Injectable Buprenorphine Research Articles

Opioid treatment (OT) is highly effective for managing opioid use disorder (OUD) but remains underutilised worldwide, including in Australia. This issue is especially pronounced in regional and rural areas; however, there has been limited research focused on the unique barriers to OT access outside of metropolitan centres. In Queensland (QLD), Australia, OT is largely community-based, with dosing, prescription and supply all occurring outside hospital settings. The state's vast size and regional spread create unique access challenges, especially given jurisdictional differences in prescriber regulations across Australia. The present study aimed to identify barriers to OT access in rural QLD. This study employed semi-structured interviews with 12 participants, including five clinicians working in the OT and seven consumers residing in rural QLD who were currently receiving OT for OUD. Transcripts were analysed thematically. Four themes were identified that articulate the primary barriers to OT: (i) restrictive dosing practices; (ii) stigma and social perceptions; (iii) overstretched access; and (iv) gaps in continuity and personalisation of care. Rurality shapes treatment access not only through geographic isolation and limited infrastructure, but also through regulatory inconsistencies across regions, restricted service flexibility and the heightened visibility of individuals within small communities. These insights underscore the need for more localised, equity-focused policy responses and further research into new alternative interventions, such as telehealth and strategies to enhance the acceptance and uptake of long-acting injectable buprenorphine.

Long-acting, injectable buprenorphine (LAIB) is a recently introduced opioid agonist treatment (OAT) for opioid dependence in Australia. Little research has been performed for its role in opioid withdrawal management. A retrospective analysis of hospital patient records was conducted for five patients who received a single dose of LAIB as part of an inpatient or outpatient opioid withdrawal management program. Patients analysed had tried and failed conventional opioid withdrawal management and were unwilling to commence or continue an OAT program. Patient demographics including types of opioid use and inpatient lengths of stay are reported. Patient withdrawal symptoms before treatment and during follow-up periods are also described. Overall, most patients were satisfied with a single dose of LAIB to adequately control withdrawal symptoms in the community. Given the stability of OAT patients on LAIB, it was inferred that some patients may do well in opioid withdrawal management using LAIB, should other conventional treatments not succeed. This was based on previous pharmacokinetic data and modelling by others which would allow for a slow, invivo wean of the drug rather than discrete, daily dose reductions. For patients, this could reduce potential withdrawal symptoms and shorten admission lengths in hospital withdrawal management wards. Further research is needed to verify these results, but these preliminary data are encouraging.

BackgroundGrowing evidence supports long-acting injectable (LAI) buprenorphine in opioid use disorder treatment. Implementation is limited due to concerns about costs as well as potential reduction of support, which could increase strain on health care services. This real-life study follows clinical patients one year prospectively and one year retrospectively from switching from daily sublingual or peroral opioid agonist treatment (OAT) to LAI buprenorphine exploring how this impacts days of inpatient care and emergency room (ER) visits.MethodsFrom electronic medical records, from four Swedish OAT clinics, we identified all patients (n=128) who had switched from sublingual or peroral OAT, to LAI buprenorphine during the first two years of implementation (2019-2021 in three clinics, 2021–2023 in the fourth). In this within-subject mirror study, patients served as their own controls. The number of days of inpatient care and ER visits were extracted from the electronic medical records using a standard operating procedure. Quasi-Poisson models were used to compare health care utilization before and after starting LAI buprenorphine.ResultsAmong the 128 patients, 28 (22%) were female and mean age was 37.8 (SD 9.0) years. Days of inpatient care were reduced by half, dropping from an average of 9.0 to 4.5 days (incidence rate ratio [IRR]: 0.5, 95% CI 0.41–0.61, p<.001), with a health care cost reduction of SEK 45,081 (~USD 4,090) per patient. The decline in days of inpatient care was even steeper among the 85 patients who remained on LAI buprenorphine treatment at 12 months (IRR 0.26, 95% CI 0.20–0.34, p<.001), with a decrease in health care costs of SEK 73,210 (~USD 6,642) per patient. ER visits showed no significant change (IRR: 0.93, 95%CI 0.79 - 1.09). One-year treatment retention to LAI buprenorphine was high (67%). Most patients who discontinued LAI buprenorphine transitioned to other sublingual/peroral forms of OAT, resulting in an overall OAT continuation rate of 89%.ConclusionsImplementation of LAI buprenorphine in OAT clinical settings was associated with a significant reduction in inpatient care and substantially reduced health care costs. These results challenge common economic hesitations and support wider integration of LAI options in opioid use disorder treatment.Clinical trial numberNot applicable.

