Testing the Efficacy of an Adaptive Approach to Delivering Psychosocial Interventions in Office-based Buprenorphine...

Clinical guidelines recommend providing adjunctive psychosocial interventions with medications for opioid use disorder (MOUD); however, limited evidence exists regarding when and how to provide them. This 2-group unblinded randomized controlled trial evaluated the efficacy of an adaptive approach to providing cognitive behavioral therapy and peer support for individuals receiving office-based buprenorphine treatment.

Between September 2020 and May 2023, 125 patients who recently initiated office-based buprenorphine treatment at 2 federally qualified health centers in the Mid-Atlantic region and provided informed consent were randomly assigned (1:1) to treatment as usual (TAU; n = 63) or TAU plus adjunctive psychosocial treatment delivered using an adaptive algorithm informed by baseline characteristics, engagement, and responsiveness (TAU+Adaptive; n = 62). Assessments occurred at baseline and 3- and 6-month follow-ups. Primary outcomes were treatment retention and opioid use.

No significant between-group differences were observed. Across conditions, about 30% tested positive for opioids at follow-up, and 40% remained in MOUD treatment at 6 months. Exploratory post hoc analyses indicated greater retention among participants prescribed a 24 mg baseline buprenorphine dose (46%) compared with those on 16 (24%) or 8 mg (26%). No serious study-related adverse events were reported.

Although the efficacy of the adaptive approach was not supported, high rates of treatment discontinuation and polysubstance use highlight the need for additional support for some patients. Findings also suggest that dosing strategies may need to be tailored to the increasing potency of the illicit opioid supply.