Pragmatic and low-cost contingency management intervention increases buprenorphine treatment engagement: Randomized controlled trial.

Individuals with opioid use disorder have difficulty sustaining prolonged buprenorphine treatment engagement. Contingency management (CM; incentives) may increase treatment reinforcement, but most buprenorphine CM studies delivered incentives multiple times per week, more often than typical outpatient frequency. This exploratory, pragmatic study compared patients randomly assigned to CM versus treatment-as-usual (TAU; n = 46 per group) in visit attendance and treatment adherence (urine samples positive for buprenorphine and negative for other opioids) over 12 weeks in new opioid treatment clinic outpatients. Incentive delivery was aligned with scheduled clinic visits, which could create natural thinning of incentives as patients stabilized. The CM participants earned incentives on a reloadable debit card. The CM group, compared to TAU, had higher rates of attendance and adherence at first follow-up after intake (attendance: CM = 67.4% vs. TAU = 45.7%; adherence: CM = 30.4% vs. TAU = 26.1%) and perfect attendance and adherence over all 12 weeks (attendance: CM = 22.2% vs. TAU = 8.7%; adherence: CM = 17.8% vs. TAU = 4.3%). Secondary outcomes showed that the CM group had 1.56 times higher average attendance (95% CI [1.28, 1.91]), 1.63 times longer continuous attendance streak (95% CI [1.31, 2.02]), 1.98 times higher average adherence (95% CI [1.35, 2.14]), and a 1.94 times longer continuous adherence streak (95% CI [1.46, 2.59]) than TAU. Out of a possible $590.00, the CM group earned an average of $138.56 (SD ± 145.97). This study supports the pragmatic implementation of a low-cost CM intervention to increase early buprenorphine engagement. (PsycInfo Database Record (c) 2026 APA, all rights reserved).