TOPLINE:

A secondary analysis of four trials found no significant benefit of adding behavioral therapy to the combination of buprenorphine and medical management for individuals with opioid use disorder in terms of remaining opioid-free or using buprenorphine consistently.

METHODOLOGY:

• Researchers performed a secondary analysis of data from four randomized clinical trials conducted at different sites across the US between 2000 and 2011 to assess whether adding behavioral therapy to a treatment module involving buprenorphine and medical management enhanced the response of patients to the treatment for opioid use disorder.
• They harmonized data from the trials by aligning core design features, measures, and treatment durations to yield a pooled sample of 869 adults (mean age, 34.2 years; 33% women; 82% White individuals) with opioid use disorder.
• The participants received either buprenorphine with medical management alone or with additional behavioral therapy interventions such as cognitive behavioral therapy, contingency management, or counseling for opioid dependence.
• Researchers recorded the number of weeks in which the participants used opioids and the number of weeks in which they received buprenorphine during the 12-week treatment.
• Substance use and functioning were scored across seven domains: medical, employment and financial support, alcohol, drug, social and family, legal, and psychiatric.

TAKEAWAY:

• Adding behavioral therapy to buprenorphine plus medical management was not associated with more opioid-free weeks; participants in both the additional behavioral therapy and no additional behavioral therapy groups had a mean of about 7 opioid-free weeks.
• Participants in both groups received buprenorphine for a mean duration of about 10 weeks, with no significant difference in duration between the two groups.
• Adding behavioral therapy was not associated with improvements in any of the seven functional domains compared with buprenorphine plus medical management alone.
• The researchers found no significant moderating effects of age, female sex, heroin or cocaine use, pain, or psychiatric disorders on the effectiveness of the additional behavioral therapy for opioid use disorder.

IN PRACTICE:

“Due to the impact of OUD [opioid use disorder] on quality of life, functioning, and mortality risk, efforts to optimize treatment response are of critical importance,” the authors of the study wrote. “Results of this secondary analysis of four randomized clinical trials highlight the efficacy of buprenorphine treatment when combined with medical management for opioid use disorder,” they added.

SOURCE:

This study was led by R. Kathryn McHugh, PhD, of the Division of Alcohol, Drugs and Addiction at the McLean Hospital in Belmont, Massachusetts. It was published online on August 20, 2025, in JAMA Network Open.

LIMITATIONS:

The studies included differed in the duration of treatment, the dosing, and the types of behavioral therapy provided. Some studies excluded certain types of polysubstance use or co-occurring psychiatric disorders. All the studies were conducted before fentanyl and fentanyl analogues became common and before new injectable buprenorphine formulations were introduced.

DISCLOSURES:

This study received support from the National Institute on Drug Abuse. One author reported receiving personal fees from Alkermes and Eli Lilly and Company. Another author reported receiving honoraria from the American Society of Addiction Medicine and reported that their spouse founded Playbl, which distributes video games for substance use prevention.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.