Patient-Reported Outcomes of Treatment of Opioid Dependence With Weekly and Monthly Subcutaneous Depot vs Daily Sublingual Buprenorphine

Lintzeris, Nicholas; Dunlop, Adrian; Haber, Paul; Lubman, Dan I.; Graham, Robert J.; Hutchinson, Sarah; Arunogiri, Shalini; Hayes, Victoria; Hjelmström, Peter; Svedberg, Agneta; Peterson, Stefan; Tiberg, Fredrik

doi:10.1001/jamanetworkopen.2021.9041

Cited by 73 publications

(57 citation statements)

References 38 publications

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“…An open label RCT conducted in Australia [ 25 ] indicated higher treatment satisfaction, measured with the Treatment Satisfaction Questionnaire, in 60 patients receiving depot injections, compared with 59 treated with sublingual buprenorphine naloxone. Although injections site reactions were more frequent of those treated with depot injections (65%) compared to those treated with sublingual formulations (20%), no patients discontinued trial medication due to adverse events.…”

Section: Introductionmentioning

confidence: 99%

Patient perspectives on depot buprenorphine treatment for opioid addiction – a qualitative interview study

Johnson

Flensburg

Capusan

2022

Subst Abuse Treat Prev Policy

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Background Recently developed buprenorphine depot injections have the potential to reduce risk for diversion and misuse, and to increase adherence with fewer visits for supervised intake. However, it is unclear how patients perceive this new form of medication. The purpose of this study was to explore patients’ experiences of depot injections and their reasons for continuing, discontinuing, or declining depot injection treatment. Methods We conducted semi-structured qualitative interviews with 32 people, 14 of whom had ongoing depot injection treatment, 11 who had discontinued depot-injections and switched to other medication and seven who had declined treatment with depot formulations. Interviews were transcribed, coded, and analysed using NVivo, based on this overall stratification into three participant groups. Results The main categories relate to the effects and side effects of the depot formulation, social and practical factors, psychological benefits and disadvantages, and interactions with treatment staff. Social and practical factors were of importance for choosing depot formulations, such as increased freedom and their making it easier to combine treatment with work and family life, as well as psychological advantages including “feeling normal”. Initial withdrawal symptoms that resolved themselves after a number of injections were reported by most participants. Reliable information and patient-staff relationships characterized by trust helped patients to cope with these initial problems. Those who discontinued treatment often did so near the beginning of the treatment, reporting withdrawal symptoms and insufficient effects as the main reasons. Coercion and insufficient information contributed to a negative pharmaceutical atmosphere at one of the clinics, which may have adversely influenced perceptions of depot formulations and decreased willingness to accept and continue treatment. Conclusions Buprenorphine depot injections may have social, practical, and psychological benefits compared to other formulations. However, depot injections are not perceived as an attractive option by all patients. Trust, consistent and adequate information, and awareness of the implications of the pharmaceutical atmosphere should be considered when introducing new medications.

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Section: Introductionmentioning

confidence: 99%

Patient perspectives on depot buprenorphine treatment for opioid addiction – a qualitative interview study

Johnson

Flensburg

Capusan

2022

Subst Abuse Treat Prev Policy

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“…These long-acting buprenorphine formulations, such as the subdermal implant, as well as subcutaneous depot formulations, have the potential to reduce the risk of diversion [40]. The new depot buprenorphine formulations were found to be non-inferior to sublingual drugs, as well as more effective than a placebo, in reducing opioid use, and it is the preferred formulation vs. the sublingual one in the latest trial [41,42]. Depot buprenorphine, in custodial settings, showed treatment retention and outcomes, comparable to those observed in community settings and for other opioid agonist treatment used in custodial settings, without increased risk of diversion [43].…”

