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Lancaster K, Gendera S, Treloar C, Rhodes T, Shahbazi J, Byrne M, Nielsen S, Degenhardt L, Farrell M. Tinkering with care: Implementing extended-release buprenorphine depot treatment for opioid dependence. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104359. [PMID: 38382354 DOI: 10.1016/j.drugpo.2024.104359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
We examine how extended-release buprenorphine depot (BUP-XR) is put to use and made to work in implementation practices, attending to how care practices are challenged and adapted as a long-acting technology is introduced into service in opioid agonist treatment (OAT) in Australia. Our approach is informed by ideas in science and technology studies (STS) emphasising the irreducible entanglement of care practices and technology, and in particular the concept of 'tinkering' as a practice of adaptation. To make our analysis, we draw on qualitative interview accounts (n = 19) of service providers involved in BUP-XR implementation across five sites. Our analysis considers the disruptive novelty of BUP-XR. Tinkering to make a novel technology work in practice slows down the expectation of implementation in relation to transformative innovation, despite the promise of dramatic or rapid change. Tinkering allowed for more open relations, for new care practices that departed from the routine and familiar, opening potential for how BUP-XR could be put to use and made to work in its new situation, and as its situation evolved along-with its implementation. Flexibility and openness of altering relations was, however, at times, held in tension with inflexibility and closure. This analysis identifies a concern for what is made present and what is made absent in the altered care network affected by BUP-XR, with the multiple effects of supervised daily dosing practices thrown into relief as they become absented. Tinkering to implement BUP-XR locally connects with a broader assemblage of trial and movement in the constitution of treatment. The introduction of long-acting technologies prompts new questions about embedded implementation practices, including supervised dosing, urinalysis, the time and place of psychosocial support, and how other social aspects of care might be recalibrated in drug treatment.
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Affiliation(s)
- K Lancaster
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia; Goldsmiths, University of London, UK.
| | - S Gendera
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - C Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - T Rhodes
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia; London School of Hygiene and Tropical Medicine, UK
| | - J Shahbazi
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M Byrne
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - S Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Neale J, Cairns B, Gardiner K, Livingston W, McCarthy T, Perkins A. Waiting for inpatient detoxification: A qualitative analysis of patient experiences. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104291. [PMID: 38071934 DOI: 10.1016/j.drugpo.2023.104291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/27/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND There is limited provision of inpatient detoxification relative to other treatments for alcohol and other drug (AOD) use. This means people often need to wait prior to detoxifying. However, waiting for healthcare is generally perceived as negative and stressful. This paper aims to understand patients' experiences of waiting for inpatient AOD detoxification to ascertain whether and how service-level policies and practices might be improved. METHODS Semi-structured telephone interviews were conducted with 32 people (20 males, 12 females; aged 25-67 years) who were waiting for inpatient detoxification. Data collection was part of a wider evaluation of a policy initiative started in 2021 to increase detoxification service capacity in England, UK. Interviews were professionally transcribed and data on waiting experiences were coded using qualitative software. Analyses were informed by new materialist thinking and undertaken via Iterative Categorisation. RESULTS We found that waiting was constituted through five dimensions: i. duration; ii. support; iii. information; iv. preparations; and v. emotions. These five dimensions were multi-faceted and operated in and through wider interacting social, material, and affective forces (e.g., professional judgements, formal and informal relationships, the availability of beds and funding, bureaucratic procedures, the utility and relevance of information, and participants' diverse feelings, including desperation for treatment). Not all accounts of waiting were negative. The experience was complex, non-uniform and variable over time. Moreover, it affected how people felt and how they behaved. CONCLUSIONS Changes to service-level policies and practices can potentially minimise the stress of waiting for inpatient AOD detoxification. The negative impact of waiting may be reduced if professionals more consistently engage patients in a wider range of constructive pre-treatment activities, offer regular 'check-ins' to mitigate any anxiety, explain changes in wait duration to help with planning and demonstrate fairness, and facilitate contact between those waiting to lessen feelings of isolation.
