Extended-release injectable buprenorphine for the treatment of opioid use disorder among individuals at high risk of overdose: The FASTER-BUP udy

Abstract

Background: Extended-release injectable buprenorphine (XR-BUP) has emerged as a promising alternative to address some of the adherence challenges of oral opioid use disorder (OUD) medications. However, real-world evaluations of XR-BUP in settings outside the United States and high-risk populations are limited. Our aim was to evaluate the feasibility and clinical utility of XR-BUP among people with OUD at risk of recurrent overdose in a low-barrier outpatient addiction treatment setting.

Methods: 24-week observational prospective cohort study of 25 adults with OUD and high risk of recurrent overdose (i.e., lifetime history of overdose, urine drug test positive for fentanyl) starting XR-BUP in a low-barrier outpatient addiction clinic in Vancouver, BC, Canada, between September 15, 2022 and July 2, 2024. The primary outcome was 6-month retention in XR-BUP treatment. Secondary outcomes included use of illicit opioids and safety.

Results: Participants were mostly men (64 %) and White (80 %), with a median age of 44 years old. Almost all participants had a lifetime history of prior overdose (92.0 %) and 76 % were using fentanyl at baseline. Only 8 (32.0 %) participants received the six scheduled XR-BUP injections (median number of injections 2). Of the 17 participants who discontinued the study, 7 switched to an alternative medication. The average percentage of opioid-free visits during the active treatment period was 28.5 %. Of the 72 injections administered, only 10 (13.9 %) were associated with mild injection site reactions. No other adverse events, including overdoses, were reported.

Conclusions: While XR-BUP was well tolerated in this sample of people with OUD at high risk of overdose, six-month retention rates were low and most continued to use illicit opioids while on treatment.

Keywords: Buprenorphine; Extended-release injectable buprenorphine; Medications for opioid use disorder; Opioid use disorder; Overdose; Sublocade.