Buprenorphine Implant Removal 7 Years Postinsertion: A Case Report

Implantable Drug Delivery Systems and Foreign Body Reaction: Traversing the Current Clinical Landscape

Precise delivery of therapeutics to the target structures is essential for treatment efficiency and safety. Drug administration via conventional routes requires overcoming multiple transport barriers to achieve and maintain the local drug concentration and commonly results in unwanted off-target effects. Patients’ compliance with the treatment schedule remains another challenge. Implantable drug delivery systems (IDDSs) provide a way to solve these problems. IDDSs are bioengineering devices surgically placed inside the patient’s tissues to avoid first-pass metabolism and reduce the systemic toxicity of the drug by eluting the therapeutic payload in the vicinity of the target tissues. IDDSs present an impressive example of successful translation of the research and engineering findings to the patient’s bedside. It is envisaged that the IDDS technologies will grow exponentially in the coming years. However, to pave the way for this progress, it is essential to learn lessons from the past and present of IDDSs clinical applications. The efficiency and safety of the drug-eluting implants depend on the interactions between the device and the hosting tissues. In this review, we address this need and analyze the clinical landscape of the FDA-approved IDDSs applications in the context of the foreign body reaction, a key aspect of implant–tissue integration.

Novel Formulations of Buprenorphine for Treatment of Opioid Use Disorder

Opioid use disorder (OUD) is epidemic in the United States. In addition to medical, economic, and social impairments, risk of overdose fatality is high. In 2017, there were 14,958 deaths from natural or semisynthetic opioids, 15,958 from heroin, and 29,406 from synthetic opioids, such as fentanyl. Psychosocial interventions do not add substantial efficacy to medical OUD treatments, and thus making evidence-based OUD treatments more accessible is urgent. However, considerable diversion of oral and transmucosal opioid maintenance medications has been documented. Delivery systems that reduce risks of nonadherence through diversion or altered self-administration may increase buprenorphine's effectiveness for clinical stabilization via increased treatment exposure. The article presents findings from multisite efficacy studies of two subcutaneous depot buprenorphine formulations and a long-acting implant. Novel delivery systems show promise in providing improved outcomes through intermediate- and long-acting exposure to medication while reducing the risk of medication nonadherence, diversion, and accidental exposure.