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Affiliation(s)
- Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8BB, UK.
| | - Beth Cairns
- Figure 8 Consultancy Services Ltd, Dundee, DD4 OHU, UK
| | | | - Wulf Livingston
- Faculty of Social and Life Sciences, Glyndwr University, Wrexham, LL11 2AW, UK
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Weimer MB, Herring AA, Kawasaki SS, Meyer M, Kleykamp BA, Ramsey KS. ASAM Clinical Considerations: Buprenorphine Treatment of Opioid Use Disorder for Individuals Using High-potency Synthetic Opioids. J Addict Med 2023; 17:632-639. [PMID: 37934520 DOI: 10.1097/adm.0000000000001202] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
ABSTRACT Treatment of opioid use disorder (OUD) with buprenorphine has evolved considerably in the last decade as the scale of the OUD epidemic has increased along with the emergence of high-potency synthetic opioids (HPSOs) and stimulants in the drug supply. These changes have outpaced the development of prospective research, so a clinical consideration document based on expert consensus is needed to address pressing clinical questions. This clinical considerations document is based on a narrative literature review and expert consensus and will specifically address considerations for changes to the clinical practice of treatment of OUD with buprenorphine for individuals using HPSO. An expert panel developed 6 key questions addressing buprenorphine initiation, stabilization, and long-term treatment for individuals with OUD exposed to HPSO in various treatment settings. Broadly, the clinical considerations suggest that individualized strategies for buprenorphine initiation may be needed. The experience of opioid withdrawal negatively impacts the success of buprenorphine treatment, and attention to its management before and during buprenorphine initiation should be proactively addressed. Buprenorphine dose and dosing frequency should be individualized based on patients' treatment needs, the possibility of novel components in the drug supply should be considered during OUD treatment, and all forms of opioid agonist treatment should be offered and considered for patients. Together, these clinical considerations attempt to be responsive to the challenges and opportunities experienced by frontline clinicians using buprenorphine for the treatment of OUD in patients using HPSOs and highlight areas where prospective research is urgently needed.
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Affiliation(s)
- Melissa B Weimer
- From the Yale School of Medicine, Program in Addiction Medicine, New Haven, CT (MBW); Yale School of Public Health, New Haven, CT (MBW); Division of Addiction Medicine, Highland Hospital-Alameda Health System, Oakland, CA (AAH); Department of Psychiatry and Internal Medicine, Penn State Health, Hershey, PA (SSK); University of Vermont, Burlington, VT (MM); BAK and Associates, Baltimore, MD (BAK); NYS Office of Addiction Services and Supports (OASAS), Albany, NY (KSR)
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Maremmani I, Dematteis M, Gorzelanczyk EJ, Mugelli A, Walcher S, Torrens M. Long-Acting Buprenorphine Formulations as a New Strategy for the Treatment of Opioid Use Disorder. J Clin Med 2023; 12:5575. [PMID: 37685642 PMCID: PMC10488107 DOI: 10.3390/jcm12175575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/12/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Long-acting buprenorphine formulations have been recently marketed for the Opioid Agonist Treatment (OAT) of opioid use disorder (OUD) associated with medical, social, and psychological support. Their duration of action ranges from one week up to 6 months. The non-medical use of opioids is increasing with a parallel rise in lethal overdoses. Methadone and buprenorphine are the standard treatment for opioid dependence. Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing the risks of overdose, crime, and transmission of HIV (Human Immunodeficiency Virus) in people who use opioids; however, its effectiveness has been hindered by low rates of uptake and retention in treatment. Furthermore, both methadone and buprenorphine are widely diverted and misused. Thus, a crucial aspect of treating OUD is facilitating patients' access to treatment while minimizing substance-related harm and improving quality of life. The newly developed long-acting buprenorphine formulations represent a significant change in the paradigm of OUD treatment, allowing an approach individualized to patients' needs. Strengths of this individualized approach are improved adherence (lack of peaks and troughs in blood concentrations) and a reduced stigma since the patient doesn't need to attend their clinic daily or nearly daily, thus facilitating social and occupational integrations as the quality of life. However, less frequent attendance at the clinic should not affect the patient-physician relationship. Therefore, teleconsulting or digital therapeutic services should be developed in parallel. In addition, diversion and intravenous misuse of buprenorphine are unlikely due to the characteristics of these formulations. These features make this approach of interest for treating OUD in particular settings, such as subjects staying or when released from prison or those receiving long-term residential treatment for OUD in the therapeutic communities. The long-lasting formulations of buprenorphine can positively impact the OUD treatment and suggest future medical and logistic developments to maximize their personalized management and impact.
