A randomized clinical trial of the Recovery Line among methadone treatment patients with ongoing illicit drug use

Abstract

Background: Relapse, drug use, and treatment dropout are common challenges facing patients receiving methadone. Though effective, multiple barriers to face-to-face counseling exist. The Recovery Line (RL), an automated, self-management system based on Cognitive Behavioral Therapy, is a phone-based adjunctive treatment that provides low cost, consistent delivery and immediate therapeutic availability 24 hours a day. Methods: The current study was a 12-week randomized clinical efficacy trial of treatment-asusual (TAU) only or RL+TAU for methadone treatment patients with continued illicit drug use (N=82). Previous small trial phases evaluated methods to increase participant engagement and use of the RL and were incorporated into the current RL version. Primary outcomes were days of selfreported illicit drug abstinence and urine screens negative for illicit drugs. Results: Days of self-reported illicit drug abstinence improved for patients in RL+TAU but not in TAU. Percent of urine screens negative for illicit drugs, coping skills efficacy, and retention in methadone treatment did not differ by condition. Patients in RL+TAU attended more substance use disorder treatment and self-help group sessions during treatment than those in TAU. RL system use was generally low and more system use was correlated with abstinence outcomes. Conclusions: Although the RL did not impact urine screen outcomes, it increases self-reported abstinence. Additional methods to increase patient engagement with automated, self-management systems for substance use disorder are needed.

Retention Strategies for Medications for Opioid Use Disorder in Adults: A Rapid Evidence Review

“…Four RCTs (3 fair-quality 37 – 39 and 1 poor 40 ) and 3 fair-quality retrospective cohort studies 41 – 43 assessed the effectiveness of Health IT (IT) interventions to improve retention on MOUD (Appendix Table 4). Figure 3 presents a graphic framework for how IT may help increase MOUD retention and summarizes the details of included studies.…”

Evaluating comparative effectiveness of psychosocial interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analyses

“…. Less common intervention characteristics were found in two studies (2.8%) that delivered a telephone-based intervention [51,102], one study that recruited couples (1.4%) [99], and one study that randomized community pharmacies and had pharmacists deliver motivational interviewing (1.4%) [109]. Two studies (2.8%) delivered interventions through a stepped care model (see S1 Data) [69,104].…”

“…One study only recruited individuals that had "failed to respond to the standard course of treatment" [46]. [40,42,43,45,68,71,73,76,77,88,92,95,97], alcohol use [42, 43, 58, 80-83, 88, 92, 95, 104], adherence to OAT [42,43,49,53,54,61,72,86,102,110], HIV/HCV risk behavior [54,57,60,61,67,88,89,91,105], withdrawal symptoms [40,49,65,73,86,87,96], adverse events [49,58,75,102], measure of craving [49,83], relapse prevention [41,106], drop-outs from...…”

“…Study comparisons involved C vs C+CM (2 studies) [65,73]; OAT only vs CBT (1 study) 96 ; C + CBT vs C + CBT + CM (1 study) [76]; C vs C + CBT vs C+CM vs CBT +CM (1 study) 49 ; C vs CBT (1 study) [87]; C vs PGS vs C+BSBNT+NLM (1 study). 40 Adverse events 4 [49,58,75,102] (n = 539) C; OAT; C+CBT; C+CM; CBT+CM X X Formal comparisons were not reported. Authors concluded no substantive differences between intervention strategies in all studies [49,58,75,102].…”

“…40 Adverse events 4 [49,58,75,102] (n = 539) C; OAT; C+CBT; C+CM; CBT+CM X X Formal comparisons were not reported. Authors concluded no substantive differences between intervention strategies in all studies [49,58,75,102].…”