A Smartphone-Smartcard Platform for Implementing Contingency Management in Buprenorphine Maintenance Patients With Concurrent Stimulant Use Disorder

Abstract

Background and Objectives: Opioid agonist pharmacotherapies are effective in the treatment of opioid use disorder (OUD) but concurrent stimulant use is common and can lead to relapse and treatment drop out. Contingency management in combination with opioid agonist pharmacotherapy has broad beneficial effects in polysubstance users, including promoting drug abstinence and treatment retention, but clinic-based implementation can be burdensome. The present study was conducted to evaluate a contingency management intervention delivered via a smartphone-smartcard platform in OUD patients who had concurrent stimulant use disorder.Methods: Retrospective comparison of (n = 124) patients; half received the contingency management intervention and half were matched controls. Drug use and clinic attendance outcomes over four consecutive 30-day periods were analyzed with regression.Results: The intervention group showed consistently higher rates of drug abstinence and clinic attendance which were significant at the latter two timepoints.Discussion: Smartphone-smartcard platforms can facilitate dissemination of contingency management by surmounting or obviating key barriers to adoption. They appear to be convenient for all stakeholders, are easy to use, and facilitate high-fidelity implementation. Delivering contingency management via a smartphone-smartcard platform produces effects consistent with those observed when the intervention is delivered with substantially costlier and more burdensome in-person procedures.

Digital Contingency Management in the Treatment of Substance Use Disorders

“…Differences between groups increased over time, and by the final timepoint, the odds ratio for the drug abstinence measure was 4.84. A similar study involving the same intervention showed similar results in a sample of patients receiving medications for opioid use disorder (i.e., buprenorphine) who had concurrent stimulant use disorder (DeFulio et al, 2021a).…”

Implications of epidemic-pandemic convergence for routine care adoption of contingency management: A case study.

“…While the use of technology-based CM has been growing (Dallery et al, 2019) the present study was a novel integration of a smartphone-based CM program into a usual care setting. The same technology has effectively promoted clinic appointment attendance and drug abstinence in an inner-city outpatient clinic (DeFulio, Furgeson, et al, 2021; DeFulio, Rzeszutek, et al, 2021). Taken together, these studies demonstrate the role of smartphone-based CM to promote entry and adherence to MAT.…”

The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder

“…Incentives are delivered via an anonymous credit card that cannot be used to withdraw cash and has additional purchasing protections. Studies show preliminary effectiveness of this model in patients with OUD, including one with patients who have concurrent StUD 89-91 …”

“…Studies show preliminary effectiveness of this model in patients with OUD, including one with patients who have concurrent StUD. [89][90][91] The CGC reviewed available evidence for a number of technology-based and alternative interventions but found it to be insufficient to include in the recommendation statements at this time. These items can be found in Appendix F, http://links.…”