Association of Counseling and Psychotherapy on Retention in Medication for Addiction Treatment Within a Large Medicaid Population.

Abstract

OBJECTIVES:

Buprenorphine/naloxone is an effective medication for the treatment of opioid use disorder. Unlike methadone, which can only be dispensed in federally waived clinics and which must be combined with specific psychosocial treatment, buprenorphine can be dispensed by individual prescribers who have completed an 8-hour training program, with no requirement that patients receive concomitant psychotherapy. The objective of this study is to quantify the association of counseling and psychotherapy on retention in treatment. We also examine the effect of buprenorphine dosage on retention.

METHODS:

We examined a cohort of 4987 members of a not-for-profit managed care organization serving Medicaid members in 41 counties in Pennsylvania. This cohort was selected from all members who had a full year without any medication for opioid use disorder followed by initiation of treatment with buprenorphine/naloxone in 2016 to 2017 and who remained Medicaid eligible for at least 80% of the following 2 years. Outcomes were estimated using inverse probability weighted propensity scores.

RESULTS:

The addition of counseling and psychotherapy within the first 8 weeks of treatment was associated with greater total retention in treatment and there was a dose-response relationship. A 16 mg/d or greater dose of buprenorphine was also associated with greater retention.

CONCLUSIONS:

These results provide support for an integrated approach to treating people with an opioid use disorder, through a combination of buprenorphine pharmacotherapy and targeted counseling and psychotherapy within the first 2 months of treatment.

• Authors: Kemal Eren, James Schuster, Amy Herschell, David Loveland, Geoffrey Neimark, Mark Mihalyo, Matthew Hurford, Patricia Houck, Neal Ryan
• Journal: Journal of addiction medicine (J Addict Med) 2022 May-Jun 01 Vol. 16 Issue 3 Pg. 346-353 ISSN: 1935-3227 [Electronic] United States
• PMID: 34561351 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 American Society of Addiction Medicine.

Chemical References

• Buprenorphine, Naloxone Drug Combination
• Narcotic Antagonists
• Buprenorphine

Topics

• Buprenorphine (therapeutic use)
• Buprenorphine, Naloxone Drug Combination (therapeutic use)
• Counseling
• Humans
• Medicaid
• Narcotic Antagonists (therapeutic use)
• Opiate Substitution Treatment
• Opioid-Related Disorders (drug therapy, rehabilitation)
• Psychotherapy
• United States