A systematic review of psychosocial interventions to increase adherence to medications for opioid use disorder.
Kevin Wenzel, Eliza Schmidt, Carolyn Clinton et al.
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In 30 seconds
This systematic review assessed randomized controlled trials of psychosocial interventions reporting medication adherence among people receiving medications for opioid use disorder (MOUD). Searches identified 23 eligible studies published between 1999 and 2025, from 809 abstracts reviewed. Interventions included contingency management, education or cognitive behavioral approaches, outreach, family-based support, technology, and Housing First. The strongest support for improving MOUD adherence was reported for contingency management, family involvement, and assertive outreach. The evidence was difficult to synthesize into an overall recommendation because adherence measures and the MOUD studied varied, and few trials treated adherence as a primary outcome.
Key findings
- Of 809 abstracts reviewed, 23 randomized controlled trials met inclusion criteria.
- The review found the strongest support for adherence benefits with contingency management, family involvement, and assertive outreach.
- Only a few included studies had MOUD adherence as a primary outcome, and adherence measurement varied across studies.
Why it matters
MOUD adherence is distinct from remaining in treatment, so retention alone may not indicate whether medication is being taken. This review identifies psychosocial approaches with promising support while highlighting that the evidence base is limited and inconsistent. Standardized adherence measures and trials designed specifically around adherence could help clarify which interventions are effective and for whom.
What to keep in mind
Only 23 studies were identified; few made adherence a primary outcome, and studies varied in adherence measures and the MOUD examined, limiting an overall recommendation.