A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine

Abstract

Objective: To determine the impact of cognitive behavioral therapy on outcomes in primary care, office-based buprenorphine/naloxone treatment of opioid dependence.

Methods: We conducted a 24-week randomized clinical trial in 141 opioid-dependent patients in a primary care clinic. Patients were randomized to physician management or physician management plus cognitive behavioral therapy. Physician management was brief, manual guided, and medically focused; cognitive behavioral therapy was manual guided and provided for the first 12 weeks of treatment. The primary outcome measures were self-reported frequency of illicit opioid use and the maximum number of consecutive weeks of abstinence from illicit opioids, as documented by urine toxicology and self-report.

Results: The 2 treatments had similar effectiveness with respect to reduction in the mean self-reported frequency of opioid use, from 5.3 days per week (95% confidence interval, 5.1-5.5) at baseline to 0.4 (95% confidence interval, 0.1-0.6) for the second half of maintenance (P<.001 for the comparisons of induction and maintenance with baseline), with no differences between the 2 groups (P=.96) or between the treatments over time (P=.44). For the maximum consecutive weeks of opioid abstinence there was a significant main effect of time (P<.001), but the interaction (P=.11) and main effect of group (P=.84) were not significant. No differences were observed on the basis of treatment assignment with respect to cocaine use or study completion.

Conclusions: Among patients receiving buprenorphine/naloxone in primary care for opioid dependence, the effectiveness of physician management did not differ significantly from that of physician management plus cognitive behavioral therapy.

Trial registration: ClinicalTrials.gov NCT00632151.

Conflict of interest statement

Conflict of Interest: Dr Fiellin has received honoraria from ParagonRx and Pinney Associates for serving on external advisory boards monitoring the abuse and diversion of buprenorphine.

Copyright © 2013 Elsevier Inc. All rights reserved.

Figures

Figure 1

Enrollment, treatment, and follow-up.

Figure 2

Opioid abstinence by urine toxicology analysis by treatment and time.

Figure 3

Study completion among opioid-dependent patients receiving buprenorphine/naloxone in primary care. Study completion was defined as not meeting the criteria for protective transfer, not missing medication for more than 7 days, or not missing 3 or more physician management sessions.