CM40UD (Contingency Management for Opioid Use Disorder)
Opioid use disorder (OUD) is a major public health issue, with recovery often requiring long-term treatment. In the UK, half of adults in treatment for substance use disorder are addressing opiate problems.
What is Opioid Agonist Treatment (OAT)?
Opioid Agonist Treatment (OAT) is the first-line medical intervention for OUD which includes medications such as methadone and buprenorphine.
However, clinical responses among sub-populations differ. Outcome data from the UK’s National Drug Treatment Monitoring System (NDTMS) indicates that heroin use continues to be prevalent among those in OAT, with more that 60% of clients still using heroin in the first six months of treatment. There are several known reasons for this, including lack of psychological therapies, personal situations and inadequate doses.
What is contingency management?
Contingency Management (CM) is a psychological intervention where people are rewarded for meeting their treatment goals, such as attending clinical appointments and taking their medications as prescribed. This intervention has been shown to also help people reduce their use of substances like alcohol, tobacco, and illicit drugs such as heroin.
Despite CM being among the most powerful psychosocial interventions, the UK has been slow to adopt these interventions. One way to make CM more accessible and reduce the burden on healthcare services is by delivering it remotely.
Technology can automate key parts of CM, such as tracking progress and delivering rewards remotely, which could make it easier for people to access and for healthcare providers to implement. The CM4OUD project involves the development and evaluation of a fully digitalised app-based CM intervention for reducing heroin use among individuals in treatment for OUD.
Aims
Our study aims to explore the acceptability and feasibility of carrying out a future randomised controlled trial. This trial would test how well an app-based Contingency Management intervention helps people stop using heroin whilst receiving OAT in UK drug treatment services.
Methods
40 OAT service users in UK drug treatment services who continue to use heroin will be randomly assigned to receive one of two treatment allocations – app-based CM or treatment as usual (TAU) over a 12-week period.
The following treatments are:
1. App-based CM with OAT
Participants will receive financial incentives if their heroin toxicology produces a negative result.
Over a 12-week period, participants will receive push notifications via the smartphone app three times a week (Monday, Wednesday, Friday) when an oral saliva test is due.
Participants will receive smartphones with data plans to eliminate barriers to access. They will need to conduct an oral saliva test and upload the result within a pre-specified time of receiving the push notification. Once they have made their submission, they’ll receive feedback, thanking them for uploading their video. The research team will review submissions upon receipt for quality and validity (ensuring self-testing and results are adequately displayed). Verified heroin-negative tests will result in notification of earnings.
Participants earn £5 for the first negative test result, which increases by a £1 for every negative result they produce after that until they reach the maximum value of £10. A ‘reset’ procedure will be used – where a missed or positive sample will result in a return to base rate for the next negative test. Earnings will be automatically loaded to the app wallet. Participants can access and spend vouchers from multiple vendors.
2. TAU (treatment as usual)
Participants will not receive the CM intervention and will continue to receive OAT as usual.
The trial design has been created to reflect the future confirmatory trial in which the novel intervention, app-based CM, will be compared to a control condition TAU in which no CM will be received.
We will recruit participants from drug and alcohol services provided by South London and the Maudsley NHS Foundation Trust (SLaM NHS) and third-sector organisations. Drug services will be eligible if they provide treatment to individuals with OUD.
Summary of Findings
The study is still ongoing, however the primary outcome of this feasibility trial is based on the number of eligible service users recruited over the six-month recruitment period.
Secondary feasibility outcomes will include:
- The number and percentage of screened service users eligible for inclusion and reasons for ineligibility.
- The number and percentage of eligible service users who consent to take part in the feasibility trial and the reasons for refusing consent.
- How well service users respond to the intervention based on app interactions, responses to push notifications, and uploads.
- The number/percentage of participants attending follow-up appointments.
- The number/percentage of oral saliva tests uploaded of sufficient quality.
- The number/percentage of urine samples collected during follow-up appointments.
- How well the intervention is received by participants and how satisfied they are with the trial overall. Their feedback will be collected via qualitative interviews.
- How widely the trial is accepted by treatment providers and if they view it as appropriate. Also, if they would consider adopting it in the future and if they view it as having positive or negative effects on the service overall. This will be assessed by qualitative interviews.
Impact
Research on CM has grown exponentially over the last decade, with remote technologies being used more than ever to expand the reach and scope of these interventions. This study will evaluate the feasibility of an app-based CM intervention to support heroin abstinence among individuals receiving OAT.
This approach has the potential to enhance treatment accessibility and effectiveness, potentially improving outcomes for those in treatment for opioid use disorder.
Research assistants
- Antonia Hannon-Thresh
- Riya Sanjay
Further reading
Protocol paper – Mobile telephone-delivered Contingency Management (mCM) to reduce heroin use in individuals with opioid use disorder (CM4OUD): A feasibility study protocol. John Strang, Ewan Carr, Jesse Dallery, Nicola Metrebian
Principal Investigator
Research Fellow
Investigators
Reader in Addiction Treatment Research
Reader in Biostatistics
Funding
Amount: -
Period: October 2023 - December 2026