Opioid treatment study ‘may impact’ future Australian guidelines

Recent research into extended-release buprenorphine injections (BUP-XR) ‘could impact future Australian and international guidelines and health policy’, the author of a new study suggests.
 
Led by the National Drug and Alcohol Research Centre (NDARC), the study assessed outcomes among people receiving 48 weeks of BUP-XR in diverse community healthcare settings – including primary care – across Australia.
 
For the 100 participants – who were mainly men (72%) and had an average age of 44 – improvements were observed in quality of life, employment, and treatment satisfaction measures.
 
‘A major strength of this study is that study sites reflected “real-world” community-based services, primarily consisting of publicly funded drug treatment services,’ NDARC Director Professor Michael Farrell said.
 
‘The high retention and treatment satisfaction rates in this study demonstrate that further expansion of BUP-XR treatment can be incorporated well within the existing service system.
 
‘These results may impact future Australian and international guidelines and health policy, and give more treatment options to people with opioid dependence.’
 
All participants had a long opioid agonist treatment (OAT) history and were recruited from across a network of specialist public drug treatment services, primary care and some private practices in three states, all receiving monthly subcutaneous BUP-XR injections for the treatment of opioid dependence.
 
The dosing standard schedule involved two doses of 300 mg BUP-XR at baseline and month one. Thereafter, doses were flexible with 100 mg or 300 mg every 28 days, based on clinical decisions between participants and treating doctors.
 
Treatment retention at 24 and 48 weeks was 86% and 75%, respectively.
 
The study also found that during treatment there were declines in heroin use, non-prescribed opioid use, and injecting drug use.
 
‘Although modest, these improvements are consistent with ongoing retention and stabilisation within a treatment program among a cohort of people already very treatment-experienced,’ Professor Farrell said.
 
When buprenorphine was first added to the PBS in 2019, Chair of the RACGP Specific Interests Addiction Medicine Dr Hester Wilson told newsGP the listing could ‘revolutionise’ the treatment of opioid dependency.
 
‘We’ve had methadone, which has been brilliant, and now we have buprenorphine, which has the advantage that it’s a partial opioid agonist, making it better for people with respiratory illness or any issues with overdose risk,’ she said.
 
‘My feeling is that this is a great change – it will give choice to patients. It means patients don’t have to attend pharmacies [as often].’
 
Other reported benefits of BUP-XR outlined in the findings include not having to travel for supervised (often daily) dosing, reducing experience of stigma, and reducing negative rituals and habits associated with dosing.
 
However, while the study showed positing outcomes for BUP-XR, Professor Farrell said it is still ‘crucial’ that OAT choice remains.
 
‘For some, particularly those who already have flexibility in their OAT, this formulation may be less attractive,’ he said.
 
‘It is important to ensure that patient choice around which medications people receive in OAT are retained, to ensure that the impact of choice on treatment outcomes is given full consideration in future planning and service change.’
 
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