Results of a newly published study suggest that patients with moderate to severe opioid use disorder (OUD) could benefit from a rapid induction protocol in which they receive a same‐day dose of injectable buprenorphine.

Standard induction (SI) using transmucosal buprenorphine-naloxone is challenging in individuals who inject opioids, use high doses of opioids, or use synthetic opioids (eg, fentanyl). To compare the effectiveness and safety of rapid induction (RI; single 4-mg dose of buprenorphine-naloxone) vs SI (≥7 days of buprenorphine-naloxone) followed by extended-release buprenorphine injection. This multicenter, open-label randomized clinical trial was conducted from October 26, 2021, to January 19, 2024, at 28 outpatient treatment centers in the US and Canada. Treatment-seeking participants with moderate or severe opioid use disorder who inject opioids, use high doses of opioids, or use fentanyl were studied. Participants were randomized 2:1 to RI or SI before 300-mg injection of extended-release buprenorphine. The primary end point, retention rate difference at injection 2 (1 week after injection 1), was estimated by a bayesian approach. Posterior probability was estimated for noninferiority of RI to SI (RI - SI >-10%) and superiority (RI - SI >0%). Adverse events (AEs), including investigator-assessed opioid withdrawal symptoms, were reported. Subgroup analyses compared participants with positive or negative fentanyl urine drug screen results. Analyses included 729 randomized participants (mean [SD] age, 40.7 [10.4] years; 406 [55.7%] male) who initiated transmucosal buprenorphine per protocol, including 474 in the RI arm and 255 in the SI arm. A total of 560 participants received extended-release buprenorphine injection 1 (409 [86.3%] in the RI arm and 151 [59.2%] in the SI arm), and 452 received injection 2 (314 [66.2%] in the RI arm and 138 [54.1%] in the SI arm). At injection 2, RI was noninferior with higher retention than SI (difference, 11.8%; 95% credible interval [CrI], 4.3%-19.0%; posterior probability greater than 0 was 99.9%). Similarly, among participants with a positive test result for fentanyl, the retention rate differential in favor of RI was 14.8% (95% CrI, 6.5%-23.7%; posterior probability greater than 0 was greater than 99.9%). AE incidence was not statistically different between RI and SI participants (202 [42.6%] vs 93 [35.5%]; difference, 6.1%; 95% CrI, -1.3% to 13.4%). Up to injection 2, most AEs were associated with opioid withdrawal. In this multicenter randomized clinical trial, RI had higher retention than SI overall and in patients who tested positive for fentanyl through extended-release buprenorphine injection 2. Administration of injection 2 after 1 week was well tolerated and minimized time below target therapeutic levels of 2 ng/mL or greater compared with injection after 1 month. ClinicalTrials.gov Identifier: NCT04995029.

Extended-release injectable buprenorphine for the treatment of opioid use disorder among individuals at high risk of overdose: The FASTER-BUP udy.

Long-Acting injectable buprenorphine PLGA microparticle formulation.

Feasibility of direct induction onto long-acting injectable buprenorphine.

