Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: A 2-phase randomized controlled trial

Roger D. Weiss, Jennifer Sharpe Potter, David A. Fiellin, Marilyn Byrne, Hilary S. Connery, William Dickinson, John Gardin, Margaret L. Griffin, Marc N. Gourevitch, Deborah L. Haller, Albert L. Hasson, Zhen Huang, Petra Jacobs, Andrzej S. Kosinski, Robert Lindblad, Elinore F. McCance-Katz, Scott E. Provost, Jeffrey Selzer, Eugene C. Somoza, Susan C. SonneWalter Ling

Research output: Contribution to journalArticlepeer-review

407 Scopus citations


Context: No randomized trials have examined treatments for prescription opioid dependence, despite its increasing prevalence. Objective: To evaluate the efficacy of brief and extended buprenorphine hydrochloride-naloxone hydrochloride treatment, with different counseling intensities, for patients dependent on prescription opioids. Design: Multisite, randomized clinical trial using a 2-phase adaptive treatment research design. Brief treatment (phase 1) included 2-week buprenorphine-naloxone stabilization, 2-week taper, and 8-week postmedication followup. Patients with successful opioid use outcomes exited the study; unsuccessful patients entered phase 2: extended (12- week) buprenorphine-naloxone treatment, 4-week taper, and 8-week postmedication follow-up. Setting: Ten US sites. Patients: A total of 653 treatment-seeking outpatients dependent on prescription opioids. Interventions: In both phases, patients were randomized to standard medical management (SMM) or SMM plus opioid dependence counseling; all received buprenorphine- naloxone. Main Outcome Measures: Predefined "successful outcome"in each phase: composite measures indicating minimal or no opioid use based on urine test-confirmed selfreports. Results: During phase 1, only 6.6% (43 of 653) of patients had successful outcomes, with no difference between SMM and SMM plus opioid dependence counseling. In contrast, 49.2% (177 of 360) attained successful outcomes in phase 2 during extended buprenorphinenaloxone treatment (week 12), with no difference between counseling conditions. Success rates 8 weeks after completing the buprenorphine-naloxone taper (phase 2, week 24) dropped to 8.6% (31 of 360), again with no counseling difference. In secondary analyses, successful phase 2 outcomes were more common while taking buprenorphine-naloxone than 8 weeks after taper (49.2% [177 of 360] vs 8.6% [31 of 360], P≲λτ∀.001). Chronic pain did not affect opioid use outcomes; a history of ever using heroin was associated with lower phase 2 success rates while taking buprenorphine-naloxone. Conclusions: Prescription opioid-dependent patients are most likely to reduce opioid use during buprenorphinenaloxone treatment; if tapered off buprenorphinenaloxone, even after 12 weeks of treatment, the likelihood of an unsuccessful outcome is high, even in patients receiving counseling in addition to SMM. Trial Registration: Identifier: NCT00316277.

Original languageEnglish (US)
Pages (from-to)1238-1246
Number of pages9
JournalArchives of General Psychiatry
Issue number12
StatePublished - Dec 2011

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Arts and Humanities (miscellaneous)


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