Elarabi, Hesham Farouk and Shawky, Mansour and Mustafa, Nael and Radwan, Doaa and Elarasheed, Abuelgasim and Yousif Ali, Ahmed and Osman, Mona and Kashmar, Ahmed and Al Kathiri, Helal and Gawad, Tarek and Kodera, Ayman and Al Jneibi, Mohammed and Adem, Abdu and Lee, Amanda J and Marsden, John (2021) Effectiveness of incentivised adherence and abstinence monitoring in buprenorphine maintenance: a pragmatic, randomised controlled trial. Addiction, 116, (9), pp. 2398-2408. doi: 10.1111/add.15394.
External website: https://onlinelibrary.wiley.com/doi/full/10.1111/a...
BACKGROUND AND AIM: Buprenorphine (BUP) maintenance treatment for opioid use disorder (OUD) begins with supervised daily dosing. We estimated the clinical effectiveness of a novel incentivised medication adherence and abstinence monitoring protocol in BUP maintenance to enable contingent access to increasing take-home medication supplies.
DESIGN: Two-arm, single-centre, pragmatic, randomised controlled trial of outpatient BUP maintenance, with during-treatment follow-ups at 4 weeks, 8 weeks, 12 weeks and 16 weeks. Setting was inpatient and outpatient addictions treatment centre in the United Arab Emirates. Partiipants were adults with OUD, voluntarily seeking treatment.
INTERVENTIONS: The experimental condition was 16 weeks BUP maintenance with incentivised adherence and abstinence monitoring (I-AAM) giving contingent access to 7-day, then 14-day, then 21-day and 28-day medication supply. The control, treatment-as-usual (TAU) was 16 weeks BUP maintenance, with contingent access to 7-day then 14-day supply.
MEASUREMENTS: The primary outcome was number of negative urine drug screens (UDS) for opioids, with non-attendance or otherwise missed UDS, imputed as positive for opioids. The secondary outcome was retention in treatment (continuous enrolment to the 16-week endpoint).
FINDINGS: Of 182 patients screened, 171 were enrolled and 141 were randomly assigned to I-AAM (70 [49.6%]) and to TAU (71 [50.4%]. Follow-up rates at 4 weeks, 8 weeks, 12 weeks and 16 weeks were 91.4%, 85.7%, 71.0%, 60.0% respectively in I-AAM and 84.5%, 83.1%, 69.0%, 56.3% in TAU. By intention-to-treat, the absolute difference in percentage negative UDS for opioids was 76.7% in TAU. In I-AAM, 40 participants (57.1%) were retained versus 33 (46.4%) in TAU.
CONCLUSIONS: Buprenorphine maintenance with incentivised therapeutic drug monitoring to enable contingent access to increasing take-home medication supplies increased abstinence from opioids compared with buprenorphine maintenance treatment-as-usual, but it did not appear to increase treatment retention.
[See also, review of this article by the Recovery Research Institute - Improving outcomes among patients on medications for opioid use disorder is challenging, but incentivizing patients may be a path forward]
HA Screening, identification, and diagnostic method > Physical / medical screening, assessment and diagnostic method
HJ Treatment or recovery method > Substance disorder treatment method > Substance replacement method (substitution) > Opioid agonist treatment (methadone maintenance / buprenorphine)
HJ Treatment or recovery method > Treatment outcome
J Health care, prevention, harm reduction and treatment > Patient / client care management
J Health care, prevention, harm reduction and treatment > Treatment and maintenance > Treatment factors
L Social psychology and related concepts > Participation incentive / reward (contingency)
VA Geographic area > Asia
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