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Chan B, Gean E, Arkhipova-Jenkins I, et al. Retention Strategies for Medications for Addiction Treatment in Adults With Opioid Use Disorder: A Rapid Evidence Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Jul.

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 [Internet].

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Evidence Summary

Main Points

  • Most studies of medications for addiction treatment (MAT) for opioid-use disorder (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 (CM) improved retention when combined with antagonist, 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 information technology (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.

Background and Purpose

To help inform policy across the Department of Health and Human Services, we conducted a rapid evidence review on the effectiveness of interventions to improve MAT retention among OUD patients to inform a broader understanding of the published literature. While evidence indicates that MAT programs are effective and save lives, retention rates are low. The review focused on nonpregnant adults with OUD.


This review followed recommendations from the World Health Organization handbook2 rapid review methodology and abridged systematic review (SR) processes. Our searches covered publication dates from February 12, 2009 to August 20, 2019. We describe our methods in detail in the full report. The protocol can be found at: [https://effectivehealthcare.ahrq.gov/topics/mat-retention-strategies-oud/rapid-protocol].


Our search retrieved 1,580 unique titles and abstracts from which we reviewed 258 full–text articles and included 2 SRs and 39 unique primary studies. A partial summary of findings includes the following.

Table A. Summary of findings by intervention type.

Table A

Summary of findings by intervention type.


We were not able to address every intervention proposed to improve retention in MAT. We did not review studies of potentially promising interventions that used non-MAT comparator groups. Measures of retention varied amongst studies, making comparisons difficult.

Implications and Conclusions

According to the National Academy of Medicine, patients who receive longer-term treatment with medication for OUD have better outcomes and are less likely to die from overdose; however, fewer than half of the studies identified in this report focused on treatment retention as a primary outcome. Initiating MAT in soon-to-be-released criminal justice populations and the use of CM for people on antagonist MAT may improve retention, although there may be challenges to implementing CM interventions in real-world contexts. MAT treatment programs that include the use of health IT may be equally as effective as those delivered using traditional, exclusively in-person approaches. Studies of XR versus daily buprenorphine formulations showed similar treatment retention, and, while comparisons between XR-naltrexone injection and daily buprenorphine yielded inconclusive findings, additional comparative effectiveness trials are underway. Future research should focus on treatment retention as a primary outcome, use standardized measures of retention, report treatment harms as well as benefits, and consider the effects of participant characteristics on the effectiveness of strategies to improve retention in MAT.


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