Psychosocial therapy adds no treatment benefit when used with medication.
Psychosocial therapy adds no treatment benefit when used with medication.
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Buprenorphine (brand name Suboxone) is a partial agonist that was introduced into the portfolio of treatment options for opioid use disorder 2002. Buprenorphine is used in office-based settings and may allow patients to avoid the stigma associated with opioid maintenance treatment programs and avoid daily attendance.
The provision of psychosocial treatment (or referral) is a mandatory requirement outlined in the Controlled Substances Act for the treatment of opioid dependent patients. Mandatory treatment has the potential to improve pharmacological treatment outcomes, however, at the time of this research, no study had directly compared the effectiveness of multiple behavioral treatment conditions and buprenorphine to a buprenorphine only condition. This study sought to fill this gap.
After a 2-week induction phase, the authors used a randomized control trial to test the effectiveness of four types of behavioral treatment combined with buprenorphine and medication management.
Medication management was delivered twice weekly for 18 weeks. Medication management was limited in counseling (consistent with office-based practice settings), and provided by study physicians who used a checklist to address each component such as reviewing the urinalysis results, medication dosage, and adherence to the dosing schedule.
The primary outcome was opioid-negative urine results.
Secondary outcomes included treatment retention, withdrawal symptoms, craving, other drug use, and adverse events.
The four behavioral treatments included: cognitive behavioral therapy (n=53), contingency management which included drawing a prize worth $1-$4 for each negative urine test (n=49), both cognitive behavior therapy and contingency management (n=49), and no additional behavioral treatment (n=51) for a 16-week duration followed by a medication only phase (n=134), and follow-ups at 40 (n=100) and 52 (n=99) weeks.
This sample consisted of opioid dependent patients recruited from an outpatient clinical research center in Los Angeles, California.
The results from this study were surprising to many. Opioid negative test results did not differ across groups at the behavioral treatment phase (weeks 3-18) or any other subsequent time point including medication only (weeks 19-34), or follow-ups at week 40 and 52. In addition, no group differences were found in other measures of opioid use, other drug use including amphetamines, cannabis, cocaine, sedatives did not differ between groups for any time point.
A number of other outcomes also showed no difference between groups including withdrawal symptoms, cravings, retention, or domains assessed by the Addiction Severity Index. Although Addiction Severity Index domains and outcomes were not further specified, the Addiction Severity Index includes medical, employment/ support, alcohol, drugs, family/social, legal and psychiatric. Last, there was no difference in adverse events (e.g., constipation, insomnia, sweating/hot flashes, etc.) between groups. Of the 253 adverse events reported, 29.2% occurred in the cognitive behavior therapy group, 24.5% in the contingency management, 24.1% in the cognitive behavior therapy plus contingency management, and 22.1% in the no behavioral treatment group.
Although no differences were found in opioid use across treatment groups, all groups reported a significant reduction in heroin use in the last 30 days at the end of the behavioral treatment phase compared to baseline.
Note. There is no statistically significant difference between groups but each group showed a significant reduction in heroin use from baseline to the end of behavioral treatment phase.
The results do not suggest that behavioral interventions are useless to patients, but that it is hard to show any benefits of adding specialized behavioral interventions for patients using Suboxone and a simpler “Medication Management” check-up by a prescriber for opioid use disorder in this treatment setting. In prior research, this type of Medication Management intervention has been shown to be as effective when used alone as when added to specialized addiction counseling and this study provided medication management to all groups which may make it difficult to detect the effect of the specialized behavioral addiction treatment because by itself it appears to be as beneficial.
Medication management (also referred to as medical management) is quite intensive in that it required twice weekly appointments for 18 weeks. Thus, it should be considered a legitimate intervention for opioid use disorder in addition to Suboxone that can make patients feel supported, cared about, and from which patients can receive recommendations, referrals, and advice. From a cost-effectiveness perspective, cognitive behavior therapy plus contingency management may require more resources than medication management alone. So if opioid use outcomes are the same then medication management alone may be the best option from a cost-effectiveness perspective.
