Interest in long-acting injectable buprenorphine among syringe services program participants

Authors

  • Hannah Epstein, BS
  • Andres Perez-Correa, MD
  • Jason Beltre, BS
  • Christine Fitzsimmons, ASN
  • Pia Marcus, BA
  • Franklin Ramirez, BA
  • L. Synn Stern, RN, MPH
  • Brianna L. Norton, DO, MPH
  • Aaron D. Fox, MD, MS
  • Andrea Jakubowski, MD, MS https://orcid.org/0000-0001-5651-5589

DOI:

https://doi.org/10.5055/jom.2021.0643

Keywords:

opioid use disorder, injectable buprenorphine, long-acting buprenorphine, syringe services programs

Abstract

Objective: To examine syringe services program (SSP) participants’ interest in long-acting injectable buprenorphine.

Design: SSP participants completed a 136-item questionnaire by phone. Items assessed quantitative ratings of interest in sublingual and injectable buprenorphine, preference for sublingual versus injectable buprenorphine, and reasons for preferences.

Setting: Two large urban SSPs.

Participants: SSP participants 18 years of age with current or lifetime opioid use disorder (OUD).

Main outcome measure(s): (1) Interest in sublingual and injectable buprenorphine, respectively, on a scale from 0 to 10 (0 = no interest and 10 = high interest); and (2) preference for sublingual buprenorphine versus injectable buprenorphine. Participants were also asked whether they agreed with statements that presented potential reasons for preferring each formulation.

Results: A total of 104 unique participants were interviewed, of which 72 (69 percent) were currently receiving or considering buprenorphine treatment. Among these 72 participants, the median level of interest in starting or continuing sublingual buprenorphine was 8 out of 10 (interquartile range [IQR]: 6-10) and in starting injectable buprenorphine was 5 out of 10 (IQR: 1-9). Thirty-six (50 percent) preferred sublingual, 27 (38 percent) preferred injectable, and 9 (13 percent) preferred neither or declined to answer. Participants who preferred injectable buprenorphine most commonly agreed that the convenience of the monthly injection was the reason for their preference.

Conclusions: Among SSP participants with OUD, we found moderate interest in injectable buprenorphine. Introducing this new form of buprenorphine treatment at SSPs could help meet the needs of individuals who are not well-served by standard OUD treatment models.

Author Biographies

Hannah Epstein, BS

Department of Internal Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York

Andres Perez-Correa, MD

Department of Internal Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York

Jason Beltre, BS

Washington Heights Corner Project, New York, New York

Christine Fitzsimmons, ASN

New York Harm Reduction Educators, New York, New York

Pia Marcus, BA

New York Harm Reduction Educators, New York, New York

Franklin Ramirez, BA

New York Harm Reduction Educators, New York, New York

L. Synn Stern, RN, MPH

New York Harm Reduction Educators, Washington Heights Corner Project, New York, New York

Brianna L. Norton, DO, MPH

Assistant Professor of Medicine, Department of Internal Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York

Aaron D. Fox, MD, MS

Associate Professor of Medicine, Department of Internal Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York

Andrea Jakubowski, MD, MS

Assistant Professor of Medicine, Department of Internal Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York

References

Ghertner R, Ali MM: Increases in providers with buprenorphine waivers in the United States from 2016 to 2019. Psychiatr Serv. 2020; 71(9): 971-971. DOI: 10.1176/appi.ps.201900635.

US Food and Drug Administration: FDA approves first once-monthly buprenorphine injection, a medication-assisted treatment option for opioid use disorder. 2017. Available at https://www.fda.gov/news-events/press-announcements/fda-approvesfirst-once-monthly-buprenorphine-injection-medicationassisted-treatment-option-opioid. Accessed July 16, 2019.

Lofwall MR, Walsh SL, Nunes EV, et al.: Weekly and monthly subcutaneous buprenorphine depot formulations vs daily sublingual buprenorphine with naloxone for treatment of opioid use disorder a randomized clinical trial. JAMA Intern Med. 2018; 178(6): 764-773. DOI: 10.1001/jamainternmed.2018.1052.

