According to the results of a study published in JAMA Psychiatry, it was found that offering financial incentives after completing treatment for an opioid use disorder was associated with decreased use of stimulants and cigarettes, and improved drug adherence and treatment visits.
Drug treatment for opioid use disorder is effective, but the use of psychomotor stimulants undermines treatment success and contributes to relapse. Emergency management – offering financial or other incentives to people undergoing treatment for opioid use disorder to motivate them to avoid stimulants – can be an effective tool in treating comorbid substance use.
Researchers searched the PubMed, Web of Science, and Cochrane Controlled Register of Trials (CENTRAL) databases to identify studies examining emergency management with patients undergoing drug treatment for opioid use disorder. They searched for studies from the inception of the databases through May 6, 2020. Of 1143 possible studies, 74 met the inclusion criteria.
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Of the 22 studies examining emergency management for increasing abstinence from psychomotor stimulants, 82% reported a significant increase in abstinence at the end of treatment.
Of the 23 studies that examined emergency management for increasing abstinence from several substances, 70% reported increased abstinence. The analysis also showed increased abstinence from illicit opioids in patients enrolled in an emergency management program. Emergency management also helped patients to improve therapy visits (small to medium effect size) and therapy adherence.
The authors note that the analysis included a small number of studies discussing post-emergency abstinence, which is a limitation of the study. In addition, the studies analyzed used different definitions of “abstinence”.
The authors conclude that “the results support a position that includes policy makers [Centers for Medicare & Medicaid Services] should make concerted efforts to support the widespread adoption of emergency management in the many community hospitals in the United States currently facing the challenges of the opioid crisis, particularly the concomitant use of psychomotor stimulants in patients who [medication for opioid-use disorder]. “
reference
Bolívar HA, Klemperer EM, Coleman SRM, DeSarno M, Skelly JM, Higgins ST. Emergency management for patients receiving medication for an opioid use disorder: a systematic review and meta-analysis. JAMA psychiatry. 2021; 78 (10): 1092-1102. doi: 10.1001 / jamapsychiatry.2021.1969
This article originally appeared on Psychiatry Advisor
