Evaluating comparative effectiveness of psychosocial interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analyses
Open accessAbstract
BACKGROUND: Guidelines recommend that individuals with opioid use disorder (OUD) receive pharmacological and psychosocial interventions; however, the most appropriate psychosocial intervention is not known. In collaboration with people with lived experience, clinicians, and policy makers, we sought to assess the relative benefits of psychosocial interventions as an adjunct to opioid agonist therapy (OAT) among persons with OUD. METHODS: A review protocol was registered a priori (CRD42018090761), and a comprehensive search for randomized controlled trials (RCT) was conducted from database inception to June 2020 in MEDLINE, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials. Established methods for study selection and data extraction were used. Primary outcomes were treatment retention and opioid use (measured by urinalysis for opioid use and opioid abstinence outcomes). Odds ratios were estimated using network meta-analyses (NMA) as appropriate based on available evidence, and in remaining cases alternative approaches to synthesis were used. RESULTS: Seventy-two RCTs met the inclusion criteria. Risk of bias evaluations commonly identified study limitations and poor reporting with regard to methods used for allocation concealment and selective outcome reporting. Due to inconsistency in reporting of outcome measures, only 48 RCTs (20 unique interventions, 5,404 participants) were included for NMA of treatment retention, where statistically significant differences were found when psychosocial interventions were used as an adjunct to OAT as compared to OAT-only. The addition of rewards-based interventions such as contingency management (alone or with community reinforcement approach) to OAT was superior to OAT-only. Few statistically significant differences between psychosocial interventions were identified among any other pairwise comparisons. Heterogeneity in reporting formats precluded an NMA for opioid use. A structured synthesis was undertaken for the remaining outcomes which included opioid use (n = 18 studies) and opioid abstinence (n = 35 studies), where the majority of studies found no significant difference between OAT plus psychosocial interventions as compared to OAT-only. CONCLUSIONS: This systematic review offers a comprehensive synthesis of the available evidence and the limitations of current trials of psychosocial interventions applied as an adjunct to OAT for OUD. Clinicians and health services may wish to consider integrating contingency management in addition to OAT for OUD in their settings to improve treatment retention. Aside from treatment retention, few differences were consistently found between psychosocial interventions adjunctive to OAT and OAT-only. There is a need for high-quality RCTs to establish more definitive conclusions. TRIAL REGISTRATION: PROSPERO registration CRD42018090761.
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There are no clear data of counseling interventions effective in combination with buprenorphine to inform detailed simulation of the bidirectional effect of counseling and MOUD.
“there are no clear data of counseling interventions effective in combination with buprenorphine to inform detailed simulation of the bidirectional effect of counseling and MOUD.47”
From Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder (2023) · cites this paper as [47]
The Introduction (page unavailable) says research on the efficacy of psychosocial interventions alongside opioid agonist therapy is limited, and Results > Study populations (page unavailable) shows that most included studies involved methadone rather than buprenorphine. This supports caution about the available evidence, but the paper does not specifically conclude that counseling with buprenorphine lacks clear effectiveness data or assess whether the data can inform a bidirectional simulation. (LLM, conf=0.78)
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- Authors
- Rice, D., Corace, K., Wolfe, D., Esmaeilisaraji, L., Michaud, A., Grima, A., Austin, B., Douma, R., Barbeau, P., Butler, C., Willows, M., Poulin, P. A., Sproule, B. A., Porath, A., Garber, G., Taha, S., Garner, G., Skidmore, B., Moher, D., Thavorn, K., & Hutton, B.
- Affiliations
- Ottawa Hospital Research Institute (CA)
- University of Ottawa (CA)
- Centre for Addiction and Mental Health (CA)
- Canadian Centre on Substance Use and Addiction (CA)
- CAPSA (CA)
- Corresponding author
- Hutton, Brian
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-12-28
- Volume
- 15
- Issue
- 12
- Pages
- e0244401
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7769275
- OpenAlex
- W3114429589
- Cited by
- 64
- References
- 113
- Citations by year
- 2026: 17 · 2025: 11 · 2024: 11 · 2023: 11 · 2022: 11 · 2021: 3
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HRB National Drugs Library (Health Research Board) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Canadian Institutes of Health Research (397976)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- opioid use disorder, psychosocial interventions, opioid substitution therapy, contingency management, community reinforcement approach, treatment retention, opioid abstinence, adjunctive therapy, harm reduction, people with lived experience, harm reduction workers, harm reduction services
- MeSH terms
- Psychosocial Intervention, Analgesics, Opioid, Combined Modality Therapy, Humans, Opioid-Related Disorders, Randomized Controlled Trials as Topic, Treatment Outcome, Practice Guidelines as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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