A pilot trial of contingency management for stimulant use in a low-barrier syringe service program.

Abstract

To pilot test the efficacy of contingency management (CM) for stimulant use disorder (StimUD) among syringe service program (SSP) recipients. This randomized, parallel-groups, 12-week pilot trial was conducted in Burlington, Vermont from 02/24-07/24. Twenty-seven individuals with StimUD participating in SSP services were randomized to health education (HE) plus CM for session attendance (HE+Att-CM) (n = 13) or HE plus CM for stimulant abstinence (HE+Abs-CM) (n = 14). Stimulant use monitoring was examined twice-weekly using point-of-care urine drug tests (UDTs). HE+Att-CM participants earned incentives for UDT samples independent of results. HE+Abs-CM participants earned incentives for stimulant-negative UDT samples. The primary outcome was the percentage of participants stimulant-negative by week. Missing UDTs were treated as stimulant positive. Outcomes were compared between conditions using repeated measures mixed models for categorical data based on generalized estimating equations using a logistic link function. The percentage of participants stimulant-negative was greater in the HE+Abs-CM condition averaging 22.6% (weekly range, 7.1%-28.6%) compared to 3.2% (weekly range, 0%-7.7%) in the HE+Att-CM condition (p = .014). Findings provide preliminary experimental evidence that CM reduces stimulant use among individuals participating in low-barrier services at a community-based SSP.