It may be easier for patients who take buprenorphine for opioid use disorder to stick with treatment if they receive a weekly or monthly injected version of the drug instead of a daily oral form of this medicine, according to a study published in May 2021 in JAMA Network Open.
For the study, researchers compared what’s known as subcutaneous depot buprenorphine, a slow-release version of the drug that’s injected weekly or monthly into the buttocks, thigh, abdomen, or upper arm, to what’s known as sublingual buprenorphine, a daily oral version that dissolves when placed under the tongue.
A total of 119 adults seeking treatment for opioid use disorder were randomly assigned to receive injected or oral buprenorphine for 24 weeks. At the end of the trial, participants completed patient satisfaction surveys that were scored from 0 to 100 points, with higher scores indicating a better experience.
Overall, average patient satisfaction scores were significantly higher with injected treatment (82.5 points) than with oral medication (74.3 points).
In addition, patients on injected buprenorphine reported that treatment was significantly less burdensome and allowed for a much higher quality of life than with oral treatment.
“Opioid dependence is a chronic relapsing disease that significantly impacts a patient's life and is associated with significant social and self-stigma,” says the new study's senior author, Fredrik Tiberg, Ph.D., the chief executive officer and head of research and development at Camurus, a pharmaceutical company in Lund, Sweden, which sells injected buprenorphine and other long-acting medicines.
“I think an important feature of long-acting depot medication is that it decreases the burden and disease reminders associated with daily dosing with oral medications,” Dr. Tiberg says. “A common feedback from patients on long-acting treatment is that it helps shift the focus from drugs and treatment to living a normal life.”
The weekly and monthly injected buprenorphine examined in the study isn’t approved in the United States, Tiberg notes. But these shots have rapidly gained market share in Europe and Australia. Sublocade, a monthly buprenorphine injection made by Indivior, is approved in the United States for adults who have already tried the oral form of the drug for at least one week.
Buprenorphine Shots Were Effective in Earlier Studies
While the current study didn’t directly examine the effectiveness of injected buprenorphine compared with alternative treatments, earlier studies looked at this and found the long-acting injected form of buprenorphine worked well for opioid use disorder.
A clinical trial published in February 2019 in The Lancet 2019, for example, randomly assigned 505 patients with opioid use disorder to take one of two doses of monthly buprenorphine injections or placebo injections and followed them for up to 24 weeks. By the end of the trial, more than 40 percent of patients taking buprenorphine injections successfully stopped using opioids, compared with just 5 percent of patients taking a placebo injection, based on drug screenings of their urine.
Another clinical trial, published in June 2018 in JAMA Internal Medicine, randomly assigned 428 patients with opioid use disorder to take either monthly injections of buprenorphine or a daily oral form of buprenorphine combined with naloxone, another anti-addiction medication. For the first 12 weeks of the trial, participants took either oral or injected buprenorphine or a placebo; then they switched to the other form of buprenorphine or placebo for the subsequent 12 weeks.
This trial found that about 35 percent of patients on injected buprenorphine tested negative for opioids in urine screenings, compared with about 28 percent of patients on oral medication, a difference that was not statistically meaningful.
Treatment Hurdles for Buprenorphine
Beyond the stigma of addiction that may deter some people with opioid use disorder from seeking treatment, limited options for obtaining treatment can also present a challenge, says Bill Soares, MD, the director of harm reduction services at Baystate Medical Center and an assistant professor at the University of Massachusetts Medical School Baystate in Springfield.
Buprenorphine is highly regulated, and clinicians who prescribe it are required to go through training and receive waivers from the federal government. Fewer than 1 in 10 primary care providers in the United States are authorized to prescribe buprenorphine, according to a study published in January 2019 in the Annals of Internal Medicine. The Biden administration has proposed changes to make opioid addiction treatment more available, according to an article published in April 2021 in the BMJ.
For now, to take daily oral buprenorphine, patients often need to get refills every 10 to 14 days because they can’t get prescriptions for a 30-day supply, Dr. Soares says. Once-a-month buprenorphine shots may be preferable for patients who can’t easily return for more frequent visits, Soares says.
More than convenience may be influencing patients’ preference for the shots in the current study, however. Injectable buprenorphine releases medication gradually and provides a more consistent level of medication in the bloodstream than can be achieved with daily oral buprenorphine, and the daily pill has an unpleasant taste and takes 5 to 10 minutes to dissolve under the tongue, Soares says.
In the United States at least, cost may be one deterrent for patients to seek injected buprenorphine. While insurance plans often cover both injectable and oral forms of the drug, people without insurance may pay up to $1,700 for each monthly buprenorphine injection, as opposed to $300 to $600 for daily oral buprenorphine, Soares says.
By far the biggest barrier to care is finding a provider to prescribe any form of buprenorphine at all, Soares notes.
If you are looking for a provider, the U.S. Substance Abuse and Mental Health Services Administration has a searchable online database of practitioners authorized to treat opioid use disorder with buprenorphine.