Factors to guide the use of extended-release buprenorphine formulations for specific patient populations

ABSTRACT

Background

Opioid agonist therapy is first line in the management of opioid use disorder (OUD). Many guidelines support buprenorphine as the optimal treatment due to its preferred safety profile. Extended-release buprenorphine (BUP-XR) is a weekly or monthly subcutaneously administered formulation of buprenorphine. Emerging research has explored the use of BUP-XR in a variety of patient populations to guide clinicians in determining which patients may or may not benefit from BUP-XR.

Methods

We conducted a literature review in Medline, PsycInfo and Embase to capture the literature to date on BUP-XR. Abstracts were reviewed, and papers which guided selection of individuals who would or would not benefit from BUP-XR were included.

Results

Our search returned 359 articles, and 31 met inclusion criteria. Special populations who may benefit from BUP-XR include individuals experiencing homelessness, incarceration, and medical or psychiatric comorbidity, while caution should be used around pregnancy. Patient preference and patient-centered outcomes were recurring considerations to guide the selection of BUP-XR.

Conclusions

Extended-release buprenorphine formulations represent a relatively new tool for managing OUD and may specifically benefit patients undergoing transitions in care. Further research on the comparative effectiveness of extended-release versus daily-dosing formulations and in other populations of interest is needed.

KEYWORDS:

• Opioids
• opioid use disorder
• buprenorphine
• depot
• special populations

Acknowledgments

The authors thank Terri Rodak (CAMH Librarian) for developing the literature review framework for this project.

Disclosure statement

Dr George receives grant support from NIDA (R21-DA-043949), is Deputy Editor with Neuropsychopharmacology (NPP) and serves as Chair, Scientific Advisory Committee for the Canadian Centre for Substance Use and Addiction (CCSA). Dr Lofwall has been a scientific consultant for Titan Pharmaceuticals in the last 36 months. For the remaining authors, no conflicts of interest were declared.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14659891.2023.2174908

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.