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Affiliation(s)
- Icro Maremmani
- VP Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy;
- UniCamillus, International Medical University in Rome, Via di Sant’Alessandro 8, 00131 Rome, Italy
| | - Maurice Dematteis
- Department of Pharmacology and Addiction Medicine, Grenoble-Alpes University Hospital, Grenoble Alpes University, Rue de la Chantourne, 38043 Grenoble, France;
| | - Edward J. Gorzelanczyk
- Department of Theoretical Basis of Biomedical Sciences and Medical Informatics, Nicolaus Copernicus University, Collegium Medicum, 85-067 Bydgoszcz, Poland;
- Faculty of Philosophy, Kazimierz Wielki University, 85-092 Bydgoszcz, Poland
- The Society for the Substitution Treatment of Addiction ”Medically Assisted Recovery”, 85-791 Bydgoszcz, Poland
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health (NeuroFarBa), University of Florence, Via della Pergola, 50121 Firenze, Italy;
| | - Stephan Walcher
- CONCEPT Center for Addiction Medicine, Kaiserstrasse 1, D-80801 Munich, Germany;
| | - Marta Torrens
- Addiction Research Group, Hospital del Mar Research Institute Barcelona, 08003 Barcelona, Spain
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Neale J, Parkin S, Strang J. Patients' goals when initiating long-acting injectable buprenorphine treatment for opioid use disorder: findings from a longitudinal qualitative study. Subst Abuse Treat Prev Policy 2023; 18:37. [PMID: 37349776 PMCID: PMC10288705 DOI: 10.1186/s13011-023-00551-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Long-acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that has been introduced against an international policy backdrop of recovery and person-centred care. This paper explores the goals that people want to achieve from LAIB to identify potential implications for policy and practice. METHODS Data derive from longitudinal qualitative interviews conducted with 26 people (18 male; 8 female) initiating LAIB in England and Wales, UK (June 2021-March 2022). Participants were interviewed up to five times by telephone over six months (107 interviews in total). Transcribed interview data relating to each participant's treatment goals were coded, summarised in Excel, and then analysed via a process of Iterative Categorization. RESULTS Participants often articulated a desire to be abstinent without defining exactly what they meant by this. Most intended to reduce their dosage of LAIB but did not want to rush. Although participants seldom used the term 'recovery', almost all identified objectives consistent with current definitions of this concept. Participants articulated broadly consistent goals over time, although some extended the timeframes for achieving treatment-related goals at later interviews. At their last interview, most participants remained on LAIB, and there were reports that the medication was enabling positive outcomes. Despite this, participants were aware of the complex personal, service-level, and situational factors that hindered their treatment progress, understood the additional support they needed to achieve their goals, and voiced frustrations when services failed them. CONCLUSIONS There is a need for wider debate regarding the goals people initiating LAIB are seeking and the diverse range of positive treatment outcomes LAIB could potentially generate. Those providing LAIB should offer regular on-going contact and other forms of non-medical support so that patients have the best opportunity to succeed. Policies relating to recovery and person-centred care have previously been criticised for responsibilising patients and service users to take better care of themselves and to change their own lives. In contrast, our findings suggest that these policies may, in fact, be empowering people to expect a greater range of support as part of the package of care they receive from service providers.
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Affiliation(s)
- Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8BB UK
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052 Australia
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8BB UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8BB UK
- South London & Maudsley (SLaM) NHS Foundation Trust, London, SE5 8AZ UK
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Clay S, Treloar C, Degenhardt L, Grebely J, Christmass M, Gough C, Hayllar J, McDonough M, Henderson C, Crawford S, Farrell M, Marshall A. 'I just thought that was the best thing for me to do at this point': Exploring patient experiences with depot buprenorphine and their motivations to discontinue. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104002. [PMID: 37003194 DOI: 10.1016/j.drugpo.2023.104002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Long-acting injectable depot buprenorphine is a recent addition to the suite of opioid agonist therapies (OAT) used to treat opioid use disorder (OUD). However, there has been little research that focuses on the lived experience of people receiving depot buprenorphine treatment and reasons for why people decide to discontinue. The aim of this study was to explore what it is like to receive depot buprenorphine and to understand the motivations behind why people discontinue. METHODS Open-ended, semi-structured interviews were conducted between November 2021 and January 2022 with individuals who were either currently receiving depot buprenorphine or had discontinued or were in the process of discontinuing depot buprenorphine. Liberati, et al.'s (2022) adaptation of Dixon-Woods's (2006) candidacy framework was used to analyse the participant experiences. RESULTS 40 participants (26 male, 13 female, 1 undisclosed; mean age 42 years) were interviewed about their experience with depot buprenorphine. At the time of the interview, 21 were currently receiving depot buprenorphine and 19 had discontinued this treatment or were in the process of discontinuing. Participants cited 4 key reasons why they decided to discontinue depot buprenorphine:1) feeling forced into the program, 2) experiencing negative side-effects, 3) finding the treatment ineffective, and 4) wanting to stop depot buprenorphine/OAT to use opioids again or feeling 'cured' and no longer in need of OAT. Participants were ultimately discussing issues related to clinician-patient power relations, agency and bodily autonomy, and the pursuit of well-being. CONCLUSION Depot buprenorphine remains a promising treatment for OUD and offers potential to improve treatment adherence. Instances of restricted OAT choice and consumer concerns regarding a lack of agency must be addressed in order to enhance therapeutic relationships. Clinicians and other healthcare workers in this field also need greater access to information about depot buprenorphine to better address issues patients face during treatment. More research is required to understand patient and treatment choice given the options of these new treatment formulations.
