Home > Opioid dependence: buprenorphine prolonged-release injection (Buvidal).

Kennelly, Helen (2019) Opioid dependence: buprenorphine prolonged-release injection (Buvidal). Drugnet Ireland, Issue 70, Summer 2019, pp. 26-27.

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An evidence summary was commissioned by Public Health England to examine the therapeutic potential of buprenorphine prolonged-release injection as an alternative opioid dependence treatment to the current treatment of daily sublingual buprenorphine-naloxone tablet.1 Buprenorphine prolonged-release injection is an opioid agonist/antagonist and is administered as a weekly or monthly subcutaneous injection. Buprenorphine injection may be an alternative treatment option for opioid addiction where people have difficulties following a daily supervised opioid substitution and also where there is a potential safety risk of storing medicines at home.

A recent randomised control trial2 demonstrated that, overall, people using buprenorphine prolonged-release injection were no less likely to have opioid-negative urine samples or respond to treatment in comparison with people receiving sublingual buprenorphine-naloxone. Similar adverse effects were reported for both treatments. A major safety issue to consider is the long duration of action of buprenorphine with the prolonged release of the injection, when considering the length of treatment needed to reverse the effects of overdose.

The trial evidence presented has certain limitations. The trial was conducted in United States healthcare settings, with only one of the study sites a primary care setting. This may limit the applicability of this treatment in these settings. The primary outcomes assessed from the trial were disease orientated. Patient-orientated outcomes, such as craving and withdrawal scores, were investigated as exploratory outcomes only. As participants were paid to take part in this study, the reported retention rates may not accurately reflect retention rates in practice.

Mental health, pharmacy, medicines management, and health and justice specialists were asked for their views on using buprenorphine prolonged-release injection in practice. They stated that it may be an alternative treatment option in certain cases, but suggested barriers to its use. Some of these included the cost of injection, training and additional staff resources, lack of clarity about treating overdose, and service user preference.

For service users, some of the suggested advantages included service user convenience, reduced accidental poisonings, and a greater flexibility to engage in work or study. While some of the disadvantages include the need to attend a clinic for the injection and a reduction in pharmacy interaction, leading to a potential reduction in the ability to quickly identify health issues with the service user.

Overall, buprenorphine prolonged-release injection is a possible alternative therapy for a specific small cohort. However, a significant change in the care pathway would be needed to facilitate this instead of the usual sublingual treatment.

1    National Institute for Health and Care Excellence (NICE) (2019) Opioid dependence: buprenorphine prolonged-release injection (Buvidal). London: NICE. https://www.drugsandalcohol.ie/30270/

2    Lofwall MR, Walsh SL, Nunes EV, et al. (2018) Weekly and monthly subcutaneous buprenorphine depot formulations vs daily sublingual buprenorphine with naloxone for treatment of opioid use disorder: a randomized clinical trial. JAMA Intern Med, 178(6): 764–73.

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