The increased prevalence of opioid use disorder (OUD) and associated overdoses and adverse events has led to a substantial increase in the number of patients being seen at emergency departments (ED). Thus, the ED may be an ideal location for identifying patients in need of OUD treatment and can serve as the first touch point in the OUD continuum of care to promote medication assisted treatment initiation. Contingency management (CM) is an effective method for promoting treatment initiation and adherence that has not been thoroughly evaluated for this purpose. The primary aim of the current study is to develop and assess the effectiveness, acceptability, and feasibility of a protocol for delivering CM to increase combined buprenorphine + nalaxone (referred to as BUP hereafter) initiation and continuous adherence for OUD in an existing ED "bridge" program (e.g., Bridge plus CM; B+CM) relative to standard care. Secondary objectives include identifying behavioral and neuropsychological correlates to treatment outcomes, including delay discounting, reinforcer demand, and neurological soft signs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
92
Financial incentives for attending bup appointments and demonstrating opioid abstinence. Rides will also be provided for up to two clinic visits per week.
Cooper University Hospital
Camden, New Jersey, United States
Attendance at first scheduled clinic appointment
We will track attendance at participant's first scheduled BUP appointment after being bridged from the ED
Time frame: 1 week
Percentage of sessions where buprenorphine positive urine results was recorded
Urine-verified buprenorphine
Time frame: 3-months
Percentage of sessions where opioid free urine results were recorded
Urine-verified opioid abstinence
Time frame: 3-months
Treatment acceptability
Participants will evaluate the treatment at the end.
Time frame: 3-months
Delay discounting as a correlate of opioid-free urine test results and buprenorphine-positive results
Delay discounting will be evaluated, using the brief, five question delay discounting procedure and will be correlated with urine results determining opioid abstinence and buprenorphine adherence.
Time frame: 3-months
Opioid demand as a correlate of opioid-free urine test results and buprenorphine-positive results
The opioid purchasing task will be used to evaluate opioid demand and will be correlated with urine results determining opioid abstinence and buprenorphine adherence.
Time frame: 3-months
Substance-free activities as a correlate of opioid-free urine test results and buprenorphine-positive results
A modified Pleasant Events Scale survey will be used to evaluate access to, and enjoyment from, substance-free activities and the results will be correlated with urine results determining opioid abstinence and buprenorphine adherence.
Time frame: 3-months
Neurological Soft Signs correlate with treatment success
Participants will complete a drawing task that has been correlated with other substance use treatment outcomes in the past.
Time frame: 3-months
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