Counseling Adds No Detected Benefit to Patients Receiving Buprenorphine Treatment and Medical Management for Opioid Dependence

The Drug Abuse Treatment Act of 2000 requires that physicians prescribing buprenorphine in the US be able to refer patients for ancillary counseling, but several studies have been unable to detect benefit from psychosocial treatments in addition to buprenorphine and medical management. This study randomized 202 outpatients with opioid dependence receiving buprenorphine and medical management to 16 weeks of treatment within one of four groups: 1) cognitive behavioral therapy (CBT); 2) contingency management (CM); 3) both CBT and CM; or 4) buprenorphine treatment and medical management alone (control).

• There was no difference across groups during the 16-week active treatment phase or over the 52-week follow-up in the percentage of participants with opioid-negative urine test results; 71% of the buprenorphine and medical management control group had three or more consecutive opioid-negative urine test results compared with 66% of the CBT group, 74% of the CM group, and 76% of those who received both CBT and CM.
• There were no differences between the groups’ treatment retention rates, withdrawal symptoms, craving, other drug use, or adverse events.

Comments:

This study confirms a recent meta-analysis (Amato et al., 2011), which found that psychosocial counseling delivers no detected benefit when combined with agonist maintenance treatment and medical management for people with opioid dependence. The possibility remains that counseling may prove to be beneficial to select subgroups or in maintaining long-term recovery after the first year; however, a provider’s inability to arrange for additional behavioral counseling should not be a barrier to the provision of effective agonist treatment.

Peter D. Friedmann, MD, MPH

Reference:

Ling W, Hillhouse M, Ang A, et al. Comparison of behavioral treatment conditions in buprenorphine maintenance. Addiction. 2013:108(10);1788–1798.

Amato L, Minozzi S, Davoli M, Vecchi S. Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database Syst Rev. 2011;(10):CD004147.