LAUSR

AIMS To estimate the efficacy of multiple psychosocial interventions for opioid dependent persons receiving methadone maintenance treatment (MMT). METHODS Systematic review and network meta-analysis of randomized controlled trials (RCTs) reporting the effect of psychosocial intervention for opioid dependent persons receiving MMT in outpatient clinics. We searched multiple data sources (Medline, Embase, Web of Science, PsycINFO and Cochrane Library) from inception to January 2022, finding 21 RCTs evaluating a total of 2862 persons with opioid dependence receiving MMT. The primary outcome was the opioid positive rate (assessed by urinalysis) and the secondary outcome was treatment discontinuation (the number of patients who terminated the study for any reason). We performed random effects Bayesian meta-analysis. We used relative ranking using surface under the cumulative ranking method and certainty of evidence using grading of recommendations, assessment, development, and evaluations. RESULTS Cognitive-behavioral therapy (CBT) [Odds Ratio (OR): 0.66, 95% Credibility Interval (CI): 0.66 to 0.96; low certainty] and educational and behavioral counseling (EBC) (OR: 0.28, 95% CI: 0.12 to 0.25; high certainty) were more effective than treatment as usual (TAU) in efficacy. In terms of treatment discontinuation, at the end of the follow-up period there was no statistical significance among psychosocial interventions. According to the ranking probabilities, EBC might be the best treatment in terms of efficacy and behavioral couple therapy (BCT) might be the best treatment in terms of treatment discontinuation. CONCLUSIONS Educational and behavioral counseling and cognitive-behavioral therapy appear to be the most effective psychosocial interventions for opioid dependent persons receiving methadone maintenance treatment.