The cohort study of 600 underserved patients found that those who chose to use the app - which combines contingency management behavioral therapy and recovery support from peers - and alongside medication, reduced their days of opioid use by 35% compared with those treated with medication only. Additionally, app users remained in treatment nearly 19% longer than those treated with medication alone.
"These findings suggest that augmenting medication for opioid use disorder with app-based contingency management may provide clinical benefits for underserved patients," said Elise Marino, PhD, director of research operations at UT Health San Antonio’s Be Well Institute on Substance Use and Related Disorders. "Expanding the availability of app-based contingency management may contribute to decreasing the immense societal, economic and personal burden of opioid use."
Marino is lead author of the study, titled, "Smartphone App-Based Contingency Management and Opioid Use Disorder Treatment Outcomes," published Dec. 2 in JAMA Network Open. The other authors also are with UT Health San Antonio’s Department of Psychiatry and Behavioral Sciences and the Be Well Institute.
Opioid use disorder continues to be a national crisis, contributing to substantial morbidity and mortality. Its annual societal cost in the United States hit $968.9 billion in 2018, the study notes.
Medication for opioid use disorder, or MOUD - including methadone, buprenorphine and naltrexone - is recognized as the only evidence-based treatment for the condition. This first-line treatment has been shown to significantly decrease opioid-related morbidity and mortality, and with consistent cost-saving benefits.
However, some patients still experience difficulties reducing opioid use and staying with their treatment, pointing to a need to augment MOUD. Many conditions benefit from dual treatment of medication and therapy. One therapy is contingency management, or CM, which provides financial incentives for accomplishing treatment goals.
This therapy traditionally has been delivered in clinics, with the goal of an opioid-negative finding from urine drug screens. While findings have been mixed, several reviews and studies have found that individuals treated with MOUD plus CM had better retention and fewer opioid-positive results from urine drug screens.
A long-standing limitation, however, is that patients are required to attend multiple in-person appointments per week for the therapy. With the recent COVID-19 pandemic, many were unwilling to make in-person CM visits. Additional access barriers, such as transportation, distance from the clinic and arranging child care, have supported other options like telehealth and leveraging new technologies.
One such technology is the WEconnect Health CM smartphone app. The app delivers evidence-based CM embedded in a recovery-oriented framework. In addition to providing substance-related behavioral targets, it permits patients to set daily goals that are personally meaningful, both substance use-related and otherwise, like attending a Narcotics Anonymous meeting, going for a walk or reading.
The app also includes a platform for tracking patients’ progress and payment, and provides encouragement for completing their daily goals. Additionally, WEconnect offers 1-to-1 peer support and online meetings facilitated by certified peers. In contrast to traditional CM, the app permits patients to make decisions regarding their own goals for treatment and to explore recovery through peer support services available anywhere and accessible outside of normal clinic hours.
For the new research, the scientists set out to evaluate whether augmenting MOUD with app-based CM is associated with fewer days of opioid use at the end of treatment and greater retention than treatment with MOUD only.
The retrospective cohort study, which refers to research that follows a group of people over time, used data from Nov.1, 2020, to Nov. 30, 2023, collected from opioid treatment programs across Texas. The cohort included 600 individuals aged 18 years or older who were uninsured or underinsured and who chose to receive MOUD only or MOUD plus CM delivered by the WEconnect smartphone app.
Those who chose to receive MOUD plus app-based CM reported a mean duration of 8.4 days of opioid use at the end of treatment compared with 12 days for those who chose to receive MOUD only. Retention analysis showed that patients who chose to receive MOUD plus app-based CM stayed with their treatment for a mean duration of 290.2 days, compared with 236.1 days for those choosing to receive MOUD only.
"These results are promising, and they highlight the potential importance of a patient’s decision to use app-based CM," the researchers concluded. "Despite the challenges of engaging patients in other app-based interventions, adding recovery-oriented, app-based CM may be one way to enhance clinical care and meet the growing needs of historically underserved patients taking MOUD."
Marino EN, Karns-Wright T, Perez MC, Potter JS.
Smartphone App-Based Contingency Management and Opioid Use Disorder Treatment Outcomes.
JAMA Netw Open. 2024 Dec 2;7(12):e2448405. doi: 10.1001/jamanetworkopen.2024.48405