Smartphone App–Based Contingency Management and Opioid Use Disorder Treatment Outcomes

Importance: 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. Objective: 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. Exposure: Opioid use disorder. Main Outcomes and Measures: 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. Results: 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). Conclusions and Relevance: 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.