Peer recovery specialist-delivered, behavioral activation intervention to improve retention in methadone treatment: Results from an open-label, Type 1 hybrid effectiveness-implementation pilot trial

Magidson, Jessica F.; Kleinman, Mary B.; Bradley, Valerie D.; Anvari, Morgan S.; Abidogun, Tolulope M.; Belcher, Annabelle M.; Greenblatt, Aaron D.; Dean, Dwayne; Hines, Abigail C.; Seitz-Brown, C. J.; Wagner, Michael; Bennett, Melanie E.; Felton, Julia W.

doi:10.1016/j.drugpo.2022.103813

Cited by 16 publications

(14 citation statements)

References 48 publications

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“…Unexpectedly, we found a significant difference in the groups’ 90-day retention rates, with 61.1% retention attrition in the TAU group and 77.9% for group C-OLP ( Figure 3 ). The observed TAU attrition rate is very similar to the 40% attrition reported in the comparison cohort of a recently published trial conducted at the same opioid treatment program, 56 reinforcing the reliability of our TAU retention findings.…”

Section: Discussionsupporting

confidence: 88%

Effectiveness of Conditioned Open-label Placebo With Methadone in Treatment of Opioid Use Disorder

et al. 2023

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ImportanceMethadone treatment is the most effective evidence-based treatment for opioid use disorder (OUD), but challenges related to dosing and premature treatment dropout argue for adjunct interventions to improve outcomes. One potential behavioral intervention with low risk involves harnessing placebo effects.ObjectiveTo determine the effect of a pharmacologically conditioned open-label placebo (C-OLP) on 90-day methadone dose, retention, drug use, withdrawal, craving, quality of life, and sleep.Design, Setting, and ParticipantsThis 2-arm, open-label, single-blind randomized clinical trial was conducted between December 5, 2017, and August 2, 2019, in an academically affiliated community opioid treatment program. Analyses were conducted between October 1, 2019, and April 30, 2020. A total of 320 newly enrolled adults seeking treatment for moderate to severe OUD were assessed for study eligibility; 131 met eligibility criteria, provided informed consent, and were randomized to either C-OLP or treatment as usual (TAU) in an unequal-block (3:2) manner. Exclusion criteria were pregnancy, hospital/program transfers, and court-ordered treatment.InterventionsParticipants randomized to C-OLP received pharmacologic conditioning and a placebo pill and methadone, and participants randomized to TAU were given methadone only. Participants met with the study team 5 times: at baseline (treatment intake) and 2, 4, 8, and 12 weeks postbaseline. Interactions were balanced between the 2 groups.Main Outcomes and MeasuresOutcomes included 90-day methadone dose (primary) and treatment retention, drug use, withdrawal, craving, quality of life, and sleep quality (secondary). Analyses were conducted as intention-to-treat.ResultsOf the 131 people enrolled in the study, 54 were randomized to TAU and 77 to C-OLP. Mean (SD) age was 45.9 (11.2) years; most of the participants were Black or African American (83 [63.4%]) and male (84 [64.1%]). No significant group differences were observed in the mean (SD) 90-day methadone dose (83.1 [25.1] mg for group TAU, 79.4 [19.6] mg for group C-OLP; t = 0.621991; P = .43), but the groups differed significantly in their retention rates: 33 (61.1%) for TAU and 60 (77.9%) for C-OLP (χ21 = 4.356; P = .04; number needed to treat for the beneficial outcome of 3-month treatment retention, 6; 95% CI, 4-119). C-OLP participants also reported significantly better sleep quality.Conclusions and RelevanceIn this randomized clinical trial, C-OLP had no effect on the primary outcome of 90-day methadone dose. However, C-OLP participants were significantly more likely to remain in treatment. These findings support the use of C-OLP as a methadone treatment adjunct, but larger trials are needed to further examine the use of C-OLP.Trial RegistrationClinicalTrials.gov Identifier: NCT02941809

