TABLE 1.
Summary of Included Studies for Strategies to Improve Retention in MOUD
| Intervention | Comparator | Number of Studies | Number of Participants | Quality of Evidence | Summary of Retention Results |
| Care settings, services, logistical support: | |||||
| MAT for soon-to-be-released incarcerated populations | No MOUD in prison | 1 SR18 + 2 additional RCTs20,29 | SR: n = 834 (range: 32–446) | SR: good; | Benefit with prerelease MOUD in all studies |
| 2 RCTs: n = 228 (15 and 213) | 1 fair; 1 poor | ||||
| Psychiatric & primary care (PC) services | Specialty outpatient setting | 3 RCTs21–23 | n = 631 (range: 94–316) | 3 fair | Inconsistent (2 psychiatric studies, benefit in one and no difference than traditional setting in other; 1 study in PC, no difference from traditional setting) |
| Emergency department (ED) / hospital setting | Treatment as usual | 2 RCTs24,27 | n = 429 (139 and 290) | 2 fair | ED no worse than traditional (1 study with no difference; 1 study with benefit for hospital-initiated MOUD) |
| Logistical support | Treatment as usual | 4 RCTs19,25,26,28 | n = 709 (range:97–300) | 1 good: 3 fair | No difference |
| Contingency management: | |||||
| Opioid receptor antagonist MOUD | Non-contingent access to a reward | 3 RCTs30–32 | n = 140 (range:35–67) | 3 fair | Benefit for contingency management in all studies |
| Opioid receptor agonist/partial agonist MOUD | Non-contingent access to a reward | 1 SR∗,14 + 4 additional RCTs26,33–35 | SR: n = 1616 | SR: good; | No difference |
| 4 RCTs: n = 698 (range:98–252) | 1 good; 3 fair | ||||
| Health IT: | |||||
| Telehealth | Treatment as usual | 3 cohort studies41–43 | n = 3965 (range:55–3733) | 3 fair | Telehealth no worse than in-person (2 studies with no difference, 1 study with benefit for telehealth) |
| Computer-based education &/or support | Treatment as usual | 3 RCTs37,39,40 | n = 262 (range:20–160) | 2 fair: 1 poor | No difference |
| Multicomponent mobile and computer-based program | Treatment as usual | 1 RCT38 | n = 1426 | 1 fair | No difference |
| Extended-release medication based treatments: | |||||
| Naltrexone extended-release 1-month injection | Daily naltrexone | 1 RCT46 | n = 60 | 1 fair | Benefit for XR injection |
| Buprenorphine extended-release 1-month injection | Daily SL-buprenorphine/ naloxone | 1 RCT47 | n = 428 | 1 fair | No difference |
| Buprenorphine extended-release 6-month implant | Daily SL-buprenorphine | 1 RCT49 | n = 177 | 1 good | No difference |
| Naltrexone extended-release 1-month injection | Daily SL-buprenorphine/ naloxone | 2 RCTs45,48 | n = 729 (159 and 570) | 1 good; 1 fair | Inconsistent (1 study no difference, 1 study with benefit for SL buprenorphine/naloxone) |
| Psychosocial Support: | |||||
| Including behavioral, psychoanalytic and counseling interventions | Treatment as usual | 1 SR∗,14 + 9 additional RCTs50–58 | SR: n = 3124 (range: 14–542) | SR: good | No difference in all but one poor quality study. Many of the studies reviewed included some form of counseling in the control groups. |
| 9 RCTs: n = 2483 (range:49–653) | 2 good; 4 fair; 3 poor | ||||
∗
SR applicable to 2 intervention types.
IT, information technology; MOUD, medications for opioid use disorder; RCT, randomized controlled trial; SL, sublingual; SR, systematic review; XR, Extended-release.