Perceptions and experiences toward extended-release buprenorphine among persons leaving jail with opioid use disorders before and during COVID-19: an in-depth qualitative study

Abstract

Background Extended-release buprenorphine (XRB) offers a novel approach to sustained monthly treatment for people who use opioids in criminal justice settings (CJS). This study explores the experiences of adults receiving XRB as a jail-to-community treatment. Methods and findings In-depth qualitative interviews were conducted among adult participants with opioid use disorder (OUD; n = 16) who were recently released from NYC jails and maintained on XRB after switching from daily sublingual buprenorphine (SLB). Interviews elaborated on the acceptability and barriers and facilitators of XRB treatment pre- and post-release. Interviews were audio recorded, transcribed, and analyzed for content related to factors influencing XRB treatment uptake and community reentry. Important themes were grouped into systems, medication, and patient-level factors. Key systems-level factors influencing initiation of XRB in jail included an alternative to perceived stigmatization and privacy concerns associated with daily in-jail SLB administration and less concerns with buprenorphine diversion. In-jail peer networks positively influenced participant adoption of XRB. XRB satisfaction was attributed to reduced in-jail clinic and medication administration visits, perceived efficacy and blockade effects upon the use of heroin/fentanyl following release, and averting the risk of criminal activities to fund opioid use. Barriers to retention included post-injection withdrawal symptoms and cravings attributed to perceived suboptimal medication dosing, injection site pain, and lack of in-jail provider information about the medication. Conclusion Participants were generally favorable to XRB initiation in jail and retention post-release. Further studies are needed to address factors influencing access to XRB in criminal justice settings, including stigma, ensuring patient privacy following initiation on XRB, and patient-, provider-, and correctional staff education pertaining to XRB. Trial Registration ClinicalTrials.gov Identified: NCT03604159.

History of the discovery, development, and FDA-approval of buprenorphine medications for the treatment of opioid use disorder

“…Although preliminary, these findings suggest that monthly injectable extended-release buprenorphine is a useful OUD treatment option before and after release from jail. This conclusion is also supported by a recent series of in-depth qualitative interviews conducted among adult participants with OUD who were recently released from New York City jails and maintained on SUBLOCADE® after switching from daily sublingual buprenorphine-naloxone ( Cheng et al., 2022 ). SUBLOCADE® treatment during jail-to-community reentry was perceived by participants as a favorable treatment approach to reduce their risk of opioid reuse, illicit activities, stigma associated with daily receipt of MOUD, and COVID-19 exposure.…”

Transitions of care between jail-based medications for opioid use disorder and ongoing treatment in the community: A retrospective cohort study

“…Examples of such programs include mobile van settings 57 or telehealth buprenorphine clinics, which have been shown to be successful in catering to incarcerated individuals at reentry, 58,59 as well as the Transitions Clinic Network, a consortium of primary care clinics that aims to increase access to health care services among people recently released from incarceration. 60 Recent trials have also shown the potential promise of injectable forms of buprenorphine in facilitating treatment continuity following discharge, 61–63 but uptake of these treatments in carceral settings has been slow.…”

Association of Medication-Assisted Therapy and Risk of Drug Overdose-Related Hospitalization or Emergency Room Visits in Patients With Opioid Use Disorder

“…Prior research showed that treatment with buprenorphine improved treatment retention for OUD, so it is possible that better consistency in use among this group could be a contributor [ 22 ]. In addition, other studies have reported higher adherence among buprenorphine users, in part due to the lesser severity of opioid withdrawal symptoms when starting buprenorphine [ 23 , 24 ]. Buprenorphine has been shown to be equivalent to methadone in alleviating the severity of opioid withdrawal, but symptoms may resolve more quickly [ 25 ].…”