Adding Enhanced Counseling to Standard Medical Management Does Not Improve Outcomes for HIV-Positive Individuals with Opioid Dependence Who are Prescribed Buprenorphine
The provision of buprenorphine with medical management in an office-based setting has been shown to be an effective treatment for opioid dependence. The addition of further counseling, however, has not been shown to improve outcomes. For HIV-positive individuals, providing buprenorphine treatment may improve their care, but the impact of further counseling has not been studied in this population. The 47 HIV-positive opioid-dependent subjects in this 12-week study were all prescribed buprenorphine and received standard bi-weekly physician visits; 22 were randomly assigned to receive additional enhanced counseling (drug counseling and medication adherence management), delivered by a trained nurse.
- There was no significant difference in the percentage of opioid-negative urine drug tests between the standard and enhanced treatment arms (64% versus 69%, respectively).
- There was no significant difference in the mean number of continuous weeks of opioid abstinence (4.9 weeks for standard treatment versus 5.2 weeks for enhanced).
- There was likewise no significant difference in the following secondary endpoints:
- percent cocaine-negative urine-drug tests
- study completion rate
- buprenorphine adherence
- antiretroviral adherence
- HIV clinical outcomes
Comments:
This study supports the findings of previous studies and extends them to individuals with opioid dependence who are HIV-positive. The results of these studies have been remarkably consistent and indicate that for patients who are prescribed buprenorphine, routinely adding counseling beyond that which is delivered by physicians in 15-minute visits does not offer additional benefit. It is worth noting that this study was small and somewhat underpowered and could not exclude a modest benefit; moreover, there may always be select individuals who benefit from additional counseling.
Darius A. Rastegar, MD
Reference:
Tetrault JM, Moore BA, Barry DT, et al. Brief versus extended counseling along with buprenorphine/naloxone for HIV-infected opioid dependent patients. J Subst Abuse Treat. 2012;43(4):433–439.