JMIR Publications

ABSTRACT

Background:

Contingency management is an evidence-based yet underutilized approach for opioid use disorder (OUD). The reasons for limited adoption in real-world practice include ethical, moral, and philosophical concerns regarding use of monetary incentives, and lack of technological innovation. In light of surging opioid overdose deaths, there is a need for development of technology-enabled solutions leveraging the power of contingency management in a way that is viewed by both patients and providers as acceptable and feasible.

Objective:

This mixed methods study sought to determine the perceived acceptability and usability of PROCare, a reward-based, technology-enabled recovery monitoring smartphone app designed to automate contingency management by immediately delivering micro payments to patients for achieving recovery goals via smart debit card with blocking capabilities.

Methods:

Participants included patients (n = 10) receiving buprenorphine for OUD and licensed prescribers (n = 5). Qualitative interviews were conducted by two PhD-level researchers via video conferencing to explore a priori hypotheses. Thematic analysis of interviews was conducted and synthesized into major themes.

Results:

Participants were overwhelmingly in favor of micro rewards (e.g., $1) to incentivize treatment participation (up to $150 monthly). Participants reported high acceptability of the planned debit card spending restrictions (blocking cash withdrawals and purchases at bars/liquor stores, casinos/online gambling). Quantitative data revealed a high level of perceived usability of PROCare.

Conclusions:

Patients and providers alike appear receptive to micro financial incentives in standard OUD treatment practices. Further pilot testing of PROCare is underway to determine acceptability, feasibility, and preliminary effectiveness in a rigorous randomized controlled trial.