Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2013 Jan;126(1):74.e11-7.
doi: 10.1016/j.amjmed.2012.07.005.

A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine

David A Fiellin  1 , Declan T Barry, Lynn E Sullivan, Christopher J Cutter, Brent A Moore, Patrick G O'Connor, Richard S Schottenfeld
Affiliations
Randomized Controlled Trial

A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine

David A Fiellin et al. Am J Med. 2013 Jan.

Abstract

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.

Trial registration: ClinicalTrials.gov NCT00632151.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: Dr Fiellin has received honoraria from ParagonRx and Pinney Associates for serving on external advisory boards monitoring the abuse and diversion of buprenorphine.

Figures

Figure 1
Figure 1
Enrollment, treatment, and follow-up.
Figure 2
Figure 2
Opioid abstinence by urine toxicology analysis by treatment and time.
Figure 3
Figure 3
Study completion among opioid-dependent patients receiving buprenorphine/naloxone in primary care. Study completion was defined as not meeting the criteria for protective transfer, not missing medication for more than 7 days, or not missing 3 or more physician management sessions.
See this image and copyright information in PMC

Comment in

References

    1. Anonymous. The DASIS Report: Facilities Providing Methadone/LAAM Treatment to Clients with Opiate Addiction. Rockville, MD: Substance Abuse Mental Health Services Administration, Office of Applied Studies; 2002.
    1. Anonymous. CESAR FAX. Vol 20. College Park, MD: University of Maryland; 2011. Buprenorphine Treatment for Opioid Dependence; p. 34.
    1. Anonymous. The N-SSATS Report: Overview of Opioid Treatment Programs Within the United States: 2008. Rockville, MD: Substance Abuse Mental Health and Services Administration, Office of Applied Studies; 2010.
    1. Kissin W, McLeod C, Sonnefeld J, Stanton A. Experiences of a national sample of qualified addiction specialists who have and have not prescribed buprenorphine for opioid dependence. J Addict Dis. 2006;25:91–103. - PubMed
    1. Arfken CL, Johanson C-E, di Menza S, Schuster CR. Expanding treatment capacity for opioid dependence with office-based treatment with buprenorphine: national surveys of physicians. J Subst Abuse Treat. 2010;39:96–104. - PubMed

Publication types

Associated data