Enhancing office-based buprenorphine treatment: An adaptive psychosocial approach

This project investigates how to enhance office-based buprenorphine treatment for opioid use disorder by integrating a tailored, adaptive psychosocial approach. Recognizing that medications such as buprenorphine are the pharmacological standard for treating OUD but that optimal psychosocial supports are not well-defined, the research team developed and is conducting a randomized controlled trial comparing an adaptive psychosocial intervention to treatment as usual. The adaptive approach operationalizes decision algorithms to determine when and for whom to implement two commonly used behavioral interventions—cognitive behavioral therapy (CBT) and peer support—based on patient-level factors at treatment onset (including life instability such as unstable housing or unemployment and risky substance use patterns) and ongoing measures of engagement and response to treatment.

The trial enrolls 125 new buprenorphine patients from two federally qualified health centers in Philadelphia. Participants complete a semi-structured baseline assessment and quarterly follow-ups for one year. Key outcomes under examination include opioid use, retention in MOUD treatment, and quality of life. The study emphasizes an individualized strategy rather than a single standardized psychosocial package, testing whether adaptive delivery of CBT and peer support improves clinical outcomes and engagement, particularly among patients presenting with concurrent stressors or concurrent non-opioid substance use. Preliminary findings and outputs, while final data collection and analysis are ongoing, point to substantial psychosocial needs in this patient population.

Early results reported by the team indicate that over half of participants were using substances in addition to opioids at study entry, a pattern that buprenorphine alone does not address. Concurrent non-opioid substance use was associated with early dropout from MOUD within the first three months, highlighting the importance of targeted psychosocial interventions to support retention. The study also documented significant historical suicidality among participants, with over one-third reporting lifetime suicidal thoughts and over one-quarter reporting lifetime suicide attempts, underscoring the complex clinical and safety needs of patients initiating buprenorphine treatment. Beyond the clinical trial, the project supported the development of a student training program to diversify the pipeline of professionals in health services and research. In partnership with Lincoln University, the grant-funded training provided didactic and experiential addictions research training to four cohorts of undergraduate psychology students from a historically Black university, fostering interest and capacity in behavioral research careers among BIPOC students.

The study has produced several publications and conference presentations documenting non-opioid substance use patterns, predictors of suicidality, and the development and early lessons from the student training program. Partners in the work include Philadelphia College of Osteopathic Medicine, University of Pennsylvania, Lincoln University, Project Home, and the PHMC Health Network. Funding is provided by the Pennsylvania Department of Health through the Commonwealth Universal Research Enhancement (CURE) program. The research advances knowledge on how to adapt psychosocial supports to patient needs in office-based buprenorphine programs and informs strategies to improve retention, reduce concurrent substance use-related harms, and address broader quality-of-life and safety concerns among people initiating MOUD.