Jessica J Wyse1, Benjamin J Morasco2, Jacob Dougherty3, Beau Edwards4, Devan Kansagara5, Adam J Gordon6, P Todd Korthuis7, Anaïs Tuepker8, Stephan Lindner9, Katherine Mackey10, Beth Williams11, Anders Herreid-O'Neill12, Robin Paynter13, Travis I Lovejoy14. 1. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States; School of Public Health, Oregon Health & Science University, 840 SW Gaines St, Portland, OR 97239, United States. Electronic address: Jessica.wyse@va.gov. 2. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States. Electronic address: Benjamin.morasco@va.gov. 3. Chicago College of Osteopathic Medicine, Midwestern University, 555 31st Street, Downers Grove, IL 60515, United States. Electronic address: jacob.dougherty@midwestern.edu. 4. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States. Electronic address: Beau.Edwards@va.gov. 5. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States; Department of General Internal Medicine & Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States. Electronic address: Devan.kansagara@va.gov. 6. Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, United States; Division of Epidemiology & Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, United States. Electronic address: Adam.gordon@va.gov. 7. Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States. Electronic address: korthuis@ohsu.edu. 8. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States; Department of General Internal Medicine & Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States. Electronic address: Anais.tuepker@va.gov. 9. School of Public Health, Oregon Health & Science University, 840 SW Gaines St, Portland, OR 97239, United States; Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Center for Health Systems Effectiveness, Oregon Health & Science University, 3030 SW Moody Ave., Portland, OR 97201, United States. Electronic address: lindners@ohsu.edu. 10. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States. Electronic address: Katherine.mackey@va.gov. 11. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States. Electronic address: Beth.williams2@va.gov. 12. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States. Electronic address: Anders.herreid-oneill@va.gov. 13. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States. Electronic address: Robin.paynter@va.gov. 14. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States. Electronic address: Travis.lovejoy@va.gov.
Abstract
BACKGROUND: A growing body of research has examined adjunctive interventions supportive of engagement and retention in treatment among patients receiving buprenorphine for opioid use disorder (OUD). We conducted a systematic review of the literature addressing the effect on key outcomes of adjunctive interventions provided alongside standard medical management of buprenorphine in outpatient settings. METHODS: We included prospective studies examining adults receiving buprenorphine paired with an adjunctive intervention for the treatment of OUD in an outpatient setting. Data sources included Medline, Cochrane Central Register of Controlled Trials, CINAHL and PsycINFO from inception through January 2020. Two raters independently reviewed full-text articles, abstracted data and appraised risk of bias. Outcomes examined included abstinence, retention in treatment and non-addiction-related health outcomes. RESULTS: The final review includes 20 manuscripts, 11 randomized control trials (RCTs), three secondary analyses of RCTs and six observational studies. Most studies examined psychosocial interventions (n = 14). Few examined complementary therapies (e.g., yoga; n = 2) or technological interventions (e.g., electronic pill dispensation; n = 3); one study examined an intervention addressing structural barriers to care (patient navigators; n = 1). Low risk of bias RCTs found no evidence that adding psychosocial interventions to buprenorphine treatment improves substance use outcomes. CONCLUSIONS: Research is needed to identify adjunctive interventions with potential to support medication adherence and addiction-related outcomes for patients engaged in buprenorphine treatment. Data from clinical trials suggest that lack of ready access to psychosocial treatments should not discourage clinicians from prescribing buprenorphine.
BACKGROUND: A growing body of research has examined adjunctive interventions supportive of engagement and retention in treatment among patients receiving buprenorphine for opioid use disorder (OUD). We conducted a systematic review of the literature addressing the effect on key outcomes of adjunctive interventions provided alongside standard medical management of buprenorphine in outpatient settings. METHODS: We included prospective studies examining adults receiving buprenorphine paired with an adjunctive intervention for the treatment of OUD in an outpatient setting. Data sources included Medline, Cochrane Central Register of Controlled Trials, CINAHL and PsycINFO from inception through January 2020. Two raters independently reviewed full-text articles, abstracted data and appraised risk of bias. Outcomes examined included abstinence, retention in treatment and non-addiction-related health outcomes. RESULTS: The final review includes 20 manuscripts, 11 randomized control trials (RCTs), three secondary analyses of RCTs and six observational studies. Most studies examined psychosocial interventions (n = 14). Few examined complementary therapies (e.g., yoga; n = 2) or technological interventions (e.g., electronic pill dispensation; n = 3); one study examined an intervention addressing structural barriers to care (patient navigators; n = 1). Low risk of bias RCTs found no evidence that adding psychosocial interventions to buprenorphine treatment improves substance use outcomes. CONCLUSIONS: Research is needed to identify adjunctive interventions with potential to support medication adherence and addiction-related outcomes for patients engaged in buprenorphine treatment. Data from clinical trials suggest that lack of ready access to psychosocial treatments should not discourage clinicians from prescribing buprenorphine.
Authors: Michael D Stein; Debra S Herman; Ethan Moitra; Jacki Hecht; Rosalie Lopez; Bradley J Anderson; Richard A Brown Journal: Drug Alcohol Depend Date: 2014-11-26 Impact factor: 4.492
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Authors: David A Fiellin; Declan T Barry; Lynn E Sullivan; Christopher J Cutter; Brent A Moore; Patrick G O'Connor; Richard S Schottenfeld Journal: Am J Med Date: 2013-01 Impact factor: 4.965
Authors: Roger D Weiss; Margaret L Griffin; Jennifer Sharpe Potter; Dorian R Dodd; Jessica A Dreifuss; Hilary S Connery; Kathleen M Carroll Journal: Drug Alcohol Depend Date: 2014-04-24 Impact factor: 4.492