Long acting (or extended release) injectable buprenorphine formulations for the treatment of opioid dependence have been introduced in a number of countries in recent years. One such product, Buvidal, available as Weekly or Monthly subcutaneous injections, has been increasingly used in many European countries and Australia for several years, and has recently been registered under the brand name Brixadi in the United States. This review provides an overview of opioid dependence, examines the rationale for the development of Buvidal, its pharmacological properties, evidence of efficacy and safety, and key principles of clinical care in the treatment of opioid dependence. Particular attention is given to issues of pain management, pregnancy, and treatment in custodial settings. This long-acting injectable buprenorphine product is an important addition to the available options for the treatment of opioid dependence, providing a safe and effective alternative to treatment with medications requiring daily dosing.

Injectable buprenorphine during transition out of prison: A pilot partially randomized preference trial protocol.

IntroductionAssociations between substance use and unemployment are well established but complex. People dependent on opioids often want to work but encounter barriers, including requirements to attend services and/or pharmacies frequently. Long-acting injectable buprenorphine (LAIB) is a new pharmacological treatment for opioid use disorder, which reduces such attendance requirements. Studies indicate positive associations between LAIB treatment and employment, but there has been no detailed analysis of this topic.MethodsLongitudinal qualitative interviews were conducted with 26 people (18 males; 8 females) initiating LAIB in English and Welsh drug treatment services. Participants were interviewed by telephone up to six times over a year (125 interviews in total). Interview data were used to produce narrative accounts of each participant’s work-related experiences. These accounts were then combined and analysed via Iterative Categorization.ResultsParticipants reported mixed education and employment histories. At first interview, three had full-time jobs, three were students, one worked occasionally, and nineteen were not working. Participants who remained on, or completed, their LAIB treatment reported ongoing work and education or new work-seeking activities, temporary/part-time work, or volunteering. Participants who discontinued LAIB did not start any new education, training or work during their time in the study. Most participants wanted to work but identified barriers to employment and little help with job-seeking. Participants confirmed that LAIB facilitated employment because they did not have to attend pharmacies so often and felt physically and psychologically more able to work. Nonetheless, they sometimes felt unwell after initiating LAIB, which interrupted work and study and made them reluctant to reduce their LAIB treatment later.ConclusionLAIB may help drug treatment patients who are interested in securing employment or achieving broader employment-related outcomes, such as education, training and volunteering. However, patients receiving LAIB may also need personalized employment support to assist them with wider barriers to working.

Implications of the fragility of opioid agonist treatment continuity on hepatitis C re-exposure concerns among people in prison: a qualitative study.

Extended-release buprenorphine (XR-BUP) is a long-acting injectable medication used for the treatment of opioid use disorder (OUD). It is currently approved for use in patients who have been administered at least seven days of sublingual buprenorphine (SL-BUP). For patients with OUD who are unstable (ie, not at treatment goal, with active opioid use) or not yet on medication for OUD (MOUD) such as SL-BUP, the emergency department (ED) setting is an essential location for access to treatment. There is, as yet, no research on the utility of on-demand XR-BUP administration in the ED. We performed a retrospective cohort study of individuals with OUD who received XR-BUP in the ED through our novel reallocation pathway. We reviewed charts from an addiction medicine specialty outpatient clinic to determine retention in treatment, continuation on XR-BUP, and reported quantitative analysis. Our primary outcome was retention in treatment, measured by subsequent XR-BUP injection after initial ED XR-BUP administration. The secondary outcome was the reason for ED administration of XR-BUP (as opposed to administration in the clinic setting). Our study population included 69 patients (68.2% male). Our primary outcome showed that 51 (73.9%) patients who had their first injection in the ED received a second XR-BUP injection and 40 (58%) received their third XR-BUP injection. Our secondary outcome showed that 7.2% had barriers with access to treatment; however, most of the patients received the injection due to instability of the treatment of the OUD (69.6%). These patients were either unable to adhere to MOUD, reported issues with the prescription, or were still using substances while on MOUD. For 52 (75%) patients, the index ED injection was their first ever XR-BUP injection. Logistical regression analyses demonstrated that clinical and demographic factors did not lead to increased attrition, while patients with other co-occurring substance use disorders were more likely to present for follow-up treatment. In our retrospective study, patients who received ED-initiated extended-release buprenorphine had a strong retention rate compared to previous studies evaluating ED-initiated sublingual BUP (retention rates ranging from 16.7-60%). The ED provided a convenient healthcare access point for XR-BUP initiation. The XR-BUP is a helpful tool for achieving induction after failed SL-BUP initiation and may have further implications in minimizing treatment gaps after discharge and improving OUD treatment retention.