Fox AD, Maradiaga J, Weiss L, et al.: Release from incarceration, relapse to opioid use and the potential for buprenorphine maintenance treatment: A qualitative study of the perceptions of former inmates with opioid use disorder. Addict Sci Clin Pract. 2015; 10(1). DOI: 10.1186/s13722-014-0023-0.

Lofwall MR, Walsh SL: A review of buprenorphine diversion and misuse: The current evidence base and experiences from around the world. J Addict Med. 2014; 8(5): 315-326. DOI: 10.1097/ADM.0000000000000045.

Kishimoto T, Hagi K, Nitta M, et al.: Effectiveness of long-acting injectable vs oral antipsychotics in patients with schizophrenia: A meta-analysis of prospective and retrospective cohort studies. Schizophr Bull. 2018; 44(3): 603-619. DOI: 10.1093/schbul/sbx090.

Winner B, Peipert JF, Zhao Q, et al.: Effectiveness of long-acting reversible contraception. N Engl J Med. 2012; 366(21): 1998-2007. DOI: 10.1056/nejmoa1110855.

The Henry J. Kaiser Family Foundation: Sterile syringe exchange programs. 2018. Available at https://www.kff.org/hivaids/state-indicator/syringe-exchange-programs/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed December 30, 2019.

Des Jarlais DC, McKnight C, Goldblatt C, et al.: Doing harm reduction better: Syringe exchange in the United States. Addiction. 2009; 104(9): 1441-1446. DOI: 10.1111/j.1360-0443.2008.02465.x.

Center for Substance Abuse Treatment: Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction. 2004. Available at http://europepmc.org/books/NBK64245. Accessed August 1, 2020.

Bachhuber MA, Thompson C, Prybylowski A, et al.: Description and outcomes of a buprenorphine maintenance treatment program integrated within Prevention Point Philadelphia, an urban syringe exchange program. Subst Abus. 2018; 39(2): 167-172. DOI: 10.1080/08897077.2018.1443541.

Stancliff S, Joseph H, Fong C, et al.: Opioid maintenance treatment as a harm reduction tool for opioid-dependent individuals in New York City: The need to expand access to buprenorphine/naloxone in marginalized populations. J Addict Dis. 2012; 31(3): 278-287. DOI: 10.1080/10550887.2012.694603.

Hood JE, Banta-Green CJ, Duchin JS, et al.: Engaging an unstably housed population with low-barrier buprenorphine treatment at a syringe services program: Lessons learned from Seattle, Washington. Subst Abus. 2020; 41(3): 356-364. DOI: 10.1080/08897077.2019.1635557.

Carter J, Zevin B, Lum PJ: Low barrier buprenorphine treatment for persons experiencing homelessness and injecting heroin in San Francisco. Addict Sci Clin Pract. 2019; 14(1): 20. DOI: 10.1186/s13722-019-0149-1.

Bluthenthal R, Kral A, Gee L, et al.: The effect of syringe exchange use on high-risk injection drug users: A cohort study. AIDS. 2000; 14(5): 605-611. Available at http://ovidsp.dc2.ovid.com.elibrary.einstein.yu.edu/sp-4.02.1a/ovidweb.cgi?WebLinkFrameset=1&S=CPHOFPPMGIEBLDNHIPCKOFPEIKIEAA00&returnUrl=ovidweb.cgi%253FMain%252BSearch%252BPage%253D1%2526S%253DCPHOFPPMGIEBLDNHIPCKOFPEIKIEAA00&fromjumpstart=1&directlink=http%253A%252F%252. Accessed November 7, 2019.

Ashford RD, Curtis B, Brown AM: Peer-delivered harm reduction and recovery support services: Initial evaluation from a hybrid recovery community drop-in center and syringe exchange program. Harm Reduct J. 2018; 15(1). DOI: 10.1186/s12954-018-0258-2.

Pizzicato LN, Johnson CC, Viner KM: Correlates of experiencing and witnessing non-fatal opioid overdoses among individuals accessing harm reduction services in Philadelphia, Pennsylvania. Subst Abus. 2020; 41(3): 301-306. DOI: 10.1080/08897077.2019.1675115.