Ling, W., Hillhouse, M., Ang, A., Jenkins, J., & Fahey, J. (2013). Comparison of behavioral treatment conditions in buprenorphine maintenance. Addiction, 108, 1788-1798.
l
Buprenorphine (brand name Suboxone) is a partial agonist that was introduced into the portfolio of treatment options for opioid use disorder 2002. Buprenorphine is used in office-based settings and may allow patients to avoid the stigma associated with opioid maintenance treatment programs and avoid daily attendance.
The provision of psychosocial treatment (or referral) is a mandatory requirement outlined in the Controlled Substances Act for the treatment of opioid dependent patients. Mandatory treatment has the potential to improve pharmacological treatment outcomes, however, at the time of this research, no study had directly compared the effectiveness of multiple behavioral treatment conditions and buprenorphine to a buprenorphine only condition. This study sought to fill this gap.
After a 2-week induction phase, the authors used a randomized control trial to test the effectiveness of four types of behavioral treatment combined with buprenorphine and medication management.
Medication management was delivered twice weekly for 18 weeks. Medication management was limited in counseling (consistent with office-based practice settings), and provided by study physicians who used a checklist to address each component such as reviewing the urinalysis results, medication dosage, and adherence to the dosing schedule.
The primary outcome was opioid-negative urine results.
Secondary outcomes included treatment retention, withdrawal symptoms, craving, other drug use, and adverse events.
The four behavioral treatments included: cognitive behavioral therapy (n=53), contingency management which included drawing a prize worth $1-$4 for each negative urine test (n=49), both cognitive behavior therapy and contingency management (n=49), and no additional behavioral treatment (n=51) for a 16-week duration followed by a medication only phase (n=134), and follow-ups at 40 (n=100) and 52 (n=99) weeks.
This sample consisted of opioid dependent patients recruited from an outpatient clinical research center in Los Angeles, California.
The results from this study were surprising to many. Opioid negative test results did not differ across groups at the behavioral treatment phase (weeks 3-18) or any other subsequent time point including medication only (weeks 19-34), or follow-ups at week 40 and 52. In addition, no group differences were found in other measures of opioid use, other drug use including amphetamines, cannabis, cocaine, sedatives did not differ between groups for any time point.
A number of other outcomes also showed no difference between groups including withdrawal symptoms, cravings, retention, or domains assessed by the Addiction Severity Index. Although Addiction Severity Index domains and outcomes were not further specified, the Addiction Severity Index includes medical, employment/ support, alcohol, drugs, family/social, legal and psychiatric. Last, there was no difference in adverse events (e.g., constipation, insomnia, sweating/hot flashes, etc.) between groups. Of the 253 adverse events reported, 29.2% occurred in the cognitive behavior therapy group, 24.5% in the contingency management, 24.1% in the cognitive behavior therapy plus contingency management, and 22.1% in the no behavioral treatment group.
Although no differences were found in opioid use across treatment groups, all groups reported a significant reduction in heroin use in the last 30 days at the end of the behavioral treatment phase compared to baseline.
Note. There is no statistically significant difference between groups but each group showed a significant reduction in heroin use from baseline to the end of behavioral treatment phase.
The results do not suggest that behavioral interventions are useless to patients, but that it is hard to show any benefits of adding specialized behavioral interventions for patients using Suboxone and a simpler “Medication Management” check-up by a prescriber for opioid use disorder in this treatment setting. In prior research, this type of Medication Management intervention has been shown to be as effective when used alone as when added to specialized addiction counseling and this study provided medication management to all groups which may make it difficult to detect the effect of the specialized behavioral addiction treatment because by itself it appears to be as beneficial.
Medication management (also referred to as medical management) is quite intensive in that it required twice weekly appointments for 18 weeks. Thus, it should be considered a legitimate intervention for opioid use disorder in addition to Suboxone that can make patients feel supported, cared about, and from which patients can receive recommendations, referrals, and advice. From a cost-effectiveness perspective, cognitive behavior therapy plus contingency management may require more resources than medication management alone. So if opioid use outcomes are the same then medication management alone may be the best option from a cost-effectiveness perspective.
