This course is based upon material published by the Agency for Healthcare Research and Quality, US Department of Health and Human Services and is available as an open-access article.
Aims: American deaths from opioid overdose now approach 50,000 annually. While evidence shows that medications for addiction treatment (MAT) save lives, retaining patients in MAT programs is challenging. The U.S. Agency for Healthcare Research and Quality, on behalf of the U.S. Department of Health and Human Services, commissioned a rapid evidence review on the effectiveness of interventions to promote a broader understanding of the published literature on MAT retention among adults with opioid use disorder (OUD).
Methods. We searched MEDLINE and the Cochrane Library from February 12, 2009, through August 20, 2019, for systematic reviews (SRs) and randomized controlled trials (RCTs). We 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. Our primary outcome was retention, defined as continued medication engagement for at least 3 months after MAT initiation. Secondary outcomes included mortality and harm.
Findings. Key findings from 2 SRs and 39 primary studies include:
•Most studies of MAT for OUD do not focus on retention as the primary outcome are small (e.g., one to two trials per intervention), and have design flaws.
•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. There were 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.
Harms were infrequently reported across studies except in studies of XR formulations. Similarly, few studies reported whether participant characteristics influenced retention.
Conclusions. 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 and/or conditions that are not fully representative of 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.
This course on retention in MAT of adults with opioid use disorder is designed for social workers, professional counselors, psychologists, nurses, and substance abuse counselors, who do clinical work. This course is appropriate for intermediate and advanced level practitioners who wish to develop or increase their knowledge of opioid use disorder MAT retention. The course material includes a literature review of interventions. It may also be useful for licensed clinicians who require clinical continuing education courses for license renewal.
The course is based on a journal article that includes research. It contains statistical analysis and data that some clinicians enjoy reading and others do not. A major benefit of reading research-based articles for continuing education is they provide practitioners with the latest findings in their field.
Authors: Chan, Gean, Arkhipova-Jenkins, Gilbert, Hilgart, Fiordalisi, Hubbard, Brandt, Stoeger, Paynter, Korthuis, and Guise.
Learning Objectives: This course will provide the practitioner with detailed information regarding MAT retention among adults with opioid use disorder. Specifically, a professional will:
- Identify the comparative effectiveness of strategies to improve retention in MAT among nonpregnant adults with OUD
- Summarize the harms of retention strategies for MAT
- Distinguish the effectiveness of MAT retention strategies relative to participant characteristics such as age, gender, socioeconomic status, geographic region, and polysubstance use
Citation: Chan, B., Gean, E., Arkhipova-Jenkins, I., Gilbert, J., Hilgart, J., Fiordalisi, C., Hubbard, K., Brandt, I., Stoeger, E., Paynter, R., Korthuis, PT., Guise, J-M. Retention Strategies for Medications for Addiction Treatment in Adults With Opioid Use Disorder: A Rapid Evidence Review. (Prepared by the Scientific Resource Center under Contract No. HHSA 290-2017- 00003C). AHRQ Publication No. 20-EHC012. Rockville, MD: Agency for Healthcare Research and Quality. July 2020. Errata August 2020.
This course content is based on a publication that has been peer-reviewed, the scientific standard for evaluating academic work. All studies and scientifically derived evidence have limitations that should be considered. If you have any questions about the accuracy or limitations of the content, please contact us at
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