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

Abstract

Introduction and Aims There has been significant recent investment in new medications for opioid use disorder, including buprenorphine depot injections. Patients and professionals need good quality, independent information on medications to help them make informed treatment decisions. This paper aims to understand patients’ information needs and preferences in relation to buprenorphine depot injections. Design and Methods Semi‐structured qualitative interviews were conducted with 36 people using opioids (26 men, 10 women; 24–63 years). Twelve participants were currently prescribed daily oral methadone; 12 were currently prescribed daily oral buprenorphine; and 12 were using heroin and not in treatment. Interviews were transcribed, coded and analysed via Iterative Categorisation. Results Participants asked many questions about depot buprenorphine injections. These related to: (i) medication purpose and availability; (ii) pharmacology; (iii) evidence base and effectiveness; (iv) safety and side effects; (v) administration and dosing; and (vi) reducing and ending treatment. Additionally, participants expressed their information preferences in terms of (i) ‘format’ and (ii) ‘source’. Specifically, they wanted printed, verbal and electronic materials provided by people in authority, particularly patients who had already had the medication. Discussion and Conclusions All potential patients should be offered accessible information on depot buprenorphine to enable them to consider their options and participate meaningfully in treatment decision making. We recommend that further qualitative research is undertaken to produce informative video material that describes patient experiences of receiving depot buprenorphine. This should help to balance biomedical knowledge with lay knowledge, so facilitating more informed discussions when decisions about depot buprenorphine treatment are made.

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“…However, people have noted important concerns about long-acting injectable buprenorphine, including being unable to control the medication dose or stop treatment easily once started, having something foreign inside of them, potential side effects, potential reduced social interactions, and reduced choice and control ( Neale et al, 2018 , Tompkins et al, 2019 ). The adaptive potentials of long-acting buprenorphine in the COVID-19 era require close monitoring in order that these treatment innovations can be attuned to patient preferences and need ( Neale, Tompkins, & Strang, 2019 ), ensuring that patient choice remains at the centre of treatment decision making.…”

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“…Early survey-based research on patients’ perspectives on depot formulations had been favorable with high ratings on topics such as the ability for depot medications to make life easier, avoid stigma, and free-up time for other activities 25. Yet, a series of in-depth qualitative studies have raised concerns 12,13,26,27. These include issues with a surgical procedure, the invariability of the daily dose, concerns for infection, and social isolation – due to no longer frequenting the methadone clinic 12,26.…”

“…Yet, a series of in-depth qualitative studies have raised concerns 12,13,26,27. These include issues with a surgical procedure, the invariability of the daily dose, concerns for infection, and social isolation – due to no longer frequenting the methadone clinic 12,26. The granular subjective experiences when patients use buprenorphine as treatment for OUD appear more powerful in making decisions about injectable formulations that extend beyond simple calculations of costs or of coverage that can vary for 1 week, 1 month and 6 months.…”