(156) Designing a Contingency Management App to Support Opioid Agonist Therapy

Background & Introduction: Unregulated drug toxicity is the leading cause of death for individuals between the ages of 10 and 59 (1) in British Columbia, Canada, the majority of which is attributed to fentanyl overdoses. The primary treatment for patients struggling with opioid use disorder (OUD) is opioid agonist therapies (OAT), a class of longer-lasting prescription opioids with an established evidence base of efficacy and safety (2). When taken according to the prescribed regimen, OAT can provide relief from painful withdrawal and cravings while preventing the risk of overdose. While OAT has shown success in stabilizing patients, long-term adherence to these protocols is challenging, and poor compliance can increase the occurrence of relapse and potential overdose (3). To keep patients motivated and enhance OAT compliance, we propose a novel smartphone app integrating contingency management (CM), remote video validation of medication administration, and gamification. This app utilizes engaging algorithms derived from popular video games and social media apps to create meaningful habits in patients and provide an extra incentive to adhere to their regimens for as long as possible. We aimed to explore the perspectives of end users to receive early feedback and inform future development.

Methods: A qualitative design approach was used to inform the development of a CM smartphone application for individuals receiving OAT. The study used semi-structured individual interviews. Participants included patients prescribed OAT (n = 5) and healthcare providers involved in OUD treatment (n = 5 interviews). Discussions explored usability, motivation, reinforcement strategies, trust, privacy, and clinical workflow integration. All sessions were conducted virtually, audio-recorded, and transcribed verbatim. Data was analyzed using an inductive thematic analysis approach. Patient and provider transcripts were initially coded separately and then synthesized to identify shared and divergent themes. Findings were translated into practical design requirements to guide iterative app development. This analysis extends prior work by incorporating a refined thematic synthesis and explicit linkage between qualitative findings and design implications.

Results: The analysis identified five themes shared across both patient and provider interviews. First, usability and simplicity were consistently identified as essential, with participants strongly preferring clear interfaces, minimal steps, and one-tap actions, while expressing frustration with overly complex health apps. Second, motivation and reinforcement were viewed as valuable, with broad support for CM-based rewards, streaks, and progress indicators. However, participants cautioned against overreliance on financial incentives and emphasized the importance of balancing extrinsic rewards with intrinsic motivators such as accountability and progress tracking. Third, trust and privacy concerns were prominent, particularly regarding data storage, artificial intelligence–based verification, and transparency around data use. Fourth, cultural sensitivity and stigma were central considerations, with patients reporting discomfort with features perceived as surveillance and preferring framing that emphasized self-accountability. Fifth, equity and access issues were highlighted, including variability in digital literacy, device access, and comfort with technology. Providers additionally emphasized minimizing added administrative burden and ensuring integration with existing clinical workflows. Collectively, findings support the feasibility of a mobile CM intervention while underscoring the need for flexible, ethical, and patient-centred implementation.

Conclusion & Discussion: This qualitative study highlights the promise of delivering CM via a smartphone app to support OAT adherence. While patients and providers view digital CM as feasible and potentially beneficial, successful implementation depends on thoughtful design that prioritizes usability, autonomy, privacy, and cultural sensitivity. Findings highlight the importance of flexible engagement options, transparent data practices, and stigma-sensitive framing to support adoption. Integrating patient and provider perspectives early in development allows digital interventions to align with real-world clinical workflows and lived experience. Limitations include the qualitative design and modest sample size. Overall, these findings support further pilot testing of CM-based mobile health tools and underscore the importance of ethical, patient-centred design in addiction care. Future research will evaluate the usability, engagement, and clinical utility of the refined app in a pilot randomized study.

References: 1. Government of British Columbia. More than 2,500 lives lost to toxic drugs in 2023. News release. January 24, 2024. https://news.gov.bc.ca/releases/2024PSSG0001-000069

2. Centre for Addiction and Mental Health. Opioid agonist therapy: Information for clients. Toronto, ON: Centre for Addiction and Mental Health; 2016. https://www.camh.ca/-/media/files/oat-info-for-clients.pdf

3. Public Health Agency of Canada. Opioid agonist therapy. In: Potential drivers of the recent decline in opioid-related deaths. Ottawa, ON: Government of Canada; 2025. https://health-infobase.canada.ca/src/doc/substances/harms/decline-opioid-related-deaths/7.%20Opioid%20agonist%20therapy_EN.pdf