Mobile telephone contingency management to encourage adherence to opioid agonist treatment: a feasibility study
Background: Opioid Agonist Treatment (OAT) with drugs such as methadone or buprenorphine is typically used for the management of opioid dependence, reducing withdrawals and cravings for heroin. Supervision of OAT by a pharmacist safeguards against diversion and overdose and ensures individuals receive their optimum dose and achieve full benefit. However, individuals often fail to attend the pharmacy to take their medication, increasing their risk of relapse and overdose. Contingency Management (CM) is a behavioural intervention utilising positive reinforcement (e.g., financial incentives) to encourage behaviour change. There is a strong evidence base for the effectiveness of CM in increasing treatment-related behaviour, such as abstinence from illicit substances, attendance at clinical appointments, vaccination uptake and medication adherence. Internet and mobile phone technology provide mechanisms to deliver CM remotely to target adherence to supervised consumption in community pharmacies.
We developed the technology to deliver mobile CM (mCM) targeting adherence to supervised OAT and completed a study to assess the feasibility of conducting a future randomised controlled trial (RCT) measuring clinical and cost-effectiveness.
Methods: This feasibility study used a cluster randomised design where three UK-based drug services (each delivering OAT to 20 clients) were allocated to: mCM (supervised OAT + financial incentives); mR (supervised OAT + text message reminders); or treatment as usual (supervised OAT only). Participants were those receiving OAT and most at risk of missed doses. The technology monitors clients’ supervised OAT consumption through an computer-tablet login at their pharmacy. Automated text messages remind clients of their appointment or rewards them for consuming their medication under supervision. A linked system sends reports of their attendance and medication consumption to their prescriber and early warning of missed doses.
Results: Feasibility outcomes will be reported in accordance with pre-specified progression criteria, including screening, recruitment and follow-up rates and adherence to the telephone system. Intervention acceptability, pharmacists’ willingness to participate, clinicians’ experiences and perspectives, and the challenges and opportunities of implementing CM interventions in real-world clinical settings will be presented.
Conclusions: Many individuals do not achieve full benefit of OAT due to non-adherence. If effective, mCM will encourage clients to adhere to their medication, leading to increased potential to become abstinent from illicit drugs. While this study demonstrates potential feasibility of progressing to a confirmatory trial of effectiveness, challenges faced could significantly hinder its implementation.