Ling, W., Hillhouse, M., Ang, A., Jenkins, J., & Fahey, J. (2013). Comparison of behavioral treatment conditions in buprenorphine maintenance. Addiction, 108, 1788-1798.
l
Buprenorphine (brand name Suboxone) is a partial agonist that was introduced into the portfolio of treatment options for opioid use disorder 2002. Buprenorphine is used in office-based settings and may allow patients to avoid the stigma associated with opioid maintenance treatment programs and avoid daily attendance.
The provision of psychosocial treatment (or referral) is a mandatory requirement outlined in the Controlled Substances Act for the treatment of opioid dependent patients. Mandatory treatment has the potential to improve pharmacological treatment outcomes, however, at the time of this research, no study had directly compared the effectiveness of multiple behavioral treatment conditions and buprenorphine to a buprenorphine only condition. This study sought to fill this gap.
After a 2-week induction phase, the authors used a randomized control trial to test the effectiveness of four types of behavioral treatment combined with buprenorphine and medication management.
Medication management was delivered twice weekly for 18 weeks. Medication management was limited in counseling (consistent with office-based practice settings), and provided by study physicians who used a checklist to address each component such as reviewing the urinalysis results, medication dosage, and adherence to the dosing schedule.
The primary outcome was opioid-negative urine results.
Secondary outcomes included treatment retention, withdrawal symptoms, craving, other drug use, and adverse events.
The four behavioral treatments included: cognitive behavioral therapy (n=53), contingency management which included drawing a prize worth $1-$4 for each negative urine test (n=49), both cognitive behavior therapy and contingency management (n=49), and no additional behavioral treatment (n=51) for a 16-week duration followed by a medication only phase (n=134), and follow-ups at 40 (n=100) and 52 (n=99) weeks.
This sample consisted of opioid dependent patients recruited from an outpatient clinical research center in Los Angeles, California.
The results from this study were surprising to many. Opioid negative test results did not differ across groups at the behavioral treatment phase (weeks 3-18) or any other subsequent time point including medication only (weeks 19-34), or follow-ups at week 40 and 52. In addition, no group differences were found in other measures of opioid use, other drug use including amphetamines, cannabis, cocaine, sedatives did not differ between groups for any time point.
A number of other outcomes also showed no difference between groups including withdrawal symptoms, cravings, retention, or domains assessed by the Addiction Severity Index. Although Addiction Severity Index domains and outcomes were not further specified, the Addiction Severity Index includes medical, employment/ support, alcohol, drugs, family/social, legal and psychiatric. Last, there was no difference in adverse events (e.g., constipation, insomnia, sweating/hot flashes, etc.) between groups. Of the 253 adverse events reported, 29.2% occurred in the cognitive behavior therapy group, 24.5% in the contingency management, 24.1% in the cognitive behavior therapy plus contingency management, and 22.1% in the no behavioral treatment group.
Although no differences were found in opioid use across treatment groups, all groups reported a significant reduction in heroin use in the last 30 days at the end of the behavioral treatment phase compared to baseline.
Note. There is no statistically significant difference between groups but each group showed a significant reduction in heroin use from baseline to the end of behavioral treatment phase.
The results do not suggest that behavioral interventions are useless to patients, but that it is hard to show any benefits of adding specialized behavioral interventions for patients using Suboxone and a simpler “Medication Management” check-up by a prescriber for opioid use disorder in this treatment setting. In prior research, this type of Medication Management intervention has been shown to be as effective when used alone as when added to specialized addiction counseling and this study provided medication management to all groups which may make it difficult to detect the effect of the specialized behavioral addiction treatment because by itself it appears to be as beneficial.
Medication management (also referred to as medical management) is quite intensive in that it required twice weekly appointments for 18 weeks. Thus, it should be considered a legitimate intervention for opioid use disorder in addition to Suboxone that can make patients feel supported, cared about, and from which patients can receive recommendations, referrals, and advice. From a cost-effectiveness perspective, cognitive behavior therapy plus contingency management may require more resources than medication management alone. So if opioid use outcomes are the same then medication management alone may be the best option from a cost-effectiveness perspective.
Ling, W., Hillhouse, M., Ang, A., Jenkins, J., & Fahey, J. (2013). Comparison of behavioral treatment conditions in buprenorphine maintenance. Addiction, 108, 1788-1798.
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