Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification

Laura Amato; Silvia Minozzi; Marina Davoli; Simona Vecchi; Marica Ferri; Soraya Mayet

doi:10.1002/14651858.CD005031.pub3

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Figure 1

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Analysis 1.1

Comparison 1 Any Psychosocial plus any Pharmacological detoxification Intervention versus any Pharmachological alone, Outcome 1 Completion of treatment.

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Analysis 1.2

Comparison 1 Any Psychosocial plus any Pharmacological detoxification Intervention versus any Pharmachological alone, Outcome 2 Use of primary substance.

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Analysis 1.3

Comparison 1 Any Psychosocial plus any Pharmacological detoxification Intervention versus any Pharmachological alone, Outcome 3 Number of subjects abstinent at follow‐up.

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Analysis 2.1

Comparison 2 Any Psychosocial Intervention plus MDT versus MDT alone, Outcome 1 Completion of treatment.

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Analysis 2.2

Comparison 2 Any Psychosocial Intervention plus MDT versus MDT alone, Outcome 2 Use of primary substance.

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Analysis 2.3

Comparison 2 Any Psychosocial Intervention plus MDT versus MDT alone, Outcome 3 Number of subjects abstinent at follow‐up.

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Analysis 2.4

Comparison 2 Any Psychosocial Intervention plus MDT versus MDT alone, Outcome 4 Compliance as clinic absences during the treatment.

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Analysis 3.1

Comparison 3 Contingency Management Approaches plus MDT versus MDT alone, Outcome 1 Completion of treatment.

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Analysis 3.2

Comparison 3 Contingency Management Approaches plus MDT versus MDT alone, Outcome 2 Compliance as clinical absences during the treatment.

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Analysis 4.1

Comparison 4 Contingency Management Approaches plus BDT versus BDT alone, Outcome 1 Use of primary substance.

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any pharmacological detoxification treatment plus psychosocial compared to any pharmacological treatment alone for opioid dependent requiring detoxification
Patient or population: patients with opioid dependent requiring detoxification Settings: outpatient and inpatient Intervention: any pharmacological detoxification treatment plus psychosocial Comparison: any pharmacological treatment alone
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	any pharmacological treatment alone	any pharmacological detoxification treatment plus psychosocial
Completion of treatment (follow‐up: mean 18 weeks)	Low risk population		RR 1.68 (1.11 to 2.55)	184 (5)	^1,2
	253 per 1000	425 per 1000 (281 to 645)
use of opiate during treatment (follow‐up: mean 018 weeks)	Low risk population		RR 0.82 (0.71 to 0.93)	320 (4)	⊕⊕⊕⊝ moderate^2,3

	Medium risk population
	790 per 1000	648 per 1000 (561 to 735)
relapsed at follow‐up (follow‐up: mean 18 weeks)	Medium risk population		RR 0.41 (0.27 to 0.62)	208 (3¹)	⊕⊕⊕⊝ moderate^2,4

The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidance High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Four studies with unclear allocation concealment and one inadequate; 2 studies were single blind and 3 did not report data on blindness ² All studies were conducted in USA ³ Four studies with unclear allocation concealment ⁴ All studies with unclear allocation concealment, 2 single blind, 1 not blind

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Comparison 1. Any Psychosocial plus any Pharmacological detoxification Intervention versus any Pharmachological alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Completion of treatment Show forest plot	5	184	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [1.11, 2.55]

2 Use of primary substance Show forest plot	4	320	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.71, 0.93]

3 Number of subjects abstinent at follow‐up Show forest plot	3	208	Risk Ratio (M‐H, Fixed, 95% CI)	2.43 [1.61, 3.66]

Comparison 1. Any Psychosocial plus any Pharmacological detoxification Intervention versus any Pharmachological alone

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Comparison 2. Any Psychosocial Intervention plus MDT versus MDT alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Completion of treatment Show forest plot	4	145	Risk Ratio (M‐H, Fixed, 95% CI)	1.48 [0.93, 2.35]

2 Use of primary substance Show forest plot	2	70	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.44, 1.07]

3 Number of subjects abstinent at follow‐up Show forest plot	2	169	Risk Ratio (M‐H, Fixed, 95% CI)	2.46 [1.61, 3.76]

4 Compliance as clinic absences during the treatment Show forest plot	3	1138	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.38, 0.59]

Comparison 2. Any Psychosocial Intervention plus MDT versus MDT alone

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Comparison 3. Contingency Management Approaches plus MDT versus MDT alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Completion of treatment Show forest plot	3	95	Risk Ratio (M‐H, Fixed, 95% CI)	1.51 [0.93, 2.46]

2 Compliance as clinical absences during the treatment Show forest plot	2	196	Risk Ratio (M‐H, Fixed, 95% CI)	0.29 [0.15, 0.56]

Comparison 3. Contingency Management Approaches plus MDT versus MDT alone

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Comparison 4. Contingency Management Approaches plus BDT versus BDT alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Use of primary substance Show forest plot	2	250	Risk Ratio (M‐H, Random, 95% CI)	0.85 [0.74, 0.97]

Comparison 4. Contingency Management Approaches plus BDT versus BDT alone

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