A Method to Increase Buprenorphine Treatment Capacity and Effectiveness

The goal of this fast track STTR proposal is to expand buprenorphine maintenance therapy for opioid dependent patients Over million people in the US are addicted to opiates Providing effective agonist therapy methadone or buprenorphine coupled with behavioral counseling greatly improves outcomes reduces morbidity and reduces societal costs Methadone maintenance treatment has been limited due to complex state and federal regulations and the need for of daily clinic visits Buprenorphine was developed as an alternative that could be self administered under the supervision of a specially trained and licensed primary care physician However due to a lack of affordable alternatives patients are usually referred to methadone or similar clinics for counseling which buprenorphine patients tend to dislike and then tend to drop out of treatment buprenorphine attrition rates are in primary care settings Therefore a cost effective method for delivering an accessible and effective form of counseling for office based buprenorphine is needed To this end we propose to develop a buprenorphine specific version of CBT CBT Computer Based Training for Cognitive Behavioral Therapy a web based validated behavioral counseling program In Phase I our Specific Aim is to test the feasibility of using CBT CBT adapted for use in buprenorphine certified primary care settings CBT CBT Buprenorphine We will tailor CBT CBT for buprenorphine treatment and then conduct a small randomized feasibility comparing it with standard buprenorphine maintenance In addition we will develop and evaluate a Physician Tutorial to accompany the CBT CBT Buprenorphine program in primary care settings Test of Feasibility The CBT CBT Buprenorphine group must demonstrate a clinically meaningful effect on increased retention and reduction of illegal drug use and increased retention relative to standard buprenorphine maintenance at least and improved respectively In addition both clinicians and patients must find CBT CBT Buprenorphine is usable average score of at least for both groups on a Likert like scale of with indicating `would definitely use CBT CBT Buprenorphine again In Phase II our Specific Aim is to determine if the use of CBT CBT Buprenorphine leads to clinically significant improved outcomes and increased retention for patients in a larger sample of individuals seeking buprenorphine treatment in a primary care setting To this end we will improve CBT CBT Buprenorphine as informed by the Phase I results and carry out an RCT that is powered to detect significance for reduced opioid use and increased retention in a cost effective manner Satisfaction and usability will also be evaluated as in Phase I Opioid use disorders are at epidemic levels in the United States This project proposes to develop a validated cost effective and accessible strategy for providing evidence based counseling to patients enrolled in primary care based buprenorphine programs