Discussion
CM
DISORDER
The innovative design of this clinical trial that will compare two adherence-promoting interventions to increase adherence to buprenorphine-naloxone medication is likely to have a significant impact on engagement of MOUD patients in treatment and may inform practices about the use of adjunctive intervention for medication adherence during treatment initiation, a known period of high risk for those with OUD.Further, the use of a SMART design will test multiple levels of intervention for individuals who may not have initial MOUD adherence success. For those who are not adherent in Stage 1, sequential intervention resources will be provided to examine if a different intervention or a more intensive (combined) intervention is needed to assist these individuals in their treatment journey.Through the extension of successful intervention into a maintenance phase, we will be able to examine long-term effects across initiation and maintenance phases of MOUD. This allows us to examine whether adapting adjunctive intervention for those who do not initially adhere is a worthwhile strategy. Results from this work will also directly inform the equipoise surrounding the long-term use of CM for medication adherence, a strategy that has demonstrated short-term gains in promoting opioid abstinence but diminished effects thereafter.Finally, this study will be able to examine how delay discounting, a malleable characteristic known to change over the phases of active substance use disorder and recovery, changes with these different forms of intervention. While CM directly supplements a need for immediate reward, BSM works explicitly to address delaying immediate rewards in favor of larger gains that come with MOUD adherence and fulfilling named goals. It is possible that the action of these intervention methods will be apparent through examination of delay discounting throughout the trial.This trial is designed to examine the comparative and sequential effects of two forms of adjunctive intervention to promote MOUD adherence. It is possible that through this work, characteristics of risk for opioid use will add to the body of evidence that allows practitioners to make the most out of limited resources and reach as many patients as possible to encourage treatment adherence.