Text Message Reminders About Free Transportation for Outpatient Substance Use Disorder Treatment: A Pilot Randomized Encouragement Study

TL;DR

This study tested if text message reminders about free transportation help people with substance use disorders stay in treatment, but found mixed results.

Contribution

The study is the first to test text message reminders for free transportation as a strategy to improve retention in outpatient SUD treatment.

Findings

Text message reminders did not significantly improve overall 12-week or 24-week retention in care.

Among patients receiving SUD medications, the intervention showed greater 12-week retention but not at 24 weeks.

No significant differences were found by SUD type at any time point.

Abstract

Substance use disorders (SUDs) are a major epidemic in the USA. Patients who lack transportation may have limited access to outpatient SUD treatment programs and are less likely to remain in care. Encouraging the use of free, reliable transportation during enrollment is an untested mechanism for greater retention.

A pragmatic pilot study was conducted in Southwest Ohio between November 2020 and July 2022, among people with SUDs like opioid and alcohol use disorders who enrolled in an outpatient treatment program and screened positive for transportation barriers. Eligible patients were offered free, unlimited transportation for the first 12 weeks of treatment and randomized 1:1 to receive weekly text message reminders to schedule their ride (intervention) versus none (control). The primary outcome was retention in care at 12 weeks. Secondary outcomes included retention at 24 weeks and retention at weeks 12 and 24 when stratifying by those dispensed SUD medications (e.g., buprenorphine/naloxone, buprenorphine, methadone) at the treatment site versus not, and SUD type.

The intervention arm included 171 patients and 190 patients were in the control arm. For retention in care at 12 weeks, there was not a statistically significant difference between intervention (77/171 = 45.0%) and control (81/190 = 42.6%) arms (odds ratio (OR) 1.10; 95% confidence interval (CI) 0.57 to 2.00, p=0.69). At 24 weeks, retention was lower for both the intervention (44/171 = 25.7%) and control (54/190 = 28.4%) arms but not statistically significantly different (p=0.54). Greater retention at 12 weeks was observed for the intervention versus the control arm among patients dispensed SUD medications but at week 24 there was no statistically significant difference. No differences were observed by SUD types at any time point.

Weekly reminders did not affect overall care retention but did at week 12 among patients dispensed SUD medications.

The online version contains supplementary material available at 10.1007/s11606-025-09508-4.