Effectiveness of incentivised adherence and abstinence monitoring in buprenorphine maintenance: a pragmatic, randomised controlled trial

Background and Aim Buprenorphine (BUP) maintenance treatment for opioid use disorder (OUD) begins with supervised daily dosing. We estimated the clinical effectiveness of a novel incentivised medication adherence abstinence monitoring protocol in BUP to enable contingent access increasing take-home supplies. Design Two-arm, single-centre, pragmatic, randomised controlled trial outpatient maintenance, during-treatment follow-ups at 4 weeks, 8 12 weeks 16 weeks. Setting Inpatient addictions centre United Arab Emirates. Participants Adults OUD, voluntarily seeking treatment. Interventions The experimental condition was (I-AAM) giving 7-day, then 14-day, 21-day 28-day supply. control, treatment-as-usual (TAU) 7-day 14-day Measurements primary outcome number negative urine drug screens (UDS) opioids, non-attendance or otherwise missed UDS, imputed as positive opioids. secondary retention (continuous enrolment 16-week endpoint). Findings Of 182 patients screened, 171 were enrolled 141 randomly assigned I-AAM (70 [49.6%]) TAU (71 [50.4%]. Follow-up rates 91.4%, 85.7%, 71.0%, 60.0% respectively 84.5%, 83.1%, 69.0%, 56.3% TAU. By intention-to-treat, absolute difference percentage UDS opioids 76.7% (SD = 25.0%) versus 63.5% 34.7%) (mean 13.3%; 95% CI 3.2%–23.3%; Cohen's d 0.44; 0.10–0.87). In I-AAM, 40 participants (57.1%) retained 33 (46.4%) (odds ratio 1.54; 0.79–2.98). Conclusions therapeutic supplies increased from compared buprenorphine treatment-as-usual, but it did not appear increase retention.