Psychosocial intervention reduces drug abuse during OAT

  • Lancet Psychiatry

  • International Clinical Digest
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Takeaway

  • Adding a personalized psychosocial intervention to usual care significantly improved response to maintenance opioid agonist therapy (OAT) in treatment-resistant patients vs usual care alone.

Why this matters

  • Adding psychosocial intervention to usual care was also cost-effective.
  • Resistance is represented by continued use of illicit or nonprescription opioids or cocaine during OAT.

Study design

  • 270 patients with opioid use disorder were randomly assigned to usual care with or without a psychosocial intervention.
  • Funding: Indivior.

Key results

  • At week 18, the treatment response rate was higher with psychosocial intervention vs standard care alone (16% vs 7%; adjusted log odds, 1.20; P=.048).
  • The probability of treatment response was significantly higher with psychosocial intervention (average marginal effect, 0.108; P=.025).
  • The probability that the psychosocial intervention was cost-effective ranged from 47% to 87% at a threshold of £0-£1000 per unit improvement.
  • Quality-adjusted life years (QALYs) were higher in the psychosocial intervention (adjusted mean difference, 0.048; P=.004).
  • The probability of the psychosocial intervention being cost-effective was 60% and 67% at National Institute for Health and Care Excellence willingness-to-pay thresholds of £20,000 and £30,000 per QALY, respectively.
  • The number of adverse events was similar between groups.
  • 1 participant in the standard care group died.

Limitations

  • Open-label design.

Coauthored with Antara Ghosh, PhD

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