A Randomized Trial of Cognitive Behavioral Therapy in Primary Care-based Buprenorphine

OBJECTIVE: To determine the impact of cognitive behavioral therapy on outcomes in primary care, office-based buprenorphine/naloxone treatment of opioid dependence. METHODS: We conducted a 24-week randomized clinical trial in 141 opioid-dependent patients in a primary care clinic. Patients were randomized to physician management or physician management plus cognitive behavioral therapy. Physician management was brief, manual guided, and medically focused; cognitive behavioral therapy was manual guided and provided for the first 12 weeks of treatment. The primary outcome measures were self-reported frequency of illicit opioid use and the maximum number of consecutive weeks of abstinence from illicit opioids, as documented by urine toxicology and self-report. RESULTS: The 2 treatments had similar effectiveness with respect to reduction in the mean self-reported frequency of opioid use, from 5.3 days per week (95% confidence interval, 5.1-5.5) at baseline to 0.4 (95% confidence interval, 0.1-0.6) for the second half of maintenance (P < .001 for the comparisons of induction and maintenance with baseline), with no differences between the 2 groups (P = .96) or between the treatments over time (P = .44). For the maximum consecutive weeks of opioid abstinence there was a significant main effect of time (P < .001), but the interaction (P = .11) and main effect of group (P = .84) were not significant. No differences were observed on the basis of treatment assignment with respect to cocaine use or study completion. CONCLUSIONS: Among patients receiving buprenorphine/naloxone in primary care for opioid dependence, the effectiveness of physician management did not differ significantly from that of physician management plus cognitive behavioral therapy. (C) 2013 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2013) 126, 74. e11-74.e17