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Affiliation(s)
- Simon Clay
- National Drug & Alcohol Research Centre, University of New South Wales, Australia.
| | - Carla Treloar
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Louisa Degenhardt
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Jason Grebely
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Michael Christmass
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Chris Gough
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Jeremy Hayllar
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Mike McDonough
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Charles Henderson
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Sione Crawford
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Michael Farrell
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Alison Marshall
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
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Neale J, Parkin S, Strang J. How do patients feel during the first 72 h after initiating long-acting injectable buprenorphine? An embodied qualitative analysis. Addiction 2023. [PMID: 36808168 DOI: 10.1111/add.16171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND AND AIMS Long-acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that is generating positive outcomes. Negative effects are typically mild and transient, but can occasionally be serious, resulting in treatment discontinuation/non-adherence. This paper aims to analyse patients' accounts of how they felt during the first 72 h after initiating LAIB. METHODS Semi-structured interviews were conducted (June 2021-March 2022) with 26 people (18 males and 8 females) who had started LAIB within the previous 72 h. Participants were recruited from treatment services in England and Wales and were interviewed by telephone using a topic guide. Interviews were audio-recorded, transcribed and coded. The concepts of embodiment and embodied cognition framed the analyses. Data on participants' substance use, initiation onto LAIB and feelings were tabulated. Next, participants' accounts of how they felt were analysed following the stages of Iterative Categorization. RESULTS Participants reported complex combinations of changing negative and positive feelings. Bodily experiences included withdrawal symptoms, poor sleep, injection-site pain/soreness, lethargy and heightened senses inducing nausea ('distressed bodies'), but also enhanced somatic wellbeing, improved sleep, better skin, increased appetite, reduced constipation and heightened senses inducing pleasure ('returning body functions'). Cognitive responses included anxiety, uncertainties and low mood/depression ('the mind in crisis') and improved mood, greater positivity and reduced craving ('feeling psychologically better'). Whereas most negative effects reported are widely recognized, the early benefits of treatment described are less well-documented and may be an overlooked distinctive feature of LAIB. CONCLUSIONS During the first 72 h after initiating long-acting injectable buprenorphine, new patients report experiencing a range of interconnected positive and negative short-term effects. Providing new patients with information about the range and nature of these effects can prepare them for what to expect and help them manage feelings and reduce anxiety. In turn, this may increase medication adherence.
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Affiliation(s)
- Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8BB, UK.,Centre for Social Research in Health, University of New South Wales, New South Wales, NSW 2052, Australia
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8BB, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8BB, UK.,South London and Maudsley (SLaM) NHS Foundation Trust, London, SE5 8AZ, UK
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Neale J, Parkin S, Strang J. Qualitative study of patients’ decisions to initiate injectable depot buprenorphine for opioid use disorder: the role of information and other factors. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2165041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London & Maudsley (SLaM), NHS Foundation Trust, London, UK
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Johnson B, Flensburg OL, Capusan AJ. Patient perspectives on depot buprenorphine treatment for opioid addiction – a qualitative interview study. Subst Abuse Treat Prev Policy 2022; 17:40. [PMID: 35614466 PMCID: PMC9131643 DOI: 10.1186/s13011-022-00474-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Recently developed buprenorphine depot injections have the potential to reduce risk for diversion and misuse, and to increase adherence with fewer visits for supervised intake. However, it is unclear how patients perceive this new form of medication. The purpose of this study was to explore patients’ experiences of depot injections and their reasons for continuing, discontinuing, or declining depot injection treatment. Methods We conducted semi-structured qualitative interviews with 32 people, 14 of whom had ongoing depot injection treatment, 11 who had discontinued depot-injections and switched to other medication and seven who had declined treatment with depot formulations. Interviews were transcribed, coded, and analysed using NVivo, based on this overall stratification into three participant groups. Results The main categories relate to the effects and side effects of the depot formulation, social and practical factors, psychological benefits and disadvantages, and interactions with treatment staff. Social and practical factors were of importance for choosing depot formulations, such as increased freedom and their making it easier to combine treatment with work and family life, as well as psychological advantages including “feeling normal”. Initial withdrawal symptoms that resolved themselves after a number of injections were reported by most participants. Reliable information and patient-staff relationships characterized by trust helped patients to cope with these initial problems. Those who discontinued treatment often did so near the beginning of the treatment, reporting withdrawal symptoms and insufficient effects as the main reasons. Coercion and insufficient information contributed to a negative pharmaceutical atmosphere at one of the clinics, which may have adversely influenced perceptions of depot formulations and decreased willingness to accept and continue treatment. Conclusions Buprenorphine depot injections may have social, practical, and psychological benefits compared to other formulations. However, depot injections are not perceived as an attractive option by all patients. Trust, consistent and adequate information, and awareness of the implications of the pharmaceutical atmosphere should be considered when introducing new medications. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-022-00474-2.
