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

92 Participants Needed

Trial Summary

What is the purpose of this trial?

This trial aims to help patients with opioid use disorder who visit emergency departments. It uses a method where patients get rewards for sticking to their treatment plan, along with a medication that reduces cravings and withdrawal symptoms. The goal is to see if this combined approach helps more people start and continue their treatment compared to standard care.

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 data supports the effectiveness of the treatment Contingency Management for Opioid Use Disorder?

Contingency management, which involves rewarding people for meeting recovery goals, is highly effective for treating substance use disorders, including opioid use disorder. It has been shown to reduce drug use by providing incentives like vouchers for drug-free urine samples, and it can also enhance motivation to change behavior. ^{1 2 3 4 5}

Is contingency management 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 for humans. The main concerns are ethical and economic, rather than safety-related. ^{1 2 4 6 7}

How is the treatment Contingency Management unique for opioid use disorder?

Contingency Management is unique because it uses financial rewards to encourage people to meet their recovery goals, which is different from traditional treatments that often focus on medication or therapy alone. This approach is backed by strong evidence but is not widely used due to concerns about ethics and practicality. ^{1 3 4 8 9}

Eligibility Criteria

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.

I am 18 years old or older.

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

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

Treatment Details

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.

Participant Groups

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+

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]

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 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 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]

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]

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]

References

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

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

2. Germany pubmed.ncbi.nlm.nih.gov

Motivation and Contingency Management Treatments for Substance Use Disorders. [2016]

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

Contingency management for treatment of substance abuse. [2019]

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

A randomized trial adapting contingency management targets based on initial abstinence status of cocaine-dependent patients. [2021]

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

Standard magnitude prize reinforcers can be as efficacious as larger magnitude reinforcers in cocaine-dependent methadone patients. [2021]

6. Ireland pubmed.ncbi.nlm.nih.gov

Internet-based group contingency management to promote abstinence from cigarette smoking: a feasibility study. [2023]

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

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

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

Contingency contracting with monetary reinforcers for abstinence from multiple drugs in a methadone program. [2019]

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

Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients. [2019]