BUP - BOOSTeR: Behavioral Optimization for Overcoming Suboptimal Treatment Retention

About This Grant

PROJECT SUMMARY/ABSTRACT Buprenorphine, a medication for opioid use disorder (MOUD), is associated with decreased opioid overdose and all-cause mortality. Treatment outcomes improve if patients remain on MOUD for at least six months, a period recommended by expert guidelines. Despite this, most studies report retention on MOUD of 50-65% at 3-6 months, with most treatment drop out occurring during the first month of treatment. Psychosocial interventions have the potential to improve OUD treatment retention particularly when applied in combination in efficient delivery systems. The objective of this study is to develop an effective and efficient multicomponent intervention to increase buprenorphine retention at 6 months through an optimization trial. We will leverage the Multiphase Optimization STrategy (MOST) framework for developing, optimizing, and evaluating a multicomponent behavioral intervention. We will test the impact of three psychosocial intervention components on buprenorphine treatment retention at six months by recruiting 240 persons initiating buprenorphine from office-based addiction treatment settings and randomizing them in a balanced 23 factorial design to 1) Brief advice to continue treatment for at least 6 months (usual care); 2) Behavioral-Activation (BA)—focused on increasing positive reinforcing activities and experiences to promote recovery; 3) Attendance Reinforcement (AR)— incentivizing attendance at nurse visits in addiction care; and 4) Peer Motivational Interviewing (Peer-MI) –increasing confidence to continue buprenorphine treatment and providing social support. The observed main and interaction effects for the 3 candidate psychosocial interventions will guide the selection of components to be included in an optimized intervention. Using mediation analyses, we will examine whether each component affects the hypothesized mechanism of action and whether hypothesized mechanisms account for observed changes in buprenorphine retention. Results from this study will be twofold: 1) it will improve our understanding of mechanisms by which psychosocial component interventions improve buprenorphine MOUD treatment retention and 2) prepare the scientific team to conduct a future randomized controlled trial of the optimized intervention package. The long-term impact will be to establish tangible and disseminatable methods to improve MOUD retention.