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Poliwoda S, Noor N, Jenkins JS, Stark CW, Steib M, Hasoon J, Varrassi G, Urits I, Viswanath O, Kaye AM, Kaye AD. Buprenorphine and its formulations: a comprehensive review. Health Psychol Res 2022; 10:37517. [PMID: 35999975 PMCID: PMC9392838 DOI: 10.52965/001c.37517] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Buprenorphine, a novel long-acting analgesic, was developed with the intention of two purposes: analgesia and opioid use disorder. Regarding its pharmacodynamics, it is a partial agonist at mu receptors, an inverse agonist at kappa receptors, and an antagonist at delta receptors. For the purpose of analgesia, three formulations of buprenorphine were developed: IV/IM injectable formulation (Buprenex®), transdermal patch formulation (Butrans®), and buccal film formulation (Belbuca®). Related to opioid dependence, the formulations developed were subcutaneous extended release (Sublocade®), subdermal implant (Probuphine®), and sublingual tablets (Subutex®). Lastly, in order to avoid misuse of buprenorphine for opioid dependence, two combination formulations paired with naloxone were developed: film formulation (Suboxone®) and tablet formulation (Zubsolv®). In this review, we present details of each formulation along with their similarities and differences between each other and clinical considerations.
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Affiliation(s)
| | - Nazir Noor
- Department of Anesthesiology, Mount Sinai Medical Center
| | | | - Cain W Stark
- Medical College of Wisconsin, 8701 West Watertown Plank Road, Wauwatosa, WI 53226
| | - Mattie Steib
- Louisiana State University Health Shreveport School of Medicine
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Beth Israel Deaconess Medical Center
| | | | - Ivan Urits
- Department of Anesthesiology, 1501 Kings Hwy, Shreveport, LA 71103, Louisiana State University Health Shreveport
| | - Omar Viswanath
- Clinical Professor of Anesthesiology, LSU Health Sciences Center School of Medicine, Creighton University School of Medicine, Innovative Pain and Wellness
| | - Adam M Kaye
- Department of Pharmacy Practice, Stockton, CA, 95211,, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific
| | - Alan D Kaye
- Department of Anesthesiology, Shreveport, LA, Louisiana State University Health Sciences Center - Shreveport
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Matheson C, Foster R, Schofield J, Browne T. Long-acting depot buprenorphine in people who are homeless: Views and experiences. J Subst Abuse Treat 2022; 139:108781. [DOI: 10.1016/j.jsat.2022.108781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/13/2022] [Accepted: 04/05/2022] [Indexed: 12/18/2022]
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Martin E, Maher H, McKeon G, Patterson S, Blake J, Chen KY. Long-acting injectable buprenorphine for opioid use disorder: A systematic review of impact of use on social determinants of health. J Subst Abuse Treat 2022; 139:108776. [DOI: 10.1016/j.jsat.2022.108776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
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Alhusein N, Scott J, Neale J, Chater A, Family H. Community pharmacists' views on providing a reproductive health service to women receiving opioid substitution treatment: A qualitative study using the TDF and COM-B. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 4:None. [PMID: 34870263 PMCID: PMC8626316 DOI: 10.1016/j.rcsop.2021.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background The absence of menstruation is common in women who use drugs. This can give a belief that conception is unlikely. When stabilised on Opioid Substitution Treatment (OST), fertility often returns, initially without realisation as ovulation precedes menstruation. This leaves women vulnerable to unplanned pregnancies. Community pharmacists (CPs) are frequently in contact with this patient group through the Supervised Consumption of OST service. This provides a timely opportunity to provide reproductive health (RH) advice. The aim of this study was to investigate pharmacists' views on providing a RH service to women receiving OST. Methods Twenty semi-structured interviews based on the Capability-Opportunity-Motivation to Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) were conducted between 2016 and 2017. Data analysis involved deductive coding using the TDF domains. The TDF domains were mapped onto the elements of the COM-B and used in the second step to create the framework and chart the data. The third step involved re-reading and clustering the codes, and inductive themes were generated to explain the data in depth. Results Nine of the 14 TDF domains, mapped into five elements of the COM-B, were identified. Five inductive themes were generated: 1) The pharmacists' experience and knowledge of reproductive health (RH) needs of women receiving OST, 2) The pharmacists' approach to providing advice, 3) The pharmacists' perception of the relationship with women receiving OST, 4) Social influences, and 5) Environmental factors. Community pharmacists feared causing offense to women receiving OST and described requiring cues as to when the service was needed. Pharmacists' highlighted a power imbalance in the relationship with women receiving OST. This could influence how receptive this patient group would be to pharmacy RH interventions. Conclusions CPs' concerns of providing RH service could hinder a proactive service provision. Supporting good rapport and providing a structured consultation would increase the accessibility of such a service. Reproductive health advice is triggered by social or physical cues from women. Provision of this advice is subject to the reflective thinking of the provider. A power imbalance characterizes supervised opioid substitution treatment. Good rapport and a structured consultation were seen to increase the accessibility.
