BUP - booster: behavioral optimization for overcoming suboptimal treatment retention

The National Institute on Drug Abuse awarded the Trustees of Boston University (doing business as Boston University Medical Campus) $3,585,871 on September 30, 2025, under the Drug Use and Addiction Research Programs (CFDA 93.279) to develop and test a multicomponent behavioral intervention designed to improve buprenorphine treatment retention.

The study, titled "BUP-BOOSTeR: Behavioral Optimization for Overcoming Suboptimal Treatment Retention," will recruit 240 persons initiating buprenorphine from office-based addiction treatment settings and randomize them in a factorial design to test three psychosocial intervention components: behavioral activation focused on increasing positive reinforcing activities to promote recovery; attendance reinforcement that incentivizes attendance at nurse visits in addiction care; and peer motivational interviewing to increase confidence in continuing buprenorphine treatment and provide social support. The study will examine main and interaction effects of these components on treatment retention at six months and will use mediation analyses to assess whether each component affects hypothesized mechanisms of action. Performance occurs in Roxbury, Massachusetts, with work extending through May 31, 2030.

Stanley Street Treatment & Resources, Inc. serves as a sub-recipient, with Dr. Bailey functioning as site principal investigator and supervising a Research Assistant responsible for patient screening, recruitment, enrollment, and baseline and follow-up data collection at the Stanley Street site. Butler Hospital, a division of Care New England Health System, serves as a second sub-recipient, with Dr. Uebelacker functioning as site principal investigator and assuming primary responsibility for overseeing the behavioral activation component, including selection, training, and supervision of interventionists. Both sub-recipients' institutional review boards will cede review to Boston University Medical Campus as the IRB of record.

Abstract

Buprenorphine, a medication for opioid use disorder (MOUD), is associated with decreased opioid overdose and all-cause mortality. Treatment outcomes improve if patients remain on MOUD for at least six months, a period recommended by expert guidelines. Despite this, MOST studies report retention on MOUD of 50-65% at 3-6 months, with MOST treatment drop out occurring during the first month of treatment. Psychosocial interventions have the potential to improve OUD treatment retention particularly when applied in combination in efficient delivery systems. The objective of this study is to develop an effective and efficient multicomponent intervention to increase buprenorphine retention at 6 months through an optimization trial. We will leverage the multiphase optimization strategy (MOST) framework for developing, optimizing, and evaluating a multicomponent behavioral intervention. We will test the impact of three psychosocial intervention components on buprenorphine treatment retention at six months by recruiting 240 persons initiating buprenorphine from office-based addiction treatment settings and randomizing them in a balanced 23 factorial design to 1) brief advice to continue treatment for at least 6 months (usual care); 2) behavioral-activation (BA)-focused on increasing positive reinforcing activities and experiences to promote recovery; 3) attendance reinforcement (AR)- incentivizing attendance at nurse visits in addiction care; and 4) PEER motivational interviewing (PEER-MI) -increasing confidence to continue buprenorphine treatment and providing social support. The observed main and interaction effects for the 3 candidate psychosocial interventions will guide the selection of components to be included in an optimized intervention. Using mediation analyses, we will examine whether each component affects the hypothesized mechanism of action and whether hypothesized mechanisms account for observed changes in buprenorphine retention. Results from this study will be twofold: 1) IT will improve our understanding of mechanisms by which psychosocial component interventions improve buprenorphine MOUD treatment retention and 2) prepare the scientific team to conduct a future randomized controlled trial of the optimized intervention package. The long-term impact will be to establish tangible and disseminatable methods to improve MOUD retention.