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.
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.