A systematic review of psychosocial interventions to increase adherence to medications for opioid use disorder

Medications for opioid use disorder (MOUD) are considered the standard of care for treating opioid use disorder (OUD), but their overall public health impact is limited by poor retention and adherence. Previous reviews synthesizing findings from randomized controlled trials suggest that psychosocial interventions can be impactful on enhancing MOUD outcomes, particularly contingency management (CM) approaches. However, most reviews have focused on MOUD treatment retention rather than MOUD adherence, which is a related but separate construct as being considered in treatment does not necessarily mean taking medication. Therefore, the purpose of this study was to provide an update on the evidence for psychosocial interventions supporting MOUD adherence.

The authors pre-registered this systematic review with PROPSERO (CRD 420251048684) and queried Ovid Medline, PsycINFO, and Web of Science for articles published before August 1, 2025. Authors included studies that used a randomized controlled trial design, tested a psychosocial intervention, and reported an MOUD adherence outcome were included in the review. At least two authors reviewed studies to determine inclusion and assess risk of bias.

Abstracts from 809 studies were reviewed and 23 studies published between 1999 and 2025 met inclusion criteria. Studies were grouped according to theme of the psychosocial interventions: CM (eight studies); manualized education, medical management, or cognitive behavioral interventions (seven studies); patient navigation or outreach intervention (six studies); family-based intervention (four studies); technology-based interventions (three studies); and housing first intervention (one study). CM, family involvement, and assertive outreach interventions demonstrated the strongest support for enhancing MOUD adherence.

There are effective strategies to enhance MOUD adherence that treatment providers and programs should consider adopting into usual practice. However, only 23 studies were identified, very few had MOUD adherence as a primary outcome, and studies varied in how adherence was measured and in what MOUD was studied, making it difficult to provide an overall recommendation to the field. Given the importance of MOUD adherence, future research should establish standardized metrics for MOUD adherence and develop and test interventions specifically aimed at increasing MOUD adherence to maximize its impact.