Qualitative study of patients’ decisions to initiate injectable depot buprenorphine for opioid use disorder: the role of information and other factors

Abstract

Background

Depot buprenorphine can potentially address many limitations of other forms of opioid replacement therapy (ORT). This paper builds upon the concept of the ‘informed patient’ to explore individuals’ decisions to initiate injectable depot buprenorphine.

Methods

Data derive from a qualitative study of 26 people with opioid use disorder who were recruited from drug treatment services in England and Wales and interviewed within 72 hours of starting injectable depot buprenorphine treatment. Interviews were conducted by telephone, audio-recorded, transcribed verbatim, and analysed via Iterative Categorization.

Findings

Participants’ decisions to initiate treatment were underpinned by receiving sufficient information to trust depot buprenorphine; current treatment not meeting their personal needs or goals; frequently uncritical perceptions of depot buprenorphine; and restricted access to depot buprenorphine making recipients feel grateful. Overall, participants said they had enough information and knowledge to decide they wanted depot buprenorphine. However, dissatisfaction with current ORT, desire for better treatment, and depot buprenorphine’s limited availability seemed to hinder informed decision-making.

Conclusions

Whilst pharmaceutical products cannot solve the complex life problems often associated with opioid use disorder, we need to increase access to all ORT forms so that patients do not feel they have to rush into any medication without adequate preparation.

Keywords:

• Depot buprenorphine
• informed patient
• opioid replacement therapy
• opioid use disorder
• treatment decision making
• qualitative

Acknowledgements

The authors thank all study participants for sharing their views, staff at the six services for enabling access to their patients, Mr Paul Lennon for providing expert feedback to help shape the study design, and Mr James Gunn for transcription. The authors also acknowledge two anonymous reviewers for their helpful comments on an earlier version of the manuscript. Joanne Neale and Stephen Parkin are part-funded by, and John Strang is supported by, the National Institute for Health and Care Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London, UK. The views expressed are those of the authors and not necessarily those of Camurus, the NHS, the NIHR, or the Department of Health.

Disclosure statement

In the last three years, J.N. has received, through her university, research funding from Mundipharma Research Ltd and Camurus AB and honoraria from Indivior and Camurus AB for unrelated webinar presentations. S.P. is part-funded by income from research grants obtained from MundiPharma Research Ltd and Camurus AB. In the last three years, J.S. has received, through his university, research funding from Mundipharma Research Ltd, Camurus AB, Accord Healthcare and Pneumowave.

Data availability statement

The data set is not publicly available. Contact the first author for further information.

Additional information

Funding

The study was funded by Camurus AB, the company which developed Buvidal.