U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Cover of Retention Strategies for Medications for Addiction Treatment in Adults With Opioid Use Disorder: A Rapid Evidence Review

Retention Strategies for Medications for Addiction Treatment in Adults With Opioid Use Disorder: A Rapid Evidence Review

Rapid Evidence Product

Investigators: , M.D., M.P.H., , Ph.D., , M.D., M.B.A., , M.D., M.P.H., , M.Sc., , M.S., , B.A., , M.A., , B.S., , M.L.I.S., , M.D., M.P.H., and , M.D., M.P.H.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 20-EHC012

Structured Abstract


American deaths from opioid overdose now approach 50,000 annually. While evidence shows that medications for addiction treatment (MAT) save lives, retaining patients in MAT programs is challenging. The U.S. Agency for Healthcare Research and Quality, on behalf of the U.S. Department of Health and Human Services, commissioned a rapid evidence review on the effectiveness of interventions to promote a broader understanding of the published literature on MAT retention among adults with opioid use disorder (OUD).


We searched MEDLINE and the Cochrane Library from February 12, 2009, through August 20, 2019, for systematic reviews (SRs) and randomized controlled trials (RCTs). We summarized evidence for six retention intervention types: care settings/services/logistical support, contingency management, health information technology (IT), extended-release (XR) medication-based treatment, psychosocial support, and financial support. Our primary outcome was retention, defined as continued medication engagement for at least 3 months after MAT initiation. Secondary outcomes included mortality and harms.


Key findings from 2 SRs and 39 primary studies include:

  • Most studies of MAT for OUD do not focus on retention as the primary outcome, are small (e.g., one to two trials per intervention), and have design flaws.
  • Care setting interventions that initiated MAT in soon-to-be-released incarcerated patients improved retention following release.
  • Contingency management improved retention when combined with antagonist MAT, but not with agonist forms of MAT. Applicability, however, may be limited due to implementation challenges.
  • Preliminary trials suggest that retention in MAT supported with health IT approaches may be no worse than in-person approaches.
  • Early studies suggest no difference in retention with XR–buprenorphine in either injectable or implant formulations compared with daily buprenorphine. There were conflicting results with XR-naltrexone injection compared with daily buprenorphine.
  • The addition of psychosocial interventions did not improve retention; however, many studies included some form of counseling in the control groups, potentially obscuring evidence of effectiveness.

Harms were infrequently reported across studies except in studies of XR formulations. Similarly, few studies reported whether participant characteristics influenced retention.


While patients who receive longer-term treatment with MAT have improved outcomes, fewer than half of the identified studies measured treatment retention as a primary outcome. Limited evidence suggests criminal justice prerelease MAT initiation and the use of contingency management for patients on antagonist forms of MAT may aid retention. XR and daily buprenorphine formulations appear to be equivalent for treatment retention and comparisons of XR–naltrexone versus daily buprenorphine showed conflicting results. Integrating MAT treatment with medical and social services and the use of health IT did not change retention. Some studies were conducted outside of the United States, where policies and practices differ, focused on highly selected populations and/or conditions that are not fully representative of the spectrum of OUD, or were studied in situations that may not be easily implemented in real-world conditions. There is a critical need for studies that use standardized definitions of retention, include measures of harms as well as benefits, and reflect the full spectrum of real-life conditions.


Errata August 2020

In the original version of this report, there was an omission with respect to the search strategy. Specifically, following the reported primary search conducted on June16, 2019, that included studies published between February 12, 2009, and June 16, 2019, we conducted a “gap search” on August 20, 2019, which was not reported in the original version of the report. No additional included studies were identified from this gap search. We have updated the search strategies portion of the Methods sections of the abstract, evidence summary, and main report to reflect the gap search and updated the Results section of the main report to indicate that no new included studies were identified.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857; www.ahrq.gov Contract No HHSA 290-2017-00003C Prepared by: Scientific Resource Center, Portland, OR

Suggested citation:

Chan B, Gean E, Arkhipova-Jenkins I, Gilbert J, Hilgart J, Fiordalisi C, Hubbard K, Brandt I, Stoeger E, Paynter R, Korthuis PT, Guise J–M. Retention Strategies for Medications for Addiction Treatment in Adults With Opioid Use Disorder: A Rapid Evidence Review. (Prepared by the Scientific Resource Center under Contract No. HHSA 290-2017-00003C). AHRQ Publication No. 20–EHC012. Rockville, MD: Agency for Healthcare Research and Quality. July 2020. Errata August 2020. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCRAPIDMAT.

This report is based on research conducted by the Scientific Resource Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290–2017-00003-C). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help health care decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

Last Update: August 20, 2020.

Bookshelf ID: NBK560315PMID: 32775956


Other titles in this collection

Related information

Similar articles in PubMed

See reviews...See all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...