Improving medication assisted treatment (MAT) of opioid use disorder (OUD): Contingency Management (CM)
The opioid epidemic continues unabated with the CDC reporting more than 81,000 drug overdose deaths in the 12 months ending May 2020, about 70% opioid-related. Persons working in startup companies are typically among the most vulnerable demographic group with risk augmented by multiple additional stressors. Medication assisted treatment (MAT) is the gold standard for treatment of opioid use disorder. A study by Bolivar, et al in the current issue of JAMA Psychiatry reports that the addition of another treatment methodology - contingency management - significantly improves treatment adherence and duration of abstinence from opioids. Contingency management (CM) is an evidence-based behavioral intervention which provides patients with a material incentive - often a cash voucher - for showing evidence of meeting a therapeutic target, i.e., objective evidence of abstinence from opioids and/or methamphetamine. Commonly the incentive is increased at regular intervals with continued abstinence. The study was a systematic review of more than 10,000 patients in 74 studies evaluating the efficacy of CM in treating OUD with or without concurrent psychostimulant (methamphetamine) use. Notably, a recent report suggests that up to 30% of persons with OUD are also using a psychostimulant, usually methamphetamine. Unfortunately, concurrent psychostimulant use doubles the dropout rate for medication assisted treatment. Bolivar’s report found CM improved treatment outcomes in more than 70% of patients with either psychostimulant use or OUD as measured by abstinence and treatment adherence compared to MAT alone.
Bolivar, et al, suggest the evidence of efficacy for CM in OUD is so compelling that the Center for Medicaid and Medicare Health Services (CMS) should authorize the use of funds for CM treatment for OUD. They suggest that development and credentialing of CM treatment programs should be a federal public health priority.