Factors of Interest in Extended-Release Buprenorphine: Comparisons Between Incarcerated and Non-Incarcerated Patients with Opioid Use Disorder

Abstract

Purpose Extended-release buprenorphine (XR-BUP) covers a range of formulations of buprenorphine-based treatments for opioid use disorder (OUD) that release the medication over a period of one week, one month, or six months. OUD is particularly prevalent among incarcerated populations, and previous findings have shown that incarcerated subjects were not less interested in XR-BUP than non-incarcerated subjects. However, no study has ever investigated whether the factors of interest in XR-BUP were similar in incarcerated and non-incarcerated populations. Patients and Methods We carried out post-hoc analyses using data from the “AMBRE” survey, which was conducted among 366 individuals with OUD, that were recruited in 68 French addiction settings, including six prison medical centers. The reasons for interest in XR-BUP were compared between incarcerated and non-incarcerated interviewees, using logistic regressions models, which provided raw and adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). Adjustment variables were gender, age category, level of education, and type of current medication for OUD, respectively. Results Data from 317 participants (ie, 221 non-incarcerated, and 96 incarcerated individuals) were included in the analyses. Adjusted comparisons found that “no longer taking a daily treatment” (aOR= 2.91; 95% CI= 1.21–6.98) and “having a more discreet medication” (aOR= 1.76; 95% CI= 1.01–3.10) were reasons that appealed more to incarcerated participants than to non-incarcerated ones. On the other hand, the potential reduction of withdrawal symptoms (aOR= 0.54; 95% CI= 0.29–0.99) or the risk of misuse (aOR= 0.56; 95% CI= 0.34–0.94) associated with XR-BUP treatment were considered more important by non-incarcerated individuals than by incarcerated ones. Conclusion Incarcerated interviewees were interested in XR-BUP for different reasons than those outside prison. In particular, incarcerated patients were more interested in practicability and discretion features, and less in improving recovery or reducing misuse than non-incarcerated patients.

The switching process from buprenorphine sublingual tablets to the monthly buprenorphine subcutaneous depot injection in opioid dependent patients

“…Furthermore, this includes a very specific nature of patients' treatment motives regarding the depot treatment, such as practicability and treatment discretion, in contrast to non-incarcerated patients, who are more interested in recovery and reduction of illicit substance co-use. 21 In addi- Patient's perceived involvement in the therapy process is a predictor of treatment satisfaction. 51 Furthermore, it should be mentioned that the patients were initially adjusted to the weekly depot injection before they were then switched to the monthly depot injection.…”

“…This sample consists of exclusively male and mainly severely dependent convicted criminals with often existing comorbid disorders like antisocial or narcissistic personality disorders. Furthermore, this includes a very specific nature of patients' treatment motives regarding the depot treatment, such as practicability and treatment discretion, in contrast to non‐incarcerated patients, who are more interested in recovery and reduction of illicit substance co‐use 21 . In addition, the doctor–patient relationship in the context of the detention in a forensic institution is of a specific and different nature compared with a regular doctor–patient relationship.…”

“…17 Comparative studies have already shown advantages of the new depot treatment in terms of its safety profile, use in therapies with risk of spontaneous treatment discontinuations or reduced treatment effort. 12,[18][19][20][21] As a quite new and advantageous substitution form in the therapy of opioid dependent patients with a high demand for newest research, the treatment with the subcutaneous buprenorphine depot injection (BUP-XR), in particular the switching process, will be examined in more detail in the present study.…”

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

“…While buprenorphine has been well-established, naltrexone has more recently been found to improve treatment retention, reduce opioid use (Bahji et al, 2020 ) and re-incarceration rates (Korownyk et al, 2019 ) among US-based correctional populations; however, naltrexone has not been approved in Canada for the clinical management of opioid use disorder and is currently only available for research purposes (The British Columbia Centre on Substance Use (BCCSU), 2017 ). Results from trials to-date emphasize that extended-release OAT formulations are a flexible option that may be beneficial for patients who are unable to attend frequent or daily in-person OAT appointments due to proximity concerns or employment and other life commitments (Chappuy et al, 2021 ; Compton & Volkow, 2021 ; Hard, 2021 ). In particular, these formulations may provide potential advantages for correctional populations who experience challenges balancing work and other community reintegration requirements.…”