The Australasian Professional Society on Alcohol and other Drugs

Clinician's Corner - February 2019

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Clinician's Corner | June 2019       

Clinician’s Corner

 

Depot buprenorphine injections for opioid use disorder: patient information needs and preferences

 

Opioid Substitution Therapy (OST, also known as Medication Assisted Therapy) with methadone or buprenorphine is one of the cornerstones of the Australian drug treatment system. However, some clients report that regularly visiting a dosing site (multiple times a week or daily) is an inconvenience that makes other life activities and commitments difficult, and is a factor that can lead to poor adherence or treatment cessation.

Depot injections containing buprenorphine have been developed and recently approved in the US, European Union and Australia. These preparations are administered subcutaneously by a health professional either daily, weekly or monthly. With a range of OST options now available, independent information about these products is needed to as medication purpose and availability. Participants were curious as to why the drugs were developed and if they were intended as an additional medication or a supplement for alternative treatments. Others asked about when depot buprenorphine would be available and how they could access it.

A recent qualitative study by Neale, Tompkins, and Strang (2019) aimed to assess the needs and information preferences of potential buprenorphine depot patients. Data were collected through semi-structured interviews with participants who were either currently prescribed methadone (n = 12), currently prescribed buprenorphine (n = 12) or still using opioids daily but not on a program (n = 12) between June and October 2018 at addiction and social services in London. Participants were queried about their perceptions and curiosities towards depot buprenorphine and how they would prefer to receive information about the treatments.

The author’s analysis revealed six themes that were grouped into ‘information need’ category, and two themes within the ‘information preferences’ category.

‘Information needs’

  1. Medication purpose and availability
    Participants were curious as to why the drugs were developed and if they were intended as an additional medication or a supplement for alternative treatments. Others asked about when depot buprenorphine would be available and how they could access it.
  2. Pharmacology
    Participants also requested further clarification on things such as whether the depots contained naloxone, what impacts the treatments may have on health, how they interact with other medications, and details about how the injections function.
  3. Evidence base and effectiveness
    Participants wanted to know about how effective the depots are in supressing opioid addiction – a similar common concern being what happens if the medication doesn’t last for as long as advised.
  4. Safety and side effects
    Participants wanted further clarification about whether or not there was an overdose risk, whether they would feel withdrawals, and what the other general side effects were.
  5. Administration and dosing
    Some participants asked whether the treatments could be self-administered, how patients would feel in their day-to-day lives, and how the dosage was determined or could be modified.
  6. Reducing and ending treatment
    Participants were curious about how long they could expect to receive depot buprenorphine and the process of reducing and ceasing the treatment.

‘Information preferences’

  1. Format
    Participants highlighted the importance of having access to information from a range of sources, including printed, verbal, and electronic materials.
  2. Source
    Health professionals, researchers, and pharmaceutical companies were seen as the main sources of information by participants, although the drug developers were perceived as being a biased and unreliable source. Participants commonly cited that peers who had already received the medication were the preferred source of information.

Discussion
For some clients, depot buprenorphine may be a more preferable, beneficial, and advantageous option compared with alternative OST. Neale, Tompkins, and Strang (2019) state that people with opioid dependencies (both in and out of treatment) are likely to have many questions in regards to depot buprenorphine. Clients will want to understand how these new treatments compare to older regimens, their potential benefits on managing opioid use, how the depot is delivered, what side effects are involved, and how they can eventually come off OST. The authors recommend that further qualitative research that explores the patient’s experience of buprenorphine injections over an extended period is needed. They also suggest that resources should be developed to inform clients at home or in treatment services, which could also serve as an education tool for clinicians.


A complimentary PDF of the article is available to APSAD members by emailing This email address is being protected from spambots. You need JavaScript enabled to view it..

Neale J, Tompkins CNE, Strang J. Depot buprenorphine injections for opioid use disorder: Patient information needs and preferences. Drug Alcohol Rev 2019 doi: https://doi.org/10.1111/dar.12939