Current and future options for opioid use disorder: a survey assessing real-world opinion of service users on novel therapies including depot formulations of buprenorphine

Abstract

PurposeIntegrated treatment for opioid use disorder (OUD) includes opioid agonist therapy (OAT) such as methadone and buprenorphine with well-evidenced benefits. Treatment with typical existing oral medications is associated with burdens and limits to successful outcomes (frequent dosing, attendance for collection/consumption, difficulty in achieving optimal dosing, misuse, diversion, accidental exposure, and stigma from the treatment process). Novel medications include injected depot formulations with less frequent administration, providing consistent drug levels after dosing. This survey assesses the opinion of those with OUD treatment services lived experience to inform future medication choices.Patients and methodsA survey of people with experience of OUD pharmacotherapy – the treatment system – was completed. Participants reviewed statements describing elements of OUD care using 7-point Likert scales to indicate their level of agreement or disagreement. Data were assessed using descriptive analysis.ResultsIn total, 35 people (16 in treatment; 19 with previous history of treatment) completed the survey. Average drug-use duration, 20 years, commonly included injected opioids. The majority agreed treatment was effective, but not tailored to their individual needs and limited normal day-to-day activities. Opinions on novel depot medications included the following: agreement on its potential to make life easier, reduce stigma, free-up time for preferred activities. Participants did not report concerns over the effectiveness and safety of depot medications, nor about reduced contact with treatment services that could be associated with less frequent dosing.ConclusionThis survey provides a useful initial record of the opinions of people experienced in OUD treatment services on novel depot medications, which may result in important benefits. Care providers and policy makers should continue to work with those with lived experience to understand the specific opportunity provided by such innovation.

Opioid users' willingness to receive prolonged-release buprenorphine depot injections for opioid use disorder

“…Our analyses add to a small but emergent literature on patients' views of prolonged-release buprenorphine (Gilman et al, 2018;Kenney et al, 2018). Findings support the argument that people are likely to welcome greater choice and flexibility in respect of OAT medications and delivery systems (Neale et al, 2018a(Neale et al, , 2018b.…”

“…We are not aware of any published studies on patients' experiences of receiving depot buprenorphine and limited research appears to have been conducted into their willingness to receive it. From the few studies we identified, quantitative research indicates that people who use opioids will be willing to receive depot buprenorphine (Gilman et al, 2018;Kenney et al, 2018), even though they recognize that it has both positive and negative features (Gilman et al, 2018). Qualitative research explored opioid users' views of novel opioid pharmacotherapy delivery systems, including depot injections (Neale et al, 2018a(Neale et al, , 2018b.…”

“…Indeed, the safety profile of depot buprenorphine appears generally consistent with that of oral buprenorphine, apart from some mild-to-moderate injection-site reactions (Haight et al, 2019;Lofwall et al, 2018). In terms of patient perspectives, a focus group study (Neale et al, 2018a;Neale et al, 2018b) and a survey (Gilman et al, 2018), both conducted with people with a history of opioid use in the UK shortly before prolonged-release buprenorphine was licensed, found that participants liked the anticipated convenience, reduced stigma, and opportunity to live more 'normally' which they believed prolongedrelease OAT would offer. Nonetheless, the focus group participants expressed concerns about its irreversibility, administration, and reduced contact with treatment services once received (Neale et al, 2018a(Neale et al, , 2018b; these issues were not reported by the survey participants (Gilman et al, 2018).…”

Perceptions of extended‐release buprenorphine injections for opioid use disorder among people who regularly use opioids in Australia

“…Although previous studies have explored OAT client views of XR‐buprenorphine using small samples , this study builds on this previous work by undertaking an in‐depth examination of demographic and clinical correlates of these perceptions in a diverse sample of people who regularly use opioids, with varied treatment experiences. Consistent with previous studies , perceptions of XR‐buprenorphine were generally positive, with two‐thirds of the current study's sample believing it would be a good treatment option for them if it were available. Overall, less frequent contact with treatment services was viewed positively by participants (endorsed as an advantage by 76%).…”

“…To date, two studies have been conducted internationally, examining clients’ perspectives on the impacts of changes to the frequency of dosing for XR‐buprenorphine and potential safety concerns . These qualitative studies indicate that perceptions of XR‐buprenorphine injections and implants may be influenced by a range of physical, psychological and social factors .…”