Two types of mental health therapies did not improve the effectiveness of using medication to treat opioid use disorder and many people who received the supplementary services stopped them early, leaving little time for meaningful intervention, according to a study led by Philadelphia College of Osteopathic Medicine (PCOM).
In a randomized, controlled trial of 340 adults with opioid use disorder who were prescribed buprenorphine, the supplementary psychological treatments cognitive behavioral therapy (CBT) and peer recovery support (PRS)—used alone or in combination— “had no effect on rates of opioid abstinence” in the year after starting medication.
The study, published in JAMA Network Open, also found that these psychosocial treatments did not improve patient satisfaction with their care. Retention in treatment, quality of life, emergency department use, or overdose rates “did not differ as a function of CBT or PRS.”
“The positive news is that medications for opioid use disorder (MOUD), such as buprenorphine, are effective treatment approaches for this condition,” said lead author Michelle R. Lent, PhD, a professor of clinical psychology and PCOM’s chief research and science officer. “In our study, we did not find peer support or cognitive behavioral therapy to result in differential rates of illicit opioid use in individuals starting medication for OUD. However, many study patients dropped out of MOUD treatment within the first few weeks or months, leaving little time to deliver any meaningful dose of either peer support or therapy.”
The study included patients in office-based treatment programs at five federally qualified health centers between 2020 and 2024. One group received medication-based treatment as usual. Another group was offered MOUD with 12 weeks of cognitive behavioral therapy. The third group received MOUD and peer recovery support, and the fourth group received MOUD and 12 weeks of both cognitive behavioral therapy and peer support.
One-on-one CBT sessions focused on goal setting, cognitive restructuring and relapse prevention. Similarly, PRS included goal setting, sharing lived experiences and assistance with meeting immediate life needs. Licensed clinicians delivered CBT while certified peers led PRS. Researchers followed patients for one year post-enrollment, with the primary study outcome being urinalysis-confirmed opioid abstinence every three months up to a year.
Dropout rates were high in both treatment types. The average number of completed CBT sessions was three, and only eight people took all 12 sessions. The average number of PRS sessions was slightly higher at nearly four, but only three people received all 12 weeks of peer support.
Various challenges contributed to patient retention in psychosocial treatment, including lack of transportation, stigma associated with treatment, the early stage of recovery and life stressors. The COVID pandemic, including restrictions on in-person visits, likely exacerbated existing issues of early dropout in treatment, Lent said.
“Practitioners should focus initially on helping individuals to remain engaged in MOUD treatment. Once stable, then providers can consider introducing additional adjunctive interventions for patients who may benefit from these services,” Lent said. “OUD can be associated with numerous life stressors that can get in the way of recovery, so those should also be addressed when patients are stable on their medication.”
Future research, she said, should focus on ways to keep patients engaged in MOUD and then study the efficacy of peer support and CBT “to really understand if and how these treatments may fit into recovery planning.”
The study was co-authored with researchers from Boston University, University of Pennsylvania and Public Health Management Corp., among others. It was supported by the Patient-Centered Outcomes Research Institute.
Established in 1899, Philadelphia College of Osteopathic Medicine (PCOM) has trained thousands of highly competent, caring physicians, health practitioners and behavioral scientists who practice a “whole person” approach to care—treating people, not just symptoms. PCOM, a private, not-for-profit accredited institution of higher education, operates three campuses (PCOM, PCOM Georgia and PCOM South Georgia) and offers doctoral degrees in clinical psychology, educational psychology, osteopathic medicine, pharmacy, physical therapy, and school psychology. The college also offers graduate degrees in applied behavior analysis, applied positive psychology, biomedical sciences, forensic medicine, medical laboratory science, mental health counseling, physician assistant studies, and school psychology. PCOM students learn the importance of health promotion, research, education and service to the community. Through its community-based Healthcare Centers, PCOM provides care to medically underserved populations. For more information, visit pcom.edu or call 215-871-6100.
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Gabrielle DePietro
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