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Affiliation(s)
- N. Alhusein
- Population Health Sciences, University of Bristol, Bristol, UK
| | - J. Scott
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - J. Neale
- National Addiction Centre, King's College London, London, UK
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - A. Chater
- Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, UK
- UCL School of Pharmacy, Centre for Behavioural Medicine, BMA House, Tavistock Square, London WC1H 9JP, UK
| | - H. Family
- Population Health Sciences, University of Bristol, Bristol, UK
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
- Corresponding author at: Population Health Sciences, University of Bristol, Bristol, UK.
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Wolfe D, Saucier R. Reprint of: Biotechnologies and the future of opioid addiction treatments. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103273. [PMID: 34391533 DOI: 10.1016/j.drugpo.2021.103273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The future of treatment-including addiction treatment-is biotechnological. Depot injections, agonist/antagonist implants, deep brain stimulation, and hapten conjugate vaccines are hailed by researchers and pharmaceutical manufacturers as medicine's best hope to minimize illicit use, to decrease risk of overdose and painful withdrawal, and to prevent diversion of medicines to illicit markets. Marketing and use of new technologies reveal old tensions framing concepts of addiction and its treatment: between medical condition and disorder of the will, between criminal justice and health, and between patient choice and system control. Using the examples of depot naltrexone and implantable and injectable buprenorphine in the U.S., this essay considers the arc of long-acting opioid treatment and implications for the future. These include the rise of Vivitrol courts and "carceral prescription"-where criminal justice systems mandate medicine to lock up brain receptors much as they might lock up people themselves-as well as use of buprenorphine formulations positioned as increasing both patient benefit and provider control. We also consider lessons from debates on long-acting contraceptive technologies such as Norplant and Depo-Provera. While multiple new long-acting formulations are under development, success will be determined less by characteristics of particular formulations and more by whether or not the new technologies are accompanied by a new ethics of addiction treatment that emphasizes therapeutic alliance, concordance over compliance, and a genuine commitment to allowing patients the ability to narrate and be believed in their descriptions of their treatment experiences.
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Affiliation(s)
- Daniel Wolfe
- Open Society Foundations, New York, NY, United States.
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15
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Eslami-Jahromi M, Keshvardoost S, Ershad-Sarabi R, Bahaadinbeigy K. Information Needs of Addicted Individuals: A Qualitative Case Study. ADDICTION & HEALTH 2021; 13:138-147. [PMID: 35140892 PMCID: PMC8730452 DOI: 10.22122/ahj.v13i3.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the information needs of addicts from the perspective of addicts. By identifying the experiences of the individuals involved in addiction and assessing the information they need, targeted educational interventions can be provided to meet their needs. METHODS Semi-structured interviews were conducted with 13 addicts in two addiction outpatient clinics. Data were analyzed using the qualitative content analysis approach proposed by Graneheim and Lundman. FINDINGS The information needs of the interviewees included recognizing types of addictive substances and the degree of dependence on them, awareness of the physical and psychological symptoms of addiction to various addictive substances, awareness of various pharmacological and non-pharmacological treatments, physical and psychological symptoms of quitting addiction, awareness of the length of treatment, knowledge about the dose and degree of dependence on drugs, recognizing the causes of failure in quitting addiction, awareness of governmental and non-governmental services, and awareness of the psychological measures and care services necessary after quitting addiction. CONCLUSION The results of the study showed that the knowledge and awareness of addicted individuals in various fields of addiction is low and it is necessary to provide education based on the information needs of these individuals. This requires the cooperation and efforts of policy makers, the Ministry of Education, welfare managers, and specialists in camps and addiction treatment centers. Specialists in addiction treatment clinics can use the information needs of addicts determined in this study to enrich the education of addicts.
