title: Behavioral drug and HIV risk reduction counseling (BDRC) with abstinence-contingent take-home buprenorphine: a pilot randomized clinical trial.
abstract: This pilot randomized clinical trial evaluated whether the efficacy of office-based buprenorphine maintenance treatment (BMT), provided with limited counseling or oversight of medication adherence is improved by the addition of individual drug counseling and abstinence-contingent take-home doses of buprenorphine. After a 2-week buprenorphine and stabilization period, heroin dependent individuals (n=24) in Muar, Malaysia were randomly assigned to Standard Services BMT (physician administered advice and support, and weekly, non-contingent medication pick-up) or Enhanced Services (nurse-delivered manual-guided behavioral drug and HIV risk reduction counseling (BDRC) and abstinence-contingent take-home buprenorphine (ACB), 7 day supply maximum). Outcomes included retention, proportion of opioid-negative urine tests, self-reported drug use, and self-reported HIV risk behaviors. 12/12 (100%) of Enhanced Services and 11/12 (92%) of Standard Services participants completed the entire protocol. The proportion of opioid-negative urine tests increased significantly over time for both groups (p<0.001), and the reductions were significantly greater in the Enhanced Services group (p<0.05); Enhanced Services group achieved higher overall proportions of opiate negative urine toxicology tests (87% vs. 69%, p=0.04) and longer periods of consecutive abstinence from opiates (10.3 weeks vs. 7.8 weeks, p=0.154). Both groups significantly reduced HIV risk behaviors during treatment (p<0.05), but the difference between Enhanced and Standard Services (26% vs. 17% reductions from the baseline levels, respectively) was not statistically significant (p=0.9). Manual-guided behavioral drug and HIV risk reduction counseling and abstinence-contingent take-home buprenorphine appear promising for adding to the efficacy of office-based BMT provided with limited drug counseling and medication oversight.
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA. marek.chawarski@yale.edu
authors.forename: M C
authors.initials: MC
authors.lastname: Chawarski
authors.forename: M
authors.initials: M
authors.lastname: Mazlan
authors.forename: R S
authors.initials: RS
authors.lastname: Schottenfeld
mesh_terms: D000293:Adolescent; D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D003376:Counseling; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006556:Heroin Dependence / Q000453:epidemiology* / Q000534:rehabilitation*; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010865:Pilot Projects; D040242:Risk Reduction Behavior
chemical_list: D009294:Narcotics; D002047:Buprenorphine