Financial Incentives for Opioid Use Disorder

Overseen By Bethany Raiff, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Rowan University

Must be taking: Buprenorphine

Must not be taking: Other MATs

Disqualifiers: Pregnancy, Schizophrenia, Bipolar, Dementia, others

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

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 3 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether financial incentives can help individuals with opioid use disorder adhere to their treatment. It targets those beginning medication-assisted treatment (MAT) in an emergency department (ED) program using buprenorphine plus naloxone, commonly known as BUP. Participants will be divided into two groups: one will receive financial rewards for attending appointments and abstaining from other opioids, while the other will receive standard care without incentives. This approach, called contingency management (CM), uses behavioral reinforcement to encourage positive behaviors. Individuals newly enrolled in the Bridge program at Cooper University's ED and scheduled for their first clinic visit soon are well-suited for this trial. As an unphased trial, this study provides a unique opportunity to contribute to innovative research that could enhance treatment strategies for opioid use disorder.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are currently using other medication-assisted therapies for opioid use disorder.

What prior data suggests that this protocol is safe for opioid use disorder treatment?

Research has shown that contingency management (CM) is generally safe for individuals with opioid use disorder. Studies have found that CM increases therapy attendance and improves outcomes compared to those not using CM. It is considered one of the most effective treatments for maintaining abstinence from opioids, although it is not yet widely available.

CM operates by rewarding patients, such as with small payments, for achieving treatment goals like attending appointments or remaining drug-free. No significant harmful effects have been reported from using CM as part of treatment. Overall, patients have responded positively to it.

For those considering joining a trial with CM, current research suggests it is a safe option to consider. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using contingency management for opioid use disorder because it offers a fresh approach by leveraging financial incentives to encourage positive behaviors. Unlike standard treatments like methadone or buprenorphine alone, which focus on medical management of withdrawal and cravings, this method rewards patients for attending appointments and staying clean. By providing tangible rewards, like cash incentives and paid transportation, it aims to boost motivation and adherence, potentially leading to better long-term outcomes.

What evidence suggests that contingency management is effective for opioid use disorder?

Research has shown that contingency management (CM), which participants in this trial may receive, effectively helps people with opioid use disorder (OUD) reduce drug use. CM operates by rewarding individuals for attending treatment sessions and remaining drug-free. It reduces drug use more effectively than some other proven treatments. Some studies also indicate that the benefits of CM can last up to 24 weeks, suggesting that CM could be a powerful tool to help people adhere to their OUD treatment plans. ^{1 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for adults over 18 with Opioid Use Disorder who are new to the Bridge program at Cooper University ED and have a clinic appointment within a week. They must be in good health, not pregnant or breastfeeding, and able to give informed consent. Those with severe psychiatric conditions or on other opioid treatments can't join.

Inclusion Criteria

People who want to be in the Bridge program must be new enrollees, who have their first appointment at the Cooper Outreach Clinic within a week of enrollment.

All subjects must be in good physical health as determined by a physical examination and premenopausal women will have a pregnancy test on the day of the study to rule out pregnancy

Exclusion Criteria

I am not pregnant, breastfeeding, or have a psychiatric condition like uncontrolled schizophrenia, bipolar disorder, or dementia.

Participants who are non-English speaking or cannot otherwise provide valid informed consent.

Individuals who are unable to complete the survey assessments, due to literacy or visual impairments.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive contingency management with financial incentives for attending buprenorphine appointments and maintaining opioid abstinence

3 months

Weekly visits

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Contingency management

Trial Overview

The study tests if financial rewards (Contingency Management) help patients start and stick to treatment with buprenorphine + naloxone for Opioid Use Disorder in an emergency department setting compared to standard care without incentives.

How Is the Trial Designed?

Group I: Contingency Management Experimental Treatment 1 Intervention

Participants in this arm of the study will receive financial incentives for attending their buprenorphine appointments and for being clean from other opioids. Participants in this group will also have up to two rides per week paid for to attend bup appointments.

Group II: Standard Care Active Control 1 Intervention

Participants in this group will be treatment as usual and will not receive any incentives for attending their bup appointments or for being opioid abstinent.

Contingency management is already approved in United States, European Union for the following indications:

Approved in United States as Contingency Management for:

• Alcohol dependence
• Substance use disorders

Approved in European Union as Contingency Management for:

• Alcohol dependence
• Substance use disorders

Who Is Running the Clinical Trial?