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Affiliation(s)
- Maryam Eslami-Jahromi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Sareh Keshvardoost
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Roghayeh Ershad-Sarabi
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran,Correspondence to: Roghayeh Ershad-Sarabi; Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman
University of Medical Sciences, Kerman, Iran;
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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16
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Futures-oriented drugs policy research: Events, trends, and speculating on what might become. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103332. [PMID: 34148724 DOI: 10.1016/j.drugpo.2021.103332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/12/2022]
Abstract
One concern in the field of drugs policy is how to make research more futures-oriented. Tracing trends and events with the potential to alter drug futures are seen as ways of becoming more prepared. This challenge is made complex in fast evolving drug markets which entangle with shifting social and material relations at global scale. In this analysis, we argue that drugs policy research orientates to detection and discovery based on the recent past. This narrows future-oriented analyses to the predictable and probable, imagined as extensions of the immediate and local present. We call for a more speculative approach; one which extends beyond the proximal, and one which orientates to possibilities rather than probabilities. Drawing on ideas on speculation from science and technology and futures studies, we argue that speculative research holds potential for more radical alterations in drugs policy. We encourage research approaches which not only valorise knowing in relation to what might happen but which conduct experiments on what could be. Accordingly, we trace how speculative research makes a difference by altering the present through making deliberative interventions on alternative policy options, including policy scenarios which make a radical break with the present. We look specifically at the 'Big Event' and 'Mega Trend' as devices of speculative intervention in futures-oriented drugs policy research. We illustrate how the device of Mega Trend helps to trace as well as to speculate on some of the entangling elements affecting drug futures, including in relation to climate, environment, development, population, drug production, digitalisation, biotechnology, policy and discourse.
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17
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Wolfe D, Saucier R. Biotechnologies and the future of opioid addiction treatments. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:103041. [PMID: 33246267 DOI: 10.1016/j.drugpo.2020.103041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/24/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022]
Abstract
The future of treatment-including addiction treatment-is biotechnological. Depot injections, agonist/antagonist implants, deep brain stimulation, and hapten conjugate vaccines are hailed by researchers and pharmaceutical manufacturers as medicine's best hope to minimize illicit use, to decrease risk of overdose and painful withdrawal, and to prevent diversion of medicines to illicit markets. Marketing and use of new technologies reveal old tensions framing concepts of addiction and its treatment: between medical condition and disorder of the will, between criminal justice and health, and between patient choice and system control. Using the examples of depot naltrexone and implantable and injectable buprenorphine in the U.S., this essay considers the arc of long-acting opioid treatment and implications for the future. These include the rise of Vivitrol courts and "carceral prescription"-where criminal justice systems mandate medicine to lock up brain receptors much as they might lock up people themselves-as well as use of buprenorphine formulations positioned as increasing both patient benefit and provider control. We also consider lessons from debates on long-acting contraceptive technologies such as Norplant and Depo-Provera. While multiple new long-acting formulations are under development, success will be determined less by characteristics of particular formulations and more by whether or not the new technologies are accompanied by a new ethics of addiction treatment that emphasizes therapeutic alliance, concordance over compliance, and a genuine commitment to allowing patients the ability to narrate and be believed in their descriptions of their treatment experiences.
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Affiliation(s)
- Daniel Wolfe
- Open Society Foundations, New York, NY, United States.
