Text Messaging + Contingency Management for Opioid Use Disorder

Overseen By Dina Abdel-Rahman, BS,

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

1649 Participants Needed

Trial Summary

What is the purpose of this trial?

There is growing recognition of the need for approaches to initiate treatment wherever patients touch the health care system, including the Emergency Department (ED). Most research has focused on initiation of medications for opioid use disorder (MOUDs) in the ED rather than ensuring continued treatment post-discharge. The investigators propose to adapt evidence-based interventions to support patients' complex needs and facilitate continued treatment, rather than discharging them and having them navigate outpatient treatment systems with limited support. The research team will randomize participants into 1 of 4 arms to receive varying degrees of augmented usual care, including daily check-ins and contingency management. The investigators plan to examine the effects of check-ins and contingency management on engagement with addiction treatment and equity of treatment effects among racial and ethnic subgroups and assess important moderators of treatment effects.

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.

What data supports the effectiveness of the treatment Text Messaging + Contingency Management for Opioid Use Disorder?

Research shows that contingency management, which involves rewarding people for meeting recovery goals, is highly effective for opioid use disorder. Studies have demonstrated that using rewards can increase attendance at counseling sessions and improve drug abstinence rates. ^{1 2 3 4 5}

Is the treatment of Contingency Management for Opioid Use Disorder safe for humans?

Contingency Management, which involves rewarding people for achieving recovery goals, has been studied for various substance use disorders and is generally considered safe. Studies have shown that using cash-based incentives does not increase drug use, suggesting it is a safe approach for clinical applications. ^{1 2 5 6 7}

How does the Text Messaging + Contingency Management treatment for opioid use disorder differ from other treatments?

This treatment is unique because it combines text messaging with contingency management, a method that rewards patients for meeting recovery goals, using mobile technology to deliver incentives. This approach allows for remote access and personalized support, making it more accessible for people in underserved or rural areas compared to traditional in-person treatments. ^{1 2 8 9 10}

Research Team

Kit Delgado, MD, MS

Principal Investigator

University of Pennsylvania

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

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]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

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

2. United States pubmed.ncbi.nlm.nih.gov

A smartphone-smartcard platform for contingency management in an inner-city substance use disorder outpatient program. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

A simple reinforcement system for methadone clients in a community-based treatment program. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Shaping cocaine abstinence by successive approximation. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Examining implementation of contingency management in real-world settings. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Contingency management in cocaine abusers: a dose-effect comparison of goods-based versus cash-based incentives. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Contingency Management Abstinence Incentives: Cost and Implications for Treatment Tailoring. [2019]

8. New Zealand 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. [2020]

9. United States pubmed.ncbi.nlm.nih.gov

Using prize-based incentives to enhance daily interactive voice response (IVR) compliance: a feasibility study. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

Telehealth-Based Contingency Management Targeting Stimulant Abstinence: A Case Series from the COVID-19 Pandemic. [2023]