Main Research Findings

Depot buprenorphine injections are a new treatment for opioid use disorder that show promise compared to oral buprenorphine, but their use is still in the early stages and under investigation. Many studies are examining the effectiveness and safety of depot buprenorphine injections. A study published in 6 reported that many patients who received depot buprenorphine injections self-reported using non-prescribed substances within the first month of treatment. These substances included heroin, crack cocaine, benzodiazepines, and cannabis. Participants cited reasons for heroin use including subjective accounts of opioid withdrawal symptoms, pain management, and experimentation (to test the blockade effect of buprenorphine). The frequency of heroin use was typically episodic rather than sustained. Participants associated crack cocaine use with stimulant cravings and social connections, and viewed their use of this substance as difficult to manage. 2 reported a case where a patient on extended-release buprenorphine experienced acute opioid withdrawal symptoms after undergoing liposuction surgery. 7 found that patients seeking treatment for opioid use disorder considered factors such as the route of administration, duration of action, side effects, and cost when making treatment decisions. A study published in 11 suggested that providing methadone or buprenorphine treatment for opioid use disorder in jail settings was associated with a lower risk of opioid overdose mortality after release from New York City jails. In 8 study, patients who switched from sublingual buprenorphine to monthly subcutaneous depot buprenorphine reported experiencing more frequent illicit drug use, worse physical well-being, lower treatment satisfaction, and increased cravings in the initial weeks after the switch compared to their experience with sublingual buprenorphine. However, these symptoms seemed to diminish over time. 5 found that depot buprenorphine injections produced smaller and less frequent fluctuations in buprenorphine plasma concentrations and pharmacodynamic responses, improved outcomes, reduced treatment burden, and lowered risks of misuse and diversion compared to daily sublingual buprenorphine. 10 reported that many patients experienced side effects such as fatigue, nausea, vomiting, constipation, and muscle aches within 72 hours of initiating long-acting injectable buprenorphine. These symptoms were typically mild and transient, but could sometimes be serious, leading to treatment discontinuation or non-adherence. Depot buprenorphine injections have the potential to provide longer-lasting effects, improving patient adherence to treatment. 14 suggests that depot buprenorphine injections may be effective and cost-effective for treating opioid use disorder compared to sublingual buprenorphine and methadone. Depot buprenorphine injections have the potential to reduce the risk of drug misuse and diversion, and increase treatment adherence. 17 found that many patients who received depot buprenorphine injections were satisfied with this new treatment and felt that it improved their adherence to treatment. Depot buprenorphine injections may be a viable treatment option for patients who have difficulty accessing treatment at hospitals or clinics. A study published in 12 suggested that hospital-based depot buprenorphine initiation may help patients maintain treatment adherence. Depot buprenorphine injections show promise for long-term treatment efficacy. 4 found that depot buprenorphine injections demonstrated sustained efficacy for 18 months in treating opioid use disorder. 16 reported high retention rates among patients receiving long-acting depot buprenorphine injections in a general practice setting in Australia. 15 suggests that depot buprenorphine injections could be an effective treatment option for incarcerated individuals. 13 found that providing depot buprenorphine injections through a specialty pharmacy within an integrated health system may make treatment more accessible for patients. 1 described two cases of tissue necrosis in postpartum women who received extended-release buprenorphine injections. A study published in 9 found that many patients who discontinued depot buprenorphine injections cited difficulty maintaining treatment adherence, experiencing side effects, and changes in their living situation as reasons for discontinuation.

Benefits and Risks

Benefits Summary

Depot buprenorphine injections are a viable alternative for treating opioid use disorder, potentially enhancing treatment adherence, reducing the risk of drug misuse and diversion, and offering a treatment option for those with limited access to traditional clinic or hospital settings. They offer promise for long-term treatment efficacy. Additionally, depot buprenorphine injections have the potential to be an effective treatment option for incarcerated individuals. Providing depot buprenorphine injections through specialty pharmacies within integrated health systems may improve patient access to treatment.

Risks Summary

Depot buprenorphine injections may cause side effects such as fatigue, nausea, vomiting, constipation, and muscle aches. While these side effects are typically mild and transient, they can be serious in some cases, potentially leading to treatment discontinuation. There is also a risk of tissue necrosis in postpartum women who receive extended-release buprenorphine injections.

Study Comparison

Commonalities

Depot buprenorphine injections present a promising alternative for treating opioid use disorder, potentially improving treatment adherence and reducing the risk of drug misuse and diversion. However, caution is needed due to the potential for side effects.

Differences

There is variability in the research findings regarding the effectiveness and safety of depot buprenorphine injections. For example, while some studies suggest that depot buprenorphine injections improve treatment adherence, others report that they may lead to treatment discontinuation. The effectiveness and safety of depot buprenorphine injections may vary among individuals, and they may not be effective for all patients.

Consistency and Inconsistencies of Results

The research findings on depot buprenorphine injections show consistency while also demonstrating inconsistencies. For instance, while depot buprenorphine injections are expected to improve treatment adherence, some studies report a potential for treatment discontinuation. The effectiveness and safety of depot buprenorphine injections may vary among individuals, and they may not be effective for all patients.

Considerations for Real-World Application

Depot buprenorphine injections present a viable treatment option for opioid use disorder, but it is important to remember that they carry the risk of side effects and may not be effective for all patients. Before starting treatment with depot buprenorphine injections, it is crucial to consult with a physician to understand the risks and benefits and make an informed decision. Depot buprenorphine injections are a relatively new treatment, and further research is needed to fully understand their effectiveness and safety.

Limitations of Current Research

Further research is needed on depot buprenorphine injections, particularly regarding long-term effects and safety. Research is also needed to determine the optimal dosing methods and management strategies for side effects. Additionally, research on the efficacy of combining depot buprenorphine injections with other treatment modalities is important.

Future Directions for Research

Future research on depot buprenorphine injections should focus on long-term efficacy and safety, as well as determining optimal dosing strategies and methods for managing side effects. Research on the effectiveness of combining depot buprenorphine injections with other treatment approaches is also essential.

Conclusion

Depot buprenorphine injections present a potential treatment option for opioid use disorder that may improve treatment adherence and reduce drug misuse and diversion. However, it is important to acknowledge that depot buprenorphine injections may cause side effects and may not be suitable for all patients. Consultation with a physician to discuss the risks and benefits is crucial before starting treatment. Further research is needed to comprehensively understand the effectiveness and safety of depot buprenorphine injections.