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18
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Grebely J, Cerdá M, Rhodes T. COVID-19 and the health of people who use drugs: What is and what could be? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102958. [PMID: 33183679 PMCID: PMC7837052 DOI: 10.1016/j.drugpo.2020.102958] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
SARS-CoV-2, the virus that causes COVID-19, has changed the world as we know it, and continues to do so. How COVID-19 affects people who use drugs, the environments in which they live, and capacities of response, warrants immediate attention. This special issue begins to map how COVID-19 is altering the health of people who use drugs, including in relation to patterns of drug use, service responses, harms that may relate to drug use, interventions to reduce risk of harms, COVID-19 health, and drug policies. We emphasise the need to envisage COVID-19 and its effects as a matter of intersecting ‘complex adaptive systems’: that is, the impacts of COVID-19 extend beyond the virus and related illness conditions to encompass multiple social, cultural, economic, policy and political effects; and these affect the health of people who use drugs directly as well as indirectly by altering the risk and enabling environments in which they live. We synthesize emergent evidence on the impact of COVID-19 on the health of people who use drugs. A key concern we identify is how to sustain policy and service delivery improvements prompted by COVID-19. We need to maintain an ethos of emergent adaptation and experimentation towards the creation of safer environments in relation to the health of people who use drugs.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, United States
| | - Tim Rhodes
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; London School of Hygiene and Tropical Medicine, London, UK
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19
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Parsons G, Ragbir C, D'Agnone O, Gibbs A, Littlewood R, Hard B. Patient-Reported Outcomes, Experiences and Satisfaction with Weekly and Monthly Injectable Prolonged-Release Buprenorphine. Subst Abuse Rehabil 2020; 11:41-47. [PMID: 33173372 PMCID: PMC7648142 DOI: 10.2147/sar.s266838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/29/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction Prolonged-release buprenorphine (PRB), administered by weekly or monthly injection, for opioid dependence (OD) treatment offers the potential to address some limitations of oral therapy including stigma, difficulty in achieving consistent appropriate dosing, risk of diversion of medications, risk of overdose, and continuing use of other drugs. Patient-reported outcomes (PRO) and experiences are important in the evaluation of OD therapy success. This work aimed to document PRO during PRB therapy to guide future treatment decision-making. Methods Qualitative interviews were completed with people on PRB OD treatment. Twenty individuals from four treatment services in England and Wales were asked to participate. A structured interview was developed guided by a person with OD lived experience. Interviews were transcribed, coded and analyzed using iterative categorization. Results Fifteen of 20 individuals approached agreed to participate, and 14 completed interviews. The average age of participants was 42 (range 33–54) years, 13 males and 1 woman, the history of problematic opioid use was 14 years (3–25 years), time in treatment was 7 years (1–20 years), and duration on treatment with PRB was 4 months (range 1–8 months). Participants reported treatment experiences leading to coding of 277 unique comments: therapy effectiveness (77% indicated a benefit of, or satisfaction with, PRB therapy, 7% neutral/general, 16% indicated concern or questions about PRB therapy), convenience (81% benefit, 7% neutral/general, 12% concern), and overall satisfaction (81% benefit, 3% neutral/general, 16% concern). Reported benefits include cravings reduction of 10 (71%), self-care improvement of 10 (71%), relationships improvement of 9 (64%), resources management of 6 (43%), positive outlook on life of 12 (86%). Participants reported a range of positive personal experiences; challenges reported included temporary injection discomfort at treatment initiation. Discussion In this small, focused population, there was generally a positive level of treatment satisfaction with PRB. These experiences provide insights to explain potential treatment benefit to others and are useful in guiding therapy choices for others in the future.
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Ling W, Shoptaw S, Goodman-Meza D. Depot Buprenorphine Injection In The Management Of Opioid Use Disorder: From Development To Implementation. Subst Abuse Rehabil 2019; 10:69-78. [PMID: 31819701 PMCID: PMC6889966 DOI: 10.2147/sar.s155843] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022] Open
Abstract
Buprenorphine has pharmacologic advantages over methadone, especially buprenorphine's better safety profile. The true significance of buprenorphine's introduction lies in returning the care of those suffering from opioid use disorder (OUD) to the hands of the physician. The clinical success of buprenorphine has been meager, in part because most physicians have not been exposed to treating these patients. For physicians inclined to treat OUD, the barriers to buprenorphine's implementation have been onerous and largely counter to the norms of medical practice. Some notable concerns pertain to buprenorphine's clinical pharmacology like street diversion, unintended use and accidental poisoning. Recently, injectable buprenorphine preparations have been introduced to mitigate these latter shortcomings. Yet, the injectable preparations' clinical and commercial success has fallen far short of expectation. Here, we review the clinical pharmacology of these products and their expected clinical advantages for the manufacturers, clinicians, policy makers and patients, and offer our perspective, as clinicians and researchers, on how things can improve. Questions remain whether clinicians are willing to overcome barriers to treat OUD using these medications.
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Affiliation(s)
- Walter Ling
- UCLA Department of Family Medicine, Center for Behavioral and Addiction Medicine, Los Angeles, CA, USA
| | - Steve Shoptaw
- UCLA Department of Family Medicine, Center for Behavioral and Addiction Medicine, Los Angeles, CA, USA
| | - David Goodman-Meza
- UCLA Department of Medicine, Division of Infectious Diseases, Los Angeles, CA, USA
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