Randomized pilot trial of Web-based cognitive-behavioral therapy adapted for use in office-based buprenorphine maintenance

Abstract

Background: Despite the clear success of office-based buprenorphine treatment in increasing availability of effective treatment for opioid use disorder, constraints on its effectiveness include high attrition and limited high-quality behavioral care in many areas. Web-based interventions may be a novel strategy for providing evidence-based behavioral care to individuals receiving office-based buprenorphine maintenance. This report describes modification and initial pilot testing of Web-based training in cognitive-behavioral therapy (CBT4CBT) specifically for use with individuals in office-based buprenorphine. Methods: Twelve-week randomized pilot trial evaluating effects of CBT4CBT-Buprenophine in retaining participants and reducing drug use with respect to standard office-based buprenorphine alone was carried out. Twenty individuals meeting DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) criteria for current opioid use disorder were randomized to standard buprenorphine treatment or buprenorphine plus access to CBT4CBT-Buprenorphine. Results: There were promising findings regarding rates of urine toxicology screens negative for opioids (91% versus 64%; P = .05, effect size d = 0.88) and all drugs (82% versus 30%; P = .004, d = 1.2). Individuals randomized to CBT4CBT-Buprenorphine completed a mean of 82.6 (SD = 4.4) days of treatment (of a possible 84) compared with 68.6 (SD = 32.6) for those assigned to standard buprenorphine treatment. Conclusions: Although preliminary and limited by the small sample size, this trial suggests the feasibility and promise of validated, Web-based interventions, tailored for this specific patient population, for improving outcomes in office-based buprenorphine.

Keywords:

• Behavioral interventions
• buprenorphine
• web-based interventions

Acknowledgments

We are grateful to the staff and patients of the APT Foundation, including Drs. Lynn Madden, Declan Barry, and Jeannette Tetrault for their support, as well as Genor8or Communications and the Studios of Moving Pictures for their assistance in production of the videos. We are also grateful to Drs. Adam Bisaga of Columbia University and Genie Bailey of Brown University, who provided valuable feedback on drafts of the material.

Author contributions

The grant was written by Drs. Shi (Principal Investigator) and Carroll. The CBT4CBT-Buprenorphine module was developed by Dr. Shi, Dr. Carroll, and Ms. Henry. The study was designed and implemented by all authors. Data management and analyses were performed independently. All authors reviewed and approved the manuscript as submitted.

Additional information

Funding

Support was provided by National Institute on Drug Abuse (NIDA) award R42DA041941 awarded to the APT Foundation and CBT4CBT LLC. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication