Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone-Based Contingency Management Intervention for Buprenorphine Adherence
A smartphone app that pays patients for verified buprenorphine adherence kept 20 adults engaged and taking medication 76% of days.
01Research in Context
What this study did
DeFulio et al. (2023) built a phone app that pays adults for taking their buprenorphine. The app checks if the pill was swallowed by using GPS or a short selfie video. A peer recovery coach also sends messages through the app.
Twenty adults with opioid-use disorder used the app for 12 weeks. They earned small gift cards each time the system confirmed a dose.
What they found
Seventy-six percent of scheduled doses were verified. Every participant stayed in the study. They said the app was easy and helpful.
The results show the idea is workable before larger trials start.
How this fits with other research
Bryant et al. (1984) first showed that cash for clean urine keeps methadone patients in care. DeFulio moves the same idea onto a phone and targets pill taking instead of drug-free tests.
Woodman et al. (2025) are now testing a similar phone-payment system with 240 methadone patients. Their larger study will tell us if the early promise holds across clinics.
Potter et al. (2013) paid sedentary adults online for walking more. Steps doubled while money flowed, then dropped when pay stopped. DeFulio saw steady adherence while incentives stayed, matching this pattern.
Why it matters
If you work with adults on buprenorphine, phone-based CM can keep them engaged between visits. The tech is cheap and the check-in takes seconds. Try adding a small gift-card reward the next time a client struggles with daily dosing.
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02At a glance
03Original abstract
Buprenorphine is an important medication for treating opioid use disorder, but medication adherence and treatment retention are key issues that can limit its impact, especially when patients have concurrent stimulant use. Contingency management is efficacious in promoting medication adherence and drug abstinence. Delivering contingency management via smartphones addresses practical barriers to its adoption and improves patient access. A single-group (n = 20) nonexperimental study was conducted to evaluate the feasibility of smartphone-based contingency management to promote adherence to buprenorphine treatment in people with opioid use disorder. Participants were recruited from outpatient treatment clinics. Over 12 weeks participants had access to a smartphone app that provided contingency management supported with peer recovery coaching. Adherence was confirmed daily either by GPS monitoring of clinic medication visits or self-recorded video, and salivary toxicology was conducted weekly. The overall rate of confirmed buprenorphine adherence was 76%, and visual inspection of individual participant outcomes shows consistent medication use for a large majority of participants. All participants were able to successfully use all app features and spend earnings. Participants rated the app and intervention highly on measures of likability, ease of use, and helpfulness. All participants (100%) were retained in buprenorphine treatment throughout the study period. Direct methods for confirming adherence appear superior to confirmation via salivary toxicology. This study shows that smartphone-based contingency management is a feasible means of promoting buprenorphine adherence. The potential efficacy of smartphone-based contingency management as a means of promoting buprenorphine adherence warrants evaluation in a randomized controlled trial.
Behavior Analysis in Practice, 2023 · doi:10.1007/s40617-022-00730-8