Marino Elise N, Karns-Wright Tara, Perez Matthew C, Potter Jennifer S
Be Well Institute on Substance Use and Related Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio.
Be Well Institute on Substance Use and Related Disorders, University of Texas Health Science Center at San Antonio.
JAMA Netw Open. 2024 Dec 2;7(12):e2448405. doi: 10.1001/jamanetworkopen.2024.48405.
Opioid use disorder continues to be a national crisis, contributing to substantial morbidity and mortality. Medication is the only evidence-based treatment for opioid use disorder; however, improving clinical outcomes may require augmenting it with psychosocial interventions, such as contingency management (CM), specifically, smartphone app-based CM.
To evaluate whether augmenting medication for opioid use disorder (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.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from November 1, 2020, to November 30, 2023, collected from opioid treatment programs and office-based opioid treatment programs across Texas. The cohort included individuals aged 18 years or older who were uninsured or underinsured and who chose to receive MOUD only or MOUD plus CM delivered via the WEconnect smartphone app. Participants who chose to receive app-based CM received monetary incentives upon achieving their self-chosen recovery goals.
Opioid use disorder.
Primary analyses examined differences in treatment outcomes (self-reported days of opioid use at the end of treatment and retention) between patients who chose MOUD only and those who chose MOUD plus app-based CM. Linear regression analysis was used to examine days of opioid use at the end of treatment, and Cox proportional hazards regression analysis was used to examine retention.
The analytic sample comprised 600 individuals (mean [SD] age, 38.4 [8.6] years; 342 male [57.0%]), with 300 included in each treatment group. Those who chose to receive MOUD plus app-based CM reported significantly fewer days of opioid use at the end of treatment compared with those who chose to receive MOUD only (mean [SD] duration, 8.4 [12.9] vs 12.0 [13.5] days; β = -6.10; 95% CI, -8.09 to -4.10). Retention analysis showed that patients who chose to receive MOUD plus app-based CM were significantly more likely to stay in treatment longer compared with those who chose to receive MOUD only (mean [SD] duration, 290.2 [109.4] vs 236.1 [128.1] days; β = 51.91; 95% CI, 33.86 to 69.95).
These findings suggest that augmenting MOUD with app-based CM may provide clinical benefits for underserved patients. Expanding the availability of app-based CM may contribute to decreasing the societal, economic, and personal burden of opioid use.
阿片类物质使用障碍仍是一场全国性危机，导致大量发病和死亡。药物治疗是阿片类物质使用障碍唯一基于证据的治疗方法；然而，改善临床结局可能需要通过心理社会干预措施（如应急管理，特别是基于智能手机应用程序的应急管理）来增强药物治疗效果。
评估在阿片类物质使用障碍药物治疗（MOUD）基础上增加基于应用程序的应急管理是否与治疗结束时阿片类物质使用天数减少以及留存率提高相关，与仅接受MOUD治疗相比。
设计、设置和参与者：这项回顾性队列研究使用了2020年11月1日至2023年11月30日期间从德克萨斯州的阿片类物质治疗项目和基于办公室的阿片类物质治疗项目收集的数据。该队列包括18岁及以上未参保或参保不足且选择仅接受MOUD或接受通过WEconnect智能手机应用程序提供的MOUD加应急管理的个体。选择接受基于应用程序的应急管理的参与者在实现自我选择的康复目标后可获得金钱奖励。
阿片类物质使用障碍。
主要分析检查了仅选择MOUD的患者与选择MOUD加基于应用程序的应急管理的患者在治疗结局（治疗结束时自我报告的阿片类物质使用天数和留存率）上的差异。线性回归分析用于检查治疗结束时的阿片类物质使用天数，Cox比例风险回归分析用于检查留存率。
分析样本包括600名个体（平均[标准差]年龄为38.4[8.6]岁；342名男性[57.0%]），每个治疗组各有300名。与仅选择接受MOUD的患者相比，选择接受MOUD加基于应用程序的应急管理的患者在治疗结束时报告的阿片类物质使用天数显著减少（平均[标准差]持续时间，8.4[12.9]天对12.0[13.5]天；β = -6.10；95%置信区间，-8.09至-4.10）。留存率分析表明，与仅选择接受MOUD的患者相比，选择接受MOUD加基于应用程序的应急管理的患者更有可能在治疗中停留更长时间（平均[标准差]持续时间，290.2[109.4]天对236.1[128.1]天；β = 51.91；95%置信区间，33.86至69.95）。
这些发现表明，在MOUD基础上增加基于应用程序的应急管理可能为服务不足的患者带来临床益处。扩大基于应用程序的应急管理的可及性可能有助于减轻阿片类物质使用的社会、经济和个人负担。