Fox AD, Chamberlain A, Frost T, et al.: Harm reduction agencies as a potential site for buprenorphine treatment. Subst Abus. 2015; 36(2): 155-160. DOI: 10.1080/08897077.2015.1011820.

Neale J, Tompkins CNE, Strang J: Prolonged-release opioid agonist therapy: Qualitative study exploring patients’ views of 1-week, 1-month, and 6-month buprenorphine formulations. Harm Reduct J. 2019; 16(1): 25. DOI: 10.1186/s12954-019-0296-4.

Neale J, Tompkins CNE, McDonald R, et al.: Implants and depot injections for treating opioid dependence: Qualitative study of people who use or have used heroin. Drug Alcohol Depend. 2018; 189: 1-7. DOI: 10.1016/j.drugalcdep.2018.03.057.

Tompkins CNE, Neale J, Strang J: Opioid users’ willingness to receive prolonged-release buprenorphine depot injections for opioid use disorder. J Subst Abuse Treat. 2019; 104: 64-71. DOI: 10.1016/j.jsat.2019.06.007.

Neale J, Tompkins CNE, Strang J: Depot buprenorphine injections for opioid use disorder: Patient information needs and preferences. Drug Alcohol Rev. 2019; 38(5): 510-518. DOI: 10.1111/dar.12939.

Neale J, Tompkins CNE, McDonald R, et al.: Patient views of opioid pharmacotherapy biodelivery systems: Qualitative study to assist treatment decision making. Exp Clin Psychopharmacol. 2018; 26(6): 570-581. DOI: 10.1037/pha0000217.

Gilman M, Li L, Hudson K, et al.: Current and future options for opioid use disorder: A survey assessing real-world opinion of service users on novel therapies including depot formulations of buprenorphine. Patient Prefer Adherence. 2018; 12: 2123-2129. DOI: 10.2147/PPA.S180641.

Larance B, Degenhardt L, Grebely J, et al.: Perceptions of extended-release buprenorphine injections for opioid use disorder among people who regularly use opioids in Australia. Addiction. 2020; 115(7): 1295-1305. DOI: 10.1111/add.14941.

Kenney SR, Anderson BJ, Bailey GL, et al.: Buprenorphine treatment formulations: Preferences among persons in opioid withdrawal management. J Subst Abuse Treat. 2018; 94: 55-59. DOI: 10.1016/j.jsat.2018.08.011.

Fiellin DA, Pantalon MV, Chawarski MC, et al.: Counseling plus buprenorphine–naloxone maintenance therapy for opioid dependence. N Engl J Med. 2006; 355(4): 365-374. DOI: 10.1056/NEJMoa055255.

Alford DP, LaBelle CT, Kretsch N, et al.: Collaborative care of opioid-addicted patients in primary care using buprenorphine: Five-year experience. Arch Intern Med. 2011; 171(5): 425-431. DOI: 10.1001/archinternmed.2010.541.

Soeffing JM, Martin LD, Fingerhood MI, et al.: Buprenorphine maintenance treatment in a primary care setting: Outcomes at 1 year. J Subst Abuse Treat. 2009; 37(4): 426-430. DOI: 10.1016/j.jsat.2009.05.003.

Cunningham C, Giovanniello A, Sacajiu G, et al.: Buprenorphine treatment in an urban community health center: What to expect. Fam Med. 40(7): 500-506. Available at http://www.ncbi.nlm.nih.gov/pubmed/18928077. Accessed January 13, 2020.

Published

08/01/2021

How to Cite

Epstein, BS, H., A. Perez-Correa, MD, J. Beltre, BS, C. Fitzsimmons, ASN, P. Marcus, BA, F. Ramirez, BA, L. S. Stern, RN, MPH, B. L. Norton, DO, MPH, A. D. Fox, MD, MS, and A. Jakubowski, MD, MS. “Interest in Long-Acting Injectable Buprenorphine Among Syringe Services Program Participants”. Journal of Opioid Management, vol. 17, no. 7, Aug. 2021, pp. 59-67, doi:10.5055/jom.2021.0643.