Randomized, placebo-controlled trial of injectable extended-release naltrexone and injectable extended-release buprenorphine for cocaine use disorder (CURB-2): Study rationale and design.

PCR83 Treatment Preferences Related to Long-Acting Injectable Buprenorphine Among Patients With Opioid Use Disorder in Australia, Finland, Germany, and Italy

The inpatient addiction medicine consult team at West Suburban Medical Center started administering long-acting injectable buprenorphine (LAIB) to hospitalized patients in response to low rates of patients continuing treatment with sublingual buprenorphine after discharge. The aims of this study are to understand patients' motivations to receive LAIB during hospitalization and their experiences with the medication after discharge. We conducted semi-structured interviews with patients who received LAIB while hospitalized between August 2022 and April 2023. Inductive analysis was used to identify themes and develop the codebook. Two researchers independently coded each interview and refined the codebook with oversight from 2 senior members of the research team. After the coding team reviewed each interview together to arrive at a joint consensus, a third coder found concordance in a random sample of interviews. Finally, the entire research team met to discuss key themes. Eighteen participants were interviewed between March and May 2023. The following key themes emerged: (1) limited knowledge and access to LAIB before hospitalization, (2) the role of peer support specialists in deciding to start LAIB while hospitalized, (3) fears around an increasingly unpredictable drug supply and personal experience with overdose as motivations to receive LAIB, (4) benefits of LAIB in multiple areas of participants' lives, and (5) negative aspects of LAIB. Our participants' overall positive experiences with hospital-administered LAIB should inform policymakers and payors to support the expansion of this model and the exploration of additional strategies to lower barriers to LAIB access.

Buprenorphine treatment for opioid-use disorder (OUD) is commonly available in both sublingual tablets/films and extended-release subcutaneous injections; however, little is known about differences in patient retention between these two buprenorphine formulations. This study measured retention differences between patients who transitioned from sublingual to subcutaneous injectable buprenorphine and those who remained on sublingual buprenorphine throughout treatment, within a multi-location outpatient addiction treatment practice. This study was an observational propensity score-matched cohort study conducted at a multi-location outpatient addiction practice in Maryland, USA. Participants included 3609 patients receiving buprenorphine treatment for OUD between June 2019 and February 2024. Patient demographics, health history and urine toxicology results. The primary outcome was time-to-dropout in days. Kaplan-Meier and Cox Proportional Hazard models with propensity score matching were used to compare treatment retention between injectable and sublingual buprenorphine receipt. Overall, 538 patients at the time of their first extended-release buprenorphine injection (INJ) were matched with 538 patients only receiving sublingual buprenorphine (SUB-only). In the unmatched sample, INJ patients were more likely than SUB-only patients to be female (INJ 47.2% vs SUB-only 38.7%, P < 0.001) and more likely to have at least an associate's degree (41.4% vs 33.9%, P < 0.001). After matching, patients who transitioned to INJ buprenorphine had lower retention in treatment compared with patients who remained on SUB buprenorphine. Median (95% confidence interval) time-to-dropout was 269 days (218-313) for INJ patients compared with 389 days (313-592) for SUB-only patients (stratified log-rank test = 13.6, P < 0.001). Among patients receiving medication treatment for opioid use disorder in an outpatient setting, those who transitioned from sublingual to subcutaneous injectable buprenorphine were at an increased risk for dropout compared with matched patients who only received sublingual buprenorphine.