Section: Discussionmentioning

confidence: 99%

Multicenter Observational/Exploratory Study Addressed to the Evaluation of the Effectiveness and Safety of Pharmacological Therapy in Opioid-Dependent Patients in Maintenance Therapy in Southern Italy

et al. 2022

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A multicenter-observational study was performed to assess the effectiveness of rac-methadone, levomethadone, and buprenorphine in opioid-dependent patients in polytherapy in Southern Italy. The primary endpoint was the reduction of urinary positivity to the substances and the maintaining doses. Patients (N = 266, age = 44.80 ± 5.65, male = 79.70%, female = 20.30%) have been recruited. At recruitment, 75% of them were on treatment with rac-methadone, levomethadone, and buprenorphine/naloxone. The patients were grouped into three clusters. The levomethadone patients of Cluster A (N patients = 211), after 180 days, showed stability in urinary methadone positivity, with a marked decrease in heroin −53 ± 4%, cannabinol’s −48 ± 2%, and cocaine −37 ± 6% positivity, with no differences between treatments. A lower QTcF value of 426 ± 8.4 ms was recorded in the levomethadone patients (delta = −19 ms) vs. rac-methadone, at significantly lower doses of levomethadone (−34%, −50.2% in males) (p < 0.05). The Cluster B data were collected from 37 patients, with a high prevalence of comorbidity infections (HIV/HCV/HPV), monitored for 21 months during COVID-19. High doses of levomethadone (58.33 ± 31.58 mg/day) were needed to stabilize those that were negative for opioids and cannabinoids, in contrast to the rac-methadone and buprenorphine/naloxone patients that showed positive toxicology. Eighteen patients of the Cluster C in double diagnosis (major depressive 38.90%, bipolar 27.78%, and schizophrenia 16.67%) were stabilized with high doses of racemate 97.5 ± 8 mg/day, 51.8 ± 5 mg/day of levomethadone (−46.8% vs. rac-methadone; −71% in men), and 2.5 ± 1 mg/day of buprenorphine/naloxone. Three patients in remission were treated with tapering doses of levomethadone. Significantly reduced QTcF values were recorded with levomethadone (delta −32 ms vs. rac-methadone) in the bipolar patients, as well as the schizophrenia patients in remission (delta −45.19 ms vs. rac-methadone). Our patients were safely stabilized. Levomethadone, compared to the racemate, contributes to reducing the illicit use, especially of opioids and cannabinoids at significantly lower doses with cardiovascular safety, which, in bipolar patients, is clinically significant.

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“…In particular, these formulations may provide potential advantages for correctional populations who experience challenges balancing work and other community reintegration requirements. Additionally, community-based studies and randomized control trials have found favourable attitudes towards use of extended-release OAT among patients (Ahamad et al, 2015 ; Compton & Volkow, 2021 ; Lintzeris et al, 2021 ). These realities highlight the need for the expansion of OAT options in Canada, with the goals of reducing opioid use and related health and social risks, including re-incarceration, among correctional populations with OUD following community release.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

Russell

Pang

Nafeh

et al. 2022

International Journal of Qualitative Studies on Health and Well

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Introduction Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada. Methods This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants’ release. Data were thematically analyzed. Results The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of ‘take-home’ OAT medications were common barriers. Conclusions Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options.

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Patient-Reported Outcomes of Treatment of Opioid Dependence With Weekly and Monthly Subcutaneous Depot vs Daily Sublingual Buprenorphine

Abstract: IMPORTANCE Patient-reported outcomes in the treatment of opioid dependence may differ between subcutaneously administered depot buprenorphine and daily sublingual buprenorphine.

Cited by 73 publications

References 38 publications

Patient perspectives on depot buprenorphine treatment for opioid addiction – a qualitative interview study

Patient perspectives on depot buprenorphine treatment for opioid addiction – a qualitative interview study

Multicenter Observational/Exploratory Study Addressed to the Evaluation of the Effectiveness and Safety of Pharmacological Therapy in Opioid-Dependent Patients in Maintenance Therapy in Southern Italy

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

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