Care Navigation for Methamphetamine Use Disorder: A Randomized Clinical Trial.

TL;DR

A randomized trial of dedicated care navigation incorporating contingency management for methamphetamine use disorder did not significantly increase linkage to treatment at 30 or 90 days, despite higher engagement with navigator services in the intervention group.

Key findings

• Care navigation plus contingency management principles did not improve treatment linkage compared to control (33.3% vs 25.0% at 90 days; RR 1.33, 95% CI 0.85-2.09)
• Participants in the intervention arm showed higher engagement with navigator services (62.5% completed ≥2 sessions) but this did not translate to increased treatment access
• The cohort was predominantly unstably housed (84.9%), unemployed (82.3%), and lacked regular phone access (49%), representing a high-barrier population
• Completion of study follow-up visits was higher in the intervention arm at both 30 days (46.9% vs 46.3%) and 90 days (49.0% vs 38.5%), though treatment linkage rates remained suboptimal

Why this matters at the bedside

This trial addresses a critical gap in methamphetamine use disorder treatment implementation. While care navigation increased patient engagement, the lack of improvement in treatment linkage suggests that addressing upstream barriers to care—such as housing instability and employment—may require additional interventions beyond navigation alone. The findings highlight the implementation challenges of delivering evidence-based contingency management to vulnerable populations with multiple social determinants of health barriers.