Characteristics, treatment patterns and retention with extended-release subcutaneous buprenorphine for opioid use disorder: a population-based cohort study in Ontario, Canada

Author: Tara Gomes, Anita Iacono, Tianru Wang, Mina Tadrous, Tonya Campbell, Gillian Kolla, Pamela Leece, Beth Sproule, Robert Kleinman, Jes Besharah, Charlotte Munro, McCaffrey Doolittle

Theme: Epidemiology & Public Health Research Year: 2023

Background: Opioid agonist treatment (OAT) is used first-line for opioid use disorder (OUD), yet uptake and retention remain low. Novel extended-release formulations were created with the intent to make OAT more accessible by reducing the frequency of healthcare visits. Our aim was to examine uptake, characteristics, treatment patterns and retention of individuals initiating extended-release subcutaneous buprenorphine (BUP-ER), a monthly injectable OAT.

Methods: We conducted a population-based cohort study among adults aged 18+ initiated on BUP-ER between February 3, 2020 and March 31, 2022 and residing in Ontario, Canada. The maximum follow-up date for outcomes was September 30, 2022. Using administrative health claims data, we defined continuous BUP-ER use on the basis of repeat injections within a 56-day period and used Kaplan-Meier curves to estimate time on treatment. Among new BUP-ER recipients, we also described individual and prescriber characteristics, healthcare utilization (ED visits, hospitalizations, outpatient visits, prior OAT) and treatment patterns (induction with buprenorphine/naloxone, dosing, and OAT supplementation).

Results: 2,366 individuals initiated BUP-ER over the study period. The median time to BUP-ER discontinuation was 183 days (interquartile range: 66-428 days) and 52.0% individuals were co-prescribed buprenorphine/naloxone. Among those who were initiated on 300mg BUP-ER, and had three or more injections, 18.8% only ever received 300mg doses (N=276 of 1,470), and 28.6% of those who had a dose reduction to 100mg (N=341 of 1,194) subsequently increased their dose to 300mg.

Conclusion: On average, people initiating BUP-ER in Ontario discontinue within the first 6 months of treatment. Therefore, while BUP-ER is likely providing an important alternative OAT option, the high occurrence of discontinuation, supplementation with buprenorphine/naloxone, and frequent dose increases suggest inadequacy of current dosing recommendations among a sizable proportion of individuals.

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