For patients with opioid use disorder, Sublocade (extended-release buprenorphine; Bup-XR-S) and Buvidal/Brixadi (long-acting buprenorphine; Bup-LA-B) formulations allow for less frequent dosing. Traditional induction with Bup-XR-S requires 7 or more days on transmucosal buprenorphine can delay care and increase disengagement risk. Quicker transition to Bup-XR-S or Bup-LA-B presents a promising strategy. With the prevalence of potent illicit opioids, stabilization within 7 days is critical to prevent overdose and withdrawal. This narrative review assesses outcomes of transitions to long-acting injectable buprenorphine within 7 days of the last sublingual dose. A systematic search of MEDLINE and EMBASE was completed through February 14, 2025. Studies involving patients with opioid use disorder who underwent Bup-XR-S and Bup-LA-B transition were included. Data on patient characteristics, buprenorphine dosing, retention rates, and outcomes were extracted and synthesized. We identified 21 studies, totaling 534 patients, that met our inclusion criteria. For Bup-XR-S studies, 75 patients transitioned to Bup-XR-S within 24 hours. Of patients, 4% experienced withdrawal symptoms requiring additional opioid support. All Bup-LA-B studies reported transitions within 24 hours. Short-term retention (4 wk) exceeded 60%. Adverse events were infrequent and primarily mild, including injection site pain, nausea, and constipation. Limited descriptive studies suggest transitioning to Bup-XR-S within 7 days appears feasible, well-tolerated, and supports treatment adherence. Following labelled dosing, Bup-LA-B transitions within 24 hours were effective and well-tolerated. While these approaches may help initiate opioid agonist therapy in high-risk populations and mitigate overdose risks, further research is needed to confirm effectiveness and impact on retention.

Barriers to accessing medications for opioid use disorder among rural individuals.

Aims: Long-acting buprenorphine has been explored in context of its use in opioid dependence, however its potential for managing self-harm behaviour is limited. Self-harming behaviour often signals extreme emotional distress. This case report brings an insight into the effectiveness of injectable buprenorphine in a person with extreme self-harm behaviour.Methods: Miss SD, 30-year-old single, unemployed woman, with history of emotional abuse, sexually abused by father from the age 6–8 and mother having difficulties with alcohol abuse. She has been involved with Psychiatric services from the age of 13 and had several Psychiatric hospital admissions, transfer to low secure Forensic unit and step down to supported accommodation. Having difficulties with self-harming behaviours, suicidal thoughts or attempts and aggression towards staff. Self-harm behaviour included cutting, overdoses, ligatures; to an extent she needed multiple surgical interventions for cutting, inserting glass and glueing the genitalia multiple times, along with glueing nose and lips.Over the course her diagnoses included EUPD, PTSD, Depressive disorder, transient Psychotic episodes, alcohol dependence and polysubstance misuse.Due to escalating behaviour she was trialled on injectable buprenorphine as off-licence use for self-harming behaviour. We have compared the data of 2 years on injectable buprenorphine to history prior to that.Initiation on buprenorphine treatment had a dramatic improvement in Miss SD given the number of incidents of both alcohol use and self-harm.Results: Buprenorphine treatment had a greater reduction in self-harming behaviour in Miss SD. There have been only 1–2 episodes of self-harm per year since she started on buprenorphine i.e, in last 2 years, when compared with the several episodes a week. In addition the number of hospital admissions reduced to 2 brief admissions, compared with several admissions including long stay in Low Secure Unit.Recurrent self-harm can have an endogenous opioid response, and in the long term the pattern is similar to addiction.Buprenorphine is a partial μ-opioid receptor agonist and a potent kappa antagonist, and treatment with long-acting opioid antagonist could block the reward of enhanced endogenous opioids caused by self-harming behaviours and subsequently lead to their extinction.Conclusion: A retrospective case study of Miss SD since the initiation of buprenorphine suggests this may be an alternative therapeutic option to treat people with significant Self-harming behaviour with functional impairment. In addition it is much safer as it causes less respiratory depression than other opioids.The evidence is promising, however more research is needed to review the effectiveness, establish efficacy, and safety.