Cognitive-behavioral therapy and buprenorphine for opioid use disorder: A systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Background: Recent systematic reviews have questioned the ability of psychosocial intervention to add substantive benefit to buprenorphine therapy.

Objectives: The purpose of the present meta-analysis was to test the random effects model (REM) null hypothesis that, for opioid use disorder (OUD) and opioid biological sample outcomes, the summary effect of cognitive-behavioral therapy (CBT) + buprenorphine randomized controlled trials (RCTs) = 0.

Methods: A systematic review was conducted searching electronic databases and the reference lists of included studies. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria were used to guide this review and the REM meta-analysis.

Results: The initial meta-analytic model (k = 4) was insignificant (REM Hedges’ g =.22, Z = 1.27, p =.206, 95% CI: −0.12–0.56) and heterogeneous (I2 = 53.47). A pre-specified categorical moderator analysis explained the heterogeneity via CBT modality. Categorical moderator analysis (k = 4) showed non-individual CBT RCTs (k = 2) to have a REM Hedges’ g summary effect of.598 (p =.006) and individual-CBT RCTs (k = 2) to have a REM Hedges’ g summary effect of −0.010 (p = .936). The difference between these two subgroups was significant (Q = 5.85, df = 1, p = .016).

Conclusion: The evidence cautiously suggests that for OUD, there may be some benefit to adding non-individual CBT to buprenorphine therapy.

KEYWORDS:

• Cognitive-behavioral therapy
• buprenorphine
• RCT
• meta-analysis
• opioid use disorder
• medication

Declaration of interest

The authors have no conflict of interest.