Instead of a set programme, a clinic in London tried offering methadone or buprenorphine patients still using heroin or cocaine a selection from a suite of well-supported psychological interventions tailored to the patient and then systematically re-tailored in the light of how they responded. It worked – but did it work well enough, and would the findings be replicated in more typical circumstances?

Key points from summary and commentary

• A personalised psychosocial intervention was trialled for opioid-dependent patients being prescribed methadone or buprenorphine on a maintenance basis but who were still using heroin or cocaine.
• Distinct from most other trials of additional psychosocial therapies, instead of a set programme, in this trial the interventions were selected from a ‘toolbox’ to match the patient’s needs and preferences and adapted in the light of how they responded.
• Compared to usual treatment, among patients randomly allocated to this approach there were greater reductions in heroin and cocaine use and improvements in health-related quality of life, making the interventions cost-effective according to some accepted yardsticks. However, these findings which emerged in relatively ideal rather than typical circumstances.