Table 1.

Summary of published randomized controlled trials on medication and behavioral therapies potentially associated with retention in medication-assisted treatment for opiate dependence (N=38 studies)

First author, year, country	Conditions	Sample N (% Male)	Medication	Retention outcome	Retention rate
Sigmon²¹, 2013, USA	1 vs 2 vs 4 week taper; all received individual behavioral therapy (Community Reinforcement Approach)	Community, illicitly using prescription opioids; 70 (69.0)	BUP taper, then NTX	In MAT at 3 months	50.0% 4-week taper 21.0% 2-week taper 21.0% 1-week taper
Tiihonen²², 2012 Russia	NTX implant vs placebo (P) implant	Polydrug dependent; 100 (not provided)	NTX	In MAT at 2.5 months	52.0% NTX, 28.0% P
Krupitsky²³, 2011, Russia	NTX vs P; all received counseling	<30 days of detox + abstinent at least 7 days; 250 (88.0)	NTX	Number of days in MAT up to 180	Med=168 NTX Med=96 P
Krupitsky²⁴, 2013, Russia	NTX+Guanfacine (G) vs NTX +GP vs NTXP+G vs NTXP+GP; all received counseling	Medically hospitalized; 301 (82.4)	NTX, G	In MAT at 6 months	26.7% NTX+G 19.7% NTX+GP 10.7% NTXP+G 6.7% NTXP+G NTX+G, NTX+GP> NTXP+G, NTXP+GP
Ling²⁵, 2010, USA	BUP vs P; all received counseling; 18 sites	In addiction treatment; 163 (68.7)	BUP	In MAT at 6 months	65.7% BUP 30.9% P
Ruger²⁶, 2012, Malaysia	P vs NTX vs BUP; all received counseling	Not provided; 126 (not provided)	BUP, NTX	In MAT at 6 months	15.4% P 20.9% NTX 40.9% BUP BUP>P,NTX
Lucas²⁷, 2010, USA	HIV clinical-based BUP vs case management plus referral to opioid treatment program	HIV+; 93 (72.0)	BUP, MET	In MAT at 12 Months	Rates not provided: BUP>referral
Saxon²⁸, 2013, USA	BUP vs MET; 8 sites	MAT seekers; 1,269 (not provided)	BUP, MET	In MAT at 4 months	Significance not reported: 45.9% BUP 73.9% MET
Woody²⁹, 2014, USA	MET vs BUP/NLX; 9 sites	MAT patients; 1,269 (67.8)	MET, BUP/NLX	In MAT at 6 months	74.0% MET 46.0% BUP
Potter³⁰, 2013, USA	MET vs BUP/NLX; 9 sites	MAT patients; 1,269 (67.8)	MET, BUP/NLX	In MAT at 6 months	Rates not provided: 57.6% overall; BUP<MET
Jones³¹, 2010, USA, Austria, Canada	BUP vs MET: all received comprehensive care and contingency management; 7 sites	Pregnant women; 187 (0.0)	BUP, MET	In MAT at end of pregnancy	82.0% MET 67.0% BUP
Strang³², 2010, England	Supervised injectable (inj) MET vs supervised inj heroin vs optimized oral MET; all patients had a case worker	Receiving oral MET but still injecting heroin; 127 (73.0)	MET, heroin	In MAT at 6.5 months	Significance not reported: 81.5% inj MET 88.0% inj heroin 69.0% oral MET
Oviedo- Joekes³³, 2010, Canada	Inj diacetylmorphine or inj hydromorphine vs oral MET	Treatment refractory; 192 (61.4)	Inj diacetelyl- morphine, inj hydromorphine, MET	In MAT at 12 months	Aboriginals: 84.4% Inj 57.1% MET Non- Aboriginals 90.7% Inj 50.9% MET
Nosyk³⁴, 2010, Canada	Heroin-assisted treatment (HAT) vs MET	Treatment refractory; 251 (61.4)	HAT, MET	In MAT at 12 months	Rates not provided; Better in HAT vs MET
Eiroia- Orosa³⁵, 2010, Germany	HAT vs MET; all received psychosocial services	Treatment refractory or treatment dropouts; 1,015 (73.3)	Heroin, MET	In MAT at 12 months	Significance not reported: 67.2% HAT 40.0% MET
Otiashvili³⁶, 2013, Republic Of Georgia	MET vs BUP/NLX +dose taper+referral to treatment; all were offered individual and group counseling	Treatment settings; 80 (95.0)	MET, BUP/NLX	In MAT at 3 months	No difference: 85.0% overall
Neumann³⁷, 2013, USA	MET vs BUP/NLX	Chronic non-malignant pain patients; 54 (53.7)	MET, BUP/NLX	In MAT at 6 months	48.1% overall 46.4% MET 50.0% BUP/NLX
Oviedo-Joekes³⁸, 2010, Canada	Diacetylmorphine vs hydromorphone	Treatment-refractory; 140 (not provided)	Diacetylmorphine, hydromorphine	In MAT at 12 months	No difference: 87.8% Diacetyl 88.0% Hydromor
Amass³⁹, 2011, 10 European countries	Direct induction (DI) vs indirect induction (II)	In MAT; 187 (80.2)	BUP/NLX	In MAT at 1 month	No difference: 81.8% DI 80.8% II
