Extended-release buprenorphine outcomes among treatment resistant veterans

Cotton, Ann J.; Lo, Katelyn; Kurtz, Fiona B.; Waldbauer, LeAnna

doi:10.1080/00952990.2021.1992773

Cited by 9 publications

(4 citation statements)

References 8 publications

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“…All patients with opioid-positive toxicology denied euphoria, NF-OD, or withdrawal symptoms after opioid use, consistent with purported opioid blockade by buprenorphine. Similar evidence for real-world effectiveness for BUP-XR has been seen in studies from Australia 28 and among US veterans 29 …”

Section: Discussionsupporting

confidence: 72%

“…Similar evidence for real-world effectiveness for BUP-XR has been seen in studies from Australia 28 and among US veterans. 29 This study has inherent limitations related to its retrospective, observational design and reliance on self-report to identify NF-OD events. The small sample size also precluded multivariate analysis of confounding factors and limited precision of model estimates.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Real-world Evidence for Impact of Opioid Agonist Therapy on Nonfatal Overdose in Patients with Opioid Use Disorder during the COVID-19 Pandemic

Lee¹,

Zhao²,

Merali³

et al. 2023

J Addict Med

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Objectives The primary objectives of this study were to describe the demographics and clinical characteristics of patients who were treated with buprenorphine extended-release versus buprenorphine-naloxone sublingual tablets versus methadone in a real-world setting and to evaluate the difference in nonfatal overdose events between treatment cohorts. Methods This study was a retrospective chart review of patients with opioid use disorder initiating opioid agonist therapy in Canada during the outset of the COVID-19 pandemic (March 11, 2020 to October 31, 2021). Three treatment cohorts were defined by the initial prescribed opioid agonist therapy regimen: buprenorphine extended-release, buprenorphine-naloxone sublingual tablets, and methadone. Baseline characteristics, as well as treatment status, overdose events, and substance use 6 months after treatment initiation were collected using a standardized form. Results Nine clinics provided data on 379 patient cases. The incidence rate (number of events per 100 person-years) for a self-reported nonfatal overdose was 46.8 (n = 18), 19.3 (n = 10), and 1.7 (n = 1) in the methadone, buprenorphine-naloxone sublingual tablets, and buprenorphine extended-release cohorts, respectively. The risk-adjusted difference for the proportion of patients with nonfatal overdose was 8.59% (95% confidence interval, 3.10–14.08%; P = 0.0022) for methadone versus buprenorphine extended-release and 6.51% (95% confidence interval, 1.46–11.56%; P = 0.0115) for buprenorphine-naloxone sublingual tablets versus buprenorphine extended-release. Conclusions Buprenorphine extended-release was associated with lower rates of nonfatal overdose events compared with daily opioid agonist therapy. Given the limitations of this naturalistic, retrospective design, further prospective studies are needed to validate these findings and demonstrate the potential for long-acting opioid agonist therapy in addressing the opioid crisis.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Real-world Evidence for Impact of Opioid Agonist Therapy on Nonfatal Overdose in Patients with Opioid Use Disorder during the COVID-19 Pandemic

Lee¹,

Zhao²,

Merali³

et al. 2023

J Addict Med

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show abstract

“… 101 Extended-release buprenorphine formulations in the form of long-acting monthly injectables have shown efficacy for OUD treatment. 102 Long-acting buprenorphine/naloxone injectables offer additional benefits compared to traditional oral formulations, such as greater convenience, greater adherence, reduced treatment cost, and little to no withdrawal symptoms upon cessation; moreover, significant reductions in the risks of diversion, nonmedical use, takeaway treatment doses, and stigma have been reported. 103 However, patients using long-acting injectables still require psychosocial support interventions such as addiction counseling, peer support, and contingency management to ensure effective treatment for OUD.…”

Section: Next Stepsmentioning

confidence: 99%

At a Crossroads: Opioid Use Disorder, the X-Waiver, and the Road Ahead

Dhillon,

Feulner,

Beitollahi

et al. 2024

TOJ

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Background: Buprenorphine/naloxone (Suboxone) is widely considered the first-line treatment for opioid use disorder (OUD), which causes significant morbidity and mortality in the United States, but prior to 2023, practitioners interested in prescribing buprenorphine/naloxone for OUD needed a special Drug Enforcement Administration certification (the X-Waiver) that imposed a patient cap and other limitations. The Consolidated Appropriations Act of 2023 considerably decreased the restrictions on prescribing practitioners. Buprenorphine/naloxone can now be prescribed like any other prescription opioid, excluding methadone. The historic context for the opioid crisis, OUD, the X-Waiver, and additional initiatives that may be needed beyond legislative change to effectively address OUD are the subjects of this review. Methods: To develop this review of the opioid crisis, OUD, and OUD treatment, we conducted a literature search of the PubMed database and constructed a timeline of the opioid crisis and changes in OUD treatment, specifically the X-Waiver, to characterize the historic context of OUD and the X-Waiver against the background of the opioid crisis. Results:The opioid crisis has had pervasive public health and economic impacts in the United States. Major changes to the treatment of OUD have occurred as a result of the Drug Addiction Treatment Act of 2000 that imposed the X-Waiver and the Consolidated Appropriations Act of 2023 that repealed the X-Waiver. Conclusion:The repeal of the X-Waiver is predicted to increase the accessibility of buprenorphine/naloxone in the United States. However, additional work beyond legislative change, including institutional support and reduction of stigma and disparities, is needed to substantially improve outcomes for OUD patients.

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“…SUBLOCADE® treatment during jail-to-community reentry was perceived by participants as a favorable treatment approach to reduce their risk of opioid reuse, illicit activities, stigma associated with daily receipt of MOUD, and COVID-19 exposure. In another pilot study across two Veterans Health Administration outpatient clinics, 26 clinically complex patients at high risk for hospitalization and mortality received at least one SUBLOCADE injection between December 1, 2018 and April 1, 2020 ( Cotton et al., 2022 ). Treatment retention was robust, 81% received more than 6 injections and 77% were maintained on the 300 mg dosage strength.…”

Section: The Regulatory Approval Of Buprenorphine For the Treatment O...mentioning

confidence: 99%

History of the discovery, development, and FDA-approval of buprenorphine medications for the treatment of opioid use disorder

Heidbreder

Fudala

Greenwald

2023

Drug and Alcohol Dependence Reports

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Extended-release buprenorphine outcomes among treatment resistant veterans

Cited by 9 publications

References 8 publications

Real-world Evidence for Impact of Opioid Agonist Therapy on Nonfatal Overdose in Patients with Opioid Use Disorder during the COVID-19 Pandemic

Real-world Evidence for Impact of Opioid Agonist Therapy on Nonfatal Overdose in Patients with Opioid Use Disorder during the COVID-19 Pandemic

At a Crossroads: Opioid Use Disorder, the X-Waiver, and the Road Ahead

History of the discovery, development, and FDA-approval of buprenorphine medications for the treatment of opioid use disorder

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