Adjunctive Interventions Do Not Improve Treatment Retention or Health Outcomes Among People With Opioid Use Disorder Receiving Buprenorphine

Buprenorphine is a very effective treatment for opioid use disorder (OUD). Advantages of this medication over other medications for OUD include ease of initiation and the ability to offer it in a variety of settings. While many treatment programs require participation in adjunctive (e.g., psychosocial) treatment in order to receive buprenorphine, the value of these interventions has not been established. Researchers conducted a systematic review of studies of adjunctive interventions plus buprenorphine for OUD.

• The review included 18 studies: 11 randomized controlled trials (RCTs), 3 secondary analyses of the results of RCTs, 2 observational studies with a comparator arm, and 4 observational studies without a comparator. Most focused on abstinence from opioids or treatment retention.
• Analysis of 6 RCTs with low risk of bias showed that the addition of psychosocial interventions to buprenorphine did not improve any addiction-related outcomes, including abstinence and retention. Interventions included cognitive behavioral treatment and contingency management.
• Five studies examined other health outcomes and likewise failed to demonstrate a benefit.
• The authors identified 26 active clinical trials that are testing adjunctive interventions paired with buprenorphine in outpatient settings.

Comments: The search continues for adjunctive interventions that improve treatment retention and health outcomes for individuals with OUD receiving buprenorphine. In the meantime, we should not require individuals to participate in unproven interventions in order to receive a life-saving medication.

Darius A. Rastegar, MD

Reference: Wyse JJ, Morasco BJ, Dougherty J, et al. Adjunct interventions to standard medical management of buprenorphine in outpatient settings: a systematic review of the evidence. Drug Alcohol Depend. 2021;228:108923. doi:10.1016/j.drugalcdep.2021.108923.