Bisaga⁴⁰, 2011, USA	Memantine (M) 60 mg/day vs M 30 mg/day vs P; all received therapy	New to MAT; 81 (81.5)	NTX	In MAT at 3 months	No difference: 22.0% M-60 19.0% M-30 26.0% P
Stein⁴¹, 2010, USA	Escitalopram (for depression) vs P; all received physician management	Depression symptoms; 147 (76.0)	BUP	In MAT at 3 months	No difference: 66.7% Escit 44.0% P
Oliveto⁴², 2011, USA	Disulfiram vs P; all received cognitive behavioral therapy (CBT)	Cocaine dependent; 161 (55.9)	MET	In MAT at 3.5 months	No difference: Rates not provided; 64.8% overall
Liebschutz⁴³, 2014, USA	Detoxification (detox) vs facilitated linkage to treatment	Medically hospitalized, not seeking addiction treatment; 145 (71.2)	BUP/NLX	In MAT at 6 months	3.0% Detox 16.7% Linkage
Chen⁴⁴, 2013, China	MET+contingency management (CM) vs MET only	New to MAT; 246 (92.3)	MET	In MAT at 3 months	81.7% MET+CM 67.5% MET
Hser⁴⁵, 2011, China	CM vs usual care (UC)	MAT patients; 319 (76.2)	MET	In MAT at 3 months	81.0% CM 67.0% UC
Dunn⁴⁶, 2013, USA	CM vs prescription (take-home MAT)	Unemployed, in detox or on street; 67 (61.2)	NTX	In MAT at 6 months	54.0% CM 16.0% Prescrip
Holland⁴⁷, 2012, Scotland	Supervision: None vs 2 times per week vs daily	In MAT for 3 months at baseline; 60 (70.0)	MET	In MAT at 3 months	No difference: 94.1% None 85.7% 2x wk 72.7% Daily
Chawarski⁴⁸, 2011, China	Daily medication (DM) vs DM plus weekly drug and HIV counseling (DM plus)	Heroin-dependent; 37 (81.0)	MET	In MAT at 6 months	No difference: 83.3% DM plus 76.2% DM
Jaffray⁴⁹, 2014, Scotland	Pharmacies randomized to intervention (pharmacists received motivational Interviewing [MI] training & resources) vs UC	Mainly unemployed; 76 pharmacies; 542 patients (63.6)	MET	In MAT at 6 months	No difference: 88% MI 81% UC
Marsch⁵⁰, 2013, USA	MAT+counseling vs MAT+reduced counseling+ web-based education	New to MAT; 160 (75.0)	MET	In MAT at 12 months	No difference: 38.7% overall
Schwartz⁵¹, 2011, USA	Interim (daily administration +emergency counseling; counseling; I) vs standard (take-home administration +regular counseling; S) vs restored (S+counselor reduced caseload; R); 2 sites	New to MAT; 230 (70.0)	MET	In MAT at 4 months	No difference: 91.9% I 80.8% S 88.9% R
Schwartz⁵², 2011, USA	I vs S vs R	On MAT program wait list; 230 (70.0)	MET	In MAT at 12 months	No difference: 60.6% I 54.8% S 37.0% R
Ling⁵³, 2013, USA	CBT vs CM vs CBT+CM vs no behavioral treatment	Community and treatment settings; 202 (69.3)	BUP	In behavioral treatment at 4 months	No difference: 71.7% CBT 69.4% CM 73.5% CBT+CM 64.7% None
Mitchell⁵⁴, 2013, USA	Outpatient (OP) counseling vs intensive outpatient (IOP) counseling	African-Americans starting MAT; 300 (62.3)	BUP	In MAT at 6 months	No difference: 58.7% OP 56.6% IOP
Ruetsch⁵⁵, 2012, USA	Telephone support (TS) vs vs UC (324 provider sites)	New to MAT; 1426 (59.0)	BUP	In MAT at 12 months	No difference: 55.0% TS 56.1% UC
Tetrault⁵⁶, 2012, USA	Physician management (PM) vs PM+enhanced medical management (EMM)	HIV+; 47 (83.0)	BUP/NLX	In MAT at 3 months	No difference: 80.0% PM 59% PI+EMM
Jones⁵⁷, 2011, USA	Helping (motivational enhancement therapy, education, case and contingency management) vs control (support group)	Non-treatment seeking partners of opioid-dependent pregnant women; 62 (100)	Detox plus aftercare or MET	Days of treatment (most commonly MAT), past month, up to 30	No difference: H; M=15.2 (SD=2.0) C; M=14.9 (SD=6.4)
Coviello⁵⁸, 2010, USA	NTX plus psychosocial treatment only; all were under judicial supervision	Offenders; 111 (82.0)	NTX	In treatment (MAT or psychosocial) at 6 months	No difference: 32.0% NTX 29.0% psychosoc

Note: Reported retention rates within studies are significantly different unless otherwise noted. BUP = buprenorphine, NTX = naltrexone, MET = methadone, NLX = naloxone; P = placebo, Med = median, inj = injectable, HAT = heroin-assisted treatment, CBT = cognitive behavioral therapy, I = interim, S= standard, R = restored, M = mean, SD = standard deviation