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

Introduction Most individuals treated for heroin use disorder receive opioid agonist treatment (OAT)(methadone or buprenorphine). However, OAT is associated with high attrition and persistent, occasional use. There some evidence the effectiveness of contingency management (CM), a behavioural intervention involving modest financial incentives, in encouraging drug abstinence when applied adjunctively OAT. UK services have minimal track record applying CM limited resources to implement it. We assessed pragmatically adapted ease implementation promote among receiving Design Cluster randomised controlled trial. Setting participants 552 adults (target 660) enrolled from 34 clusters (drug clinics) England between November 2012 October 2015. Interventions Clusters were randomly allocated 1:1:1 plus 12× weekly appointments with: (1) targeted at opiate (CM Abstinence); (2) on-time attendance Attendance); (3) no (treatment as usual; TAU). Modifications included monitoring behaviour fixed incentives schedule. Measurements Primary outcome: measured by heroin-free urines (weeks 9–12). Secondary outcomes: 12 weeks after discontinuation 21–24); attendance; self-reported use, physical mental health. Results Attendance was superior TAU abstinence. Odds heroin-negative urine 9–12 statistically significantly greater compared (OR=2.1; 95% CI 1.1 3.9; p=0.030). Abstinence not (OR=1.6; 0.9 3.0; p=0.146) (OR=1.3; 0.7 2.4; p=0.438) (not significant differences). Reductions sustained 21–24 weeks. No differences groups Conclusions A routine moderately effective only attendance. effective. Trial registration number ISRCTN 01591254.