1. Using a pragmatically adapted, low-cost contingency management intervention to promote heroin abstinence in individuals undergoing treatment for heroin use disorder in UK drug services (PRAISE): a cluster randomised trial
- Author
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Claire Goodfellow, Jalpa Bajaria, Tim Weaver, Andrew Pickles, Dilkushi Poovendran, Roopal Desai, Sam Forshall, Prun Bijral, Sarah Byford, Owen Bowden-Jones, Elizabeth Bishop, Elizabeth Phillips, Ruth Pauli, Jo Morris, Carmel Bennett, Shabana Akhtar, Vikki Charles, Kimberley Goldsmith, Ed Day, Franziska Mosler, Farjana Haque, John Strang, Hortencia McKechnie, Nicola Metrebian, Clare Davey, Luke Mitcheson, Stephen Pilling, Nadine Bogdan, Jennifer Hellier, Emily Finch, John Dunn, Anthony Glasper, Nicholas Little, James Shearer, and Julian Mutz
- Subjects
Adult ,medicine.medical_specialty ,media_common.quotation_subject ,Contingency management ,Addiction ,Heroin ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,mental disorders ,Medicine ,Humans ,030212 general & internal medicine ,Cluster randomised controlled trial ,media_common ,clinical trials ,business.industry ,substance misuse ,Attendance ,General Medicine ,Abstinence ,Drug Abstinence ,United Kingdom ,Buprenorphine ,England ,Pharmaceutical Preparations ,adult psychiatry ,business ,030217 neurology & neurosurgery ,Methadone ,medicine.drug - Abstract
IntroductionMost individuals treated for heroin use disorder receive opioid agonist treatment (OAT)(methadone or buprenorphine). However, OAT is associated with high attrition and persistent, occasional heroin use. There is some evidence for the effectiveness of contingency management (CM), a behavioural intervention involving modest financial incentives, in encouraging drug abstinence when applied adjunctively with OAT. UK drug services have a minimal track record of applying CM and limited resources to implement it. We assessed a CM intervention pragmatically adapted for ease of implementation in UK drug services to promote heroin abstinence among individuals receiving OAT.DesignCluster randomised controlled trial.Setting and participants552 adults with heroin use disorder (target 660) enrolled from 34 clusters (drug treatment clinics) in England between November 2012 and October 2015.InterventionsClusters were randomly allocated 1:1:1 to OAT plus 12× weekly appointments with: (1) CM targeted at opiate abstinence at appointments (CM Abstinence); (2) CM targeted at on-time attendance at appointments (CM Attendance); or (3) no CM (treatment as usual; TAU). Modifications included monitoring behaviour weekly and fixed incentives schedule.MeasurementsPrimary outcome: heroin abstinence measured by heroin-free urines (weeks 9–12). Secondary outcomes: heroin abstinence 12 weeks after discontinuation of CM (weeks 21–24); attendance; self-reported drug use, physical and mental health.ResultsCM Attendance was superior to TAU in encouraging heroin abstinence. Odds of a heroin-negative urine in weeks 9–12 was statistically significantly greater in CM Attendance compared with TAU (OR=2.1; 95% CI 1.1 to 3.9; p=0.030). CM Abstinence was not superior to TAU (OR=1.6; 95% CI 0.9 to 3.0; p=0.146) or CM Attendance (OR=1.3; 95% CI 0.7 to 2.4; p=0.438) (not statistically significant differences). Reductions in heroin use were not sustained at 21–24 weeks. No differences between groups in self-reported heroin use.ConclusionsA pragmatically adapted CM intervention for routine use in UK drug services was moderately effective in encouraging heroin abstinence compared with no CM only when targeted at attendance. CM targeted at abstinence was not effective.Trial registration numberISRCTN 01591254.
- Published
- 2021