Contingency management may prevent deaths in stimulant use disorder

The use of contingency management (CM) in real-world healthcare settings results in a reduction in mortality risk among patients with stimulant use disorder (SUD), according to a study.

Overall, 1,481 patients with SUC received CM and were matched to 1,481 control participants. Patients who received CM benefitted from a 41-percent lower risk of death (adjusted hazard ratio, 0.59, 95 percent confidence interval, 0.36‒0.95) than those who did not receive CM over the 1-year follow-up period.

A team of investigators conducted this retrospective cohort study in patients with SUD who received or did not receive CM using linked electronic health records and death records in the largest integrated health system in the US, the Veterans Health Administration, from July 2018 through December 2020.

Mortality in the year following the index CM visit was the primary outcome. The investigators obtained all-cause mortality data from the National Death Index and linked to electronic health record data. They also used stratified Cox proportional hazards models to estimate the adjusted hazard ratios.

“While opioid overdose has begun to decrease in recent years, stimulant overdose has continued to increase and has not been adequately addressed,” the investigators said. “Unlike opioid use disorder, there are no medications approved by the US Food and Drug Administration to treat SUD.”

CM is a behavioural intervention that provides rewards to reinforce target behaviours, such as biochemically verified abstinence.