furgeson, J., et al.[2021]

In a 16-week study involving 12 cocaine-dependent methadone patients, cash-based incentives of $50 and $100 significantly increased short-term cocaine abstinence compared to a control condition with no incentives.

The study found that cash-based incentives did not lead to increased cocaine use after receiving the incentives, suggesting they are a safe option for improving treatment outcomes in substance abuse interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management in cocaine abusers: a dose-effect comparison of goods-based versus cash-based incentives. Vandrey, R., Bigelow, GE., Stitzer, ML.[2022]

In a study of 255 substance users undergoing outpatient treatment, participants who were drug-free at the start (baseline negative) earned significantly more in contingency management (CM) incentives compared to those who were using drugs (baseline positive), with median prizes of $237 versus $44, respectively.

The findings suggest that tailoring CM interventions based on a participant's drug use status at treatment entry could enhance the effectiveness of abstinence-focused programs, as the majority of incentive expenditures were directed towards those who were already abstinent.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency Management Abstinence Incentives: Cost and Implications for Treatment Tailoring. Cunningham, C., Stitzer, M., Campbell, AN., et al.[2019]

A survey of 214 substance use treatment providers revealed that while many clinics are using reward programs, they often do not follow effective practices recommended by research, such as providing higher reward amounts or immediate reinforcement.

Providers with more extensive training in contingency management (CM) were more likely to implement effective strategies, suggesting that better training could improve the quality of reward-based interventions in real-world settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining implementation of contingency management in real-world settings. Rash, CJ., Alessi, SM., Zajac, K.[2021]

The study found that using a prize-based contingency management approach significantly increased compliance with daily interactive voice response (IVR) calls, with participants in the prize group being 4.7 times more likely to call than those in the fixed dollar group.

Higher rates of IVR calls were linked to better outcomes in cocaine abstinence, suggesting that engaging participants through innovative reward systems can enhance treatment effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using prize-based incentives to enhance daily interactive voice response (IVR) compliance: a feasibility study. Lindsay, JA., Minard, CG., Hudson, S., et al.[2021]

Contingency management, which rewards individuals for achieving recovery goals, is proven to be highly effective for treating opioid use disorder but remains underutilized in clinical practice due to various concerns.

Barriers to implementing contingency management include ethical and economic issues, but leveraging technology and fostering partnerships between academia and industry could enhance its adoption and improve treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rewarding recovery: the time is now for contingency management for opioid use disorder. Proctor, SL.[2022]

In a study involving 95 methadone-maintenance patients, a contingency management approach that rewarded gradual reductions in cocaine use (shaping group) led to lower cocaine use compared to a standard abstinence-based approach, particularly in the final 5 weeks of the 8-week intervention.

The study also found that once patients achieved abstinence through escalating-value vouchers, they could maintain this abstinence with a simpler, nonescalating reward schedule, indicating that contingency management can be an effective long-term treatment strategy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Shaping cocaine abstinence by successive approximation. Preston, KL., Umbricht, A., Wong, CJ., et al.[2019]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC4203362/

Prize-based Contingency Management for the Treatment of ...

Adding prize-based contingency management to behavioral support for substance use disorders can increase short-term abstinence but the effect does not appear ...

2.

jamanetwork.com

jamanetwork.com/journals/jamapsychiatry/fullarticle/2782768

Contingency Management for Patients Receiving ...

Prior reviews noted that contingency management effectively reduced nonprescribed drug use among populations with OUD but are now dated or ...

3.

case.edu

case.edu/socialwork/centerforebp/sites/default/files/2024-11/CM%20for%20OUD%20Research%20Summary%20Report%2011.22.24.pdf

CONTINGENCY MANAGEMENT FOR THE TREATMENT ...

However, CM had little effect on opioid use, except in the high- dose group, where its addition accelerated the decrease in opioid-positive urine drug tests ...

4.

tandfonline.com

tandfonline.com/doi/full/10.1080/07853890.2022.2068805

Rewarding recovery: the time is now for contingency ...

When combined with medication for OUD, contingency management demonstrates significant reductions in morbidity and mortality from OUD, considerable cost savings ...

5.

library.samhsa.gov

library.samhsa.gov/sites/default/files/contingency-management-advisory-pep24-06-001.pdf

contingency-management-advisory-pep24-06-001.pdf

CM is equally effective among those with concurrent stimulant and opioid use disorder, as well as in promoting abstinence from cannabis use (SAMHSA, 2021a).

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC9045772/

Rewarding recovery: the time is now for contingency ...

This paper provides a succinct, up-to-date overview of the current evidence base for contingency management for opioid use disorder.

7.

jamanetwork.com

jamanetwork.com/journals/jamapsychiatry/article-abstract/2836114

Data-Driven Contingency Management Incentive Magnitudes

This report provides contemporary weekly incentive magnitude estimates that can be used to calculate total incentive magnitude for protocols of custom ...

8.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8340014/

Contingency Management for Patients Receiving Medication ...

Our review supports the association of contingency management with an increase in abstinence from illicit opioid use at an effect size of 0.58, ...

9.

pennmedicine.org

pennmedicine.org/news/how-incentives-could-better-treat-stimulant-use-disorder

How incentives could better treat stimulant use disorder

Penn Medicine experts advocate for refinements in contingency management, a proven method that rewards patients for avoiding drugs.