Rowan University

Lead Sponsor

Trials

25

Recruited

3,000+

The Cooper Health System

Collaborator

Trials

82

Recruited

35,600+

Published Research Related to This Trial

Contingency management (CM) is an effective psychosocial treatment for substance use disorders that uses tangible rewards to reinforce drug-negative behaviors, showing strong efficacy based on behavioral analysis principles.

CM not only provides external rewards but may also enhance a patient's intrinsic motivation to change their substance use behavior, suggesting broader applications for this intervention beyond substance use disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motivation and Contingency Management Treatments for Substance Use Disorders. Walter, KN., Petry, NM.[2016]

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 333 cocaine-negative patients, both attendance-based and abstinence-based contingency management (CM) were equally effective in enhancing the longest duration of abstinence, with attendance-based CM leading to higher participation and submission of negative samples.

For 109 cocaine-positive patients, a higher magnitude abstinence-based CM ($560Abs) significantly improved abstinence outcomes compared to standard care, indicating that greater rewards can enhance treatment effectiveness for those actively using cocaine.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized trial adapting contingency management targets based on initial abstinence status of cocaine-dependent patients. Petry, NM., Barry, D., Alessi, SM., et al.[2021]

Contingency management procedures have been shown to effectively treat substance use disorders by providing rewards, like vouchers, for drug abstinence, particularly in psychosocial and methadone maintenance settings.

Recent adaptations of these procedures include using lower-cost reinforcers and expanding their application to improve treatment attendance, adherence to goals, and medication compliance, highlighting the versatility of this approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management for treatment of substance abuse. Stitzer, M., Petry, N.[2019]

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 low-cost contingency management (CM) procedure significantly improved continuous abstinence from cocaine and opioids among 42 methadone patients over a 12-week treatment period, compared to standard treatment alone.

Patients in the CM group not only achieved longer periods of abstinence but also maintained these effects for 6 months after treatment, earning an average of $137 in prizes, indicating the potential effectiveness of this approach in community settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients. Petry, NM., Martin, B.[2019]

In a study involving 240 cocaine-dependent methadone patients over 12 weeks, all contingency management (CM) interventions significantly reduced cocaine use compared to usual care, with effect sizes ranging from 0.38 to 0.59.

Interestingly, the standard prize CM offering $300 was just as effective as higher reward options, suggesting that lower-cost interventions can still effectively promote cocaine abstinence in methadone patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Standard magnitude prize reinforcers can be as efficacious as larger magnitude reinforcers in cocaine-dependent methadone patients. Petry, NM., Alessi, SM., Barry, D., et al.[2021]

Citations

1.

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 ...

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8034391/

Long-Term Efficacy of Contingency Management ...

CM showed long-term benefit in reducing objective indices of drug use, above and beyond other active, evidence-based treatments (e.g., cognitive–behavioral ...

3.

jamanetwork.com

jamanetwork.com/journals/jamanetworkopen/fullarticle/2827185

Smartphone App–Based Contingency Management and ...

This cohort study compares treatment outcomes associated with augmented medication for opioid use disorder with smartphone app–based ...

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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 ...

Although effective in reducing opioid use, these medications (often referred to as first-line treatments) can be combined with other interventions to generate ...

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 widely studied and has been successful in treating a variety of SUDs in diverse populations, and with demonstrated long-term benefit (a median of 24 weeks ...

6.

pmc.ncbi.nlm.nih.gov

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

Contingency Management for Patients Receiving Medication ...

Contingency management was associated with increased therapy attendance in 5 studies (45%). Studies that targeted therapy attendance and drug ...

7.

legislativeanalysis.org

legislativeanalysis.org/wp-content/uploads/2023/10/Contingency-Management-Fact-Sheet-FINAL.pdf

Contingency Management Fact Sheet

Moreover, nine meta-analyses performed during the past two decades used the combined data from multiple studies to find positive results from contingency.

8.

sciencedirect.com

sciencedirect.com/science/article/pii/S2772724621000032

COVID-related barriers and innovative workflow adaptations

Contingency Management (CM) is one of the most effective interventions for persons with opioid use disorder, but one of the least available interventions in ...