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Section: Discussionsupporting

confidence: 88%

Effectiveness of Conditioned Open-label Placebo With Methadone in Treatment of Opioid Use Disorder

et al. 2023

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“…Emergency department–based peer recovery support services (PRSSs) are a promising approach for promoting treatment linkage, but evidence regarding their effectiveness is limited. Studies in other settings suggest that PRSSs are associated with reduced alcohol and drug use, improved treatment engagement, and lower likelihood of rehospitalization . A PRSS may be an important strategy for addressing opioid use disorder (OUD) in the ED, and pilot studies suggest that PRSSs may promote postdischarge SUD treatment enrollment and reduce repeat overdose …”

Section: Introductionmentioning

confidence: 99%

Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose

Treitler,

Crystal,

Cantor

et al. 2024

JAMA Netw Open

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ImportancePatients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department–based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking.ObjectiveTo examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization.Design, Setting, and ParticipantsThis intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023.ExposureHospital OORP implementation.Main Outcomes and MeasuresThe primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access.ResultsA total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (−0.086; 95% CI, −0.154 to −0.018) and 5 half-years (−0.106; 95% CI, −0.184 to −0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities.Conclusions and RelevanceIn this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.

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“…PRSs provide a variety of services, such as linkage to resources, case management, and assistance in navigating the health care systems. PRS services have been found to be linked to reduced substance use/return to use, improved relationships with treatment providers, increased treatment retention, and greater treatment satisfaction [5,6]. PRSs are often trained in motivational interviewing; however, they are not consistently trained in the delivery of any other evidence-based interventions (EBIs) [4,5,7,8].…”

Section: Introductionmentioning

confidence: 99%

“…(2) breaking the negative cycle; and (3) identifying and scheduling substance-free activities that are in line with one's values. Emerging evidence led by our team has demonstrated that PRSs can deliver BA with feasibility, acceptability, and fidelity, and that peer-delivered BA has been associated with improvements in SUD outcomes [6,10,[12][13][14]. However, there is a lack of research regarding best practices (i.e., length, teaching techniques, etc.)…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study of Training Peer Recovery Specialists in Behavioral Activation in the United States: Preliminary Outcomes and Predictors of Competence

Anvari

Kleinman

Dean

et al. 2023

IJERPH

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Background: The peer recovery specialist (PRS) workforce has rapidly expanded to increase access to substance-use disorder services for underserved communities. PRSs are not typically trained in evidence-based interventions (EBIs) outside of motivational interviewing, although evidence demonstrates the feasibility of PRS delivery of certain EBIs, such as a brief behavioral intervention, behavioral activation. However, characteristics that predict PRS competency in delivering EBIs such as behavioral activation remain unknown, and are critical for PRS selection, training, and supervision if the PRS role is expanded. This study aimed to explore the outcomes of a brief PRS training period in behavioral activation and identify predictors of competence. Method: Twenty PRSs in the United States completed a two-hour training on PRS-delivered behavioral activation. Participants completed baseline and post-training assessments, including roleplay and assessments of PRS characteristics, attitudes towards EBIs, and theoretically relevant personality constructs. Roleplays were coded for competence (behavioral activation specific and PRS skills more broadly, i.e., PRS competence) and changes were assessed from baseline to post-training. Linear regression models tested factors predicting post-training competence, controlling for baseline competence. Results: There was a significant pre-post increase in behavioral activation competence (t = −7.02, p < 0.001). Years working as a PRS significantly predicted post-training behavioral activation skills (B = 0.16, p = 0.005). No variables predicted post-training PRS competence. Conclusions: This study provides preliminary evidence that behavioral activation may be appropriate for dissemination to PRSs through brief trainings, particularly for PRSs with more work experience. However, additional research is needed to examine predictors of competence among PRSs.

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Peer recovery specialist-delivered, behavioral activation intervention to improve retention in methadone treatment: Results from an open-label, Type 1 hybrid effectiveness-implementation pilot trial

Cited by 16 publications

References 48 publications

Effectiveness of Conditioned Open-label Placebo With Methadone in Treatment of Opioid Use Disorder

Effectiveness of Conditioned Open-label Placebo With Methadone in Treatment of Opioid Use Disorder

Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose

A Pilot Study of Training Peer Recovery Specialists in Behavioral Activation in the United States: Preliminary Outcomes and Predictors of Competence

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