Nearly 50,000 Americans die annually from opioid overdose. While we know that medications for addiction treatment (MAT) save lives, retaining patients in MAT programs is difficult. The Agency for Healthcare Research and Quality commissioned a rapid evidence review (1.6MB) on the effectiveness of interventions, to promote a broader understanding of the published literature on MAT retention among adults with opioid use disorder (OUD).
The study team searched MEDLINE and the Cochrane Library from February 12, 2009, through August 20, 2019, for systematic reviews (SRs) and randomized controlled trials (RCTs). They summarized evidence for six retention intervention types:
- Care settings/services/logistical support,
- Contingency management,
- Health information technology (IT),
- Extended-release (XR) medication-based treatment,
- Psychosocial support, and
- Financial support.
The primary outcome was retention, defined as continued medication engagement for at least 3 months after MAT initiation. Secondary outcomes included mortality and harms.
Researchers reported the following key findings from 2 SRs and 39 primary studies:
- Care setting interventions that initiated MAT in soon-to-be-released incarcerated patients improved retention following release.
- Contingency management improved retention when combined with antagonist MAT but not with agonist forms of MAT. Applicability, however, may be limited due to implementation challenges.
- Preliminary trials suggest that retention in MAT supported with health IT approaches may be no worse than in-person approaches.
- Early studies suggest no difference in retention with XR-buprenorphine in either injectable or implant formulations compared with daily buprenorphine. Studies showed conflicting results with XR-naltrexone injection compared with daily buprenorphine.
- The addition of psychosocial interventions did not improve retention; however, many studies included some form of counseling in the control groups, potentially obscuring evidence of effectiveness.
The authors concluded:
- While patients who receive longer term treatment with MAT have improved outcomes, fewer than half of the identified studies measured treatment retention as a primary outcome.
- Limited evidence suggests criminal justice prerelease MAT initiation and the use of contingency management for patients on antagonist forms of MAT may aid retention.
- XR and daily buprenorphine formulations appear to be equivalent for treatment retention and comparisons of XR-naltrexone versus daily buprenorphine showed conflicting results.
- Integrating MAT treatment with medical and social services and the use of health IT did not change retention.
- Some studies were conducted outside of the United States, where policies and practices differ, focused on highly selected populations or conditions that do not fully represent the spectrum of OUD, or were studied in situations that may not be easily implemented in real-world conditions.
- There is a critical need for studies that use standardized definitions of retention, include measures of harms as well as benefits, and reflect the full spectrum of real-life conditions.
For more information, refer to the posted final reports on the Effective Health Care Program search page.