Contingency Management for Patients Receiving Medication for Opioid Use Disorder: A Systematic Review and Meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of prospective experimental studies
PubMed 34347030 · doi:10.1001/jamapsychiatry.2021.1969
What was done
A systematic review and random-effects meta-analysis following PRISMA guidelines evaluated prospective experimental studies examining monetary-based contingency management among adult patients receiving medication for opioid use disorder (MOUD). Databases (PubMed, Cochrane CENTRAL, Web of Science) were searched from inception through May 5, 2020. The primary outcome was the weighted mean effect size (Cohen d) at end of treatment across six clinical domains: stimulant use, polysubstance use, illicit opioid use, cigarette smoking, therapy attendance, and medication adherence.
What was found
Of 74 eligible reports (10,444 unique participants), 60 were included in the meta-analyses. Contingency management was associated with statistically significant improvements across all six outcomes at end of treatment: cigarette use (Cohen d = 0.78; 95% CI, 0.43-1.14), medication adherence (Cohen d = 0.75; 95% CI, 0.30-1.21), stimulant use (Cohen d = 0.70; 95% CI, 0.49-0.92), illicit opioid use (Cohen d = 0.58; 95% CI, 0.30-0.86), polysubstance use (Cohen d = 0.46; 95% CI, 0.30-0.62), and therapy attendance (Cohen d = 0.43; 95% CI, 0.22-0.65). Collapsing categories yielded medium effect sizes for overall abstinence (Cohen d = 0.58; 95% CI, 0.47-0.69) and treatment adherence (Cohen d = 0.62; 95% CI, 0.40-0.84).
Why it matters
Comorbid stimulant and substance use frequently compromise opioid agonist therapy. This meta-analysis establishes that contingency management produces moderate to large end-of-treatment gains across multiple critical clinical behaviors in MOUD populations.
Limits
Evaluations focused on end-of-treatment outcomes, leaving post-intervention sustained efficacy unmeasured in the abstract. The abstract does not provide data on monetary incentive magnitude, cost-effectiveness, or study-level risk of bias.
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