Rapid upscale of depot buprenorphine (CAM2038) in custodial settings during the early COVID-19 pandemic in New South Wales, Australia.

Abstract

The COVID-19 pandemic has highlighted the need for novel approaches to ensure ongoing provision of treatment for opioid dependence in the community [1, 2]. The pandemic also presents enormous public health challenges in correctional settings [3-5], with a recent report from the United States finding the COVID-19 mortality rate three times higher than in the general population [6]. The prevalence of opioid dependence is also substantially higher in correctional settings than in the community [7]. In early 2020, a range of measures were introduced to reduce the risk of SARS CoV-2 infections in correctional centres in NSW, Australia, including suspension of face-to-face social visits [8]. This was associated with a reduction in illicit sublingual buprenorphine–naloxone availability, the most frequently injected drug in NSW prisons [9, 10], resulting in a rapid increase in demand for opioid agonist treatment (OAT) [11]. This further escalated the existing demand for a newly available treatment, long-acting depot buprenorphine, arising from positive results of a trial of CAM2038 completed in late 2019 in 67 patients that found a comparable safety and effectiveness profile to other OAT in this setting [12]. Based on trial findings, prior to the COVID-19 pandemic, depot buprenorphine had become the first-line treatment option for new commencements on OAT unless clinically contraindicated. With COVID-19 diagnoses in the community increasing, all patients on sublingual buprenorphine–naloxone were transferred to depot buprenorphine, as monthly rather than daily dosing would reduce the resources required for OAT delivery and increase availability of staff for other clinical activities. This also minimized the impact of probable increases in lock-downs either due to infection risk or impact staff needing to self-isolate due to fever, respiratory symptoms and/or close contact with known cases. In the context of surging COVID-19 related activity, scale-up of depot buprenorphine was achieved through high-level cooperation between custodial and health services. Between January and June 2020, the average number of patients per month in OAT was 1250. During this period, while methadone remained the most commonly prescribed OAT, the remaining proportion of the OAT programme changed from 14% buprenorphine (sublingual) to 45% buprenorphine (depot), and by late July 2020 more than 800 patients had received depot buprenorphine treatment throughout NSW correctional centres. Our experience suggests that depot buprenorphine could be considered for widespread rapid scale-up of OAT in custodial settings, a key high-risk environment during a global pandemic. None. Jillian Roberts: Conceptualization; data curation. Bethany White: Conceptualization; data curation. Dena Attalla: Conceptualization; data curation. Adrian Dunlop: Conceptualization; data curation. Stephen Ward: Conceptualization; data curation.