Provide psychosocial therapy as well as buprenorphine, or extend treatment to more opioid-dependent patients by not requiring therapy? Across relatively uncomplicated patients treated at a primary care clinic, this US study found no benefit from cognitive-behavioural therapy, but other patients may need this kind of support to make the most of buprenorphine or methadone treatment.

Key points From summary and commentary
• US primary care practices which prescribe buprenorphine to opioid-dependent patients generally offer only limited counselling, raising the issue of whether further psychosocial support would improve outcomes.
• At a US practice, this randomised trial supplemented medical care with cognitive-behavioural therapy.
• There was no statistically significant indication that adding these sessions further reduced opioid or cocaine use or improved the treatment-completion rate or other outcomes.
• Some patients in opiate substitute prescribing programmes have however benefited from extra counselling or therapy. Patients with psychiatric problems may particularly benefit.