Buprenorphine treatment for opioid use disorder: recent progress

ABSTRACT

Introduction: Opioid use disorder (OUD) has risen globally and is exerting an enormous toll on public health in many countries, particularly in the United States (US). Buprenorphine (BUP) has become one of the mainstays of pharmacological treatment for OUD and newer delivery methods have been developed to improve its effectiveness in treatment.

Areas covered: We provide a review of BUP products available for OUD, with a focus on the newer long-acting formulations. A literature search was conducted using PubMed, Google Scholar, and ClinicalTrials.gov to find randomized clinical trials of long-acting BUP products. Four randomized clinical trials were found: two with BUP implant and two with subcutaneous injectable BUP.

Expert opinion: In these clinical trials, new BUP formulations were found to be non-inferior to sublingual (SL) BUP and more effective than placebo in reducing opioid use. Longer-acting formulations can improve flexibility in dosing but superiority over existing SL BUP with regards to outcomes needs to be ascertained. There is a need for more comparative studies between longer-acting BUP formulations and currently available SL BUP. Future studies should also include other clinically meaningful outcomes such as quality of life measures, long-term remission rates, and cost-effectiveness.

KEYWORDS:

• Buprenorphine
• long-acting
• subcutaneous
• injection
• implant
• sublingual
• transmucosal

Article Highlights

• The opioid epidemic has resulted in a rapidly expanding population in need of treatment in many countries.

• Buprenorphine has emerged as one of the mainstays of outpatient treatment with its unique pharmacological profile.

• Newer long-acting buprenorphine formulations are as efficacious as existing sublingual formulations but only a few comparison studies exist.

• There is a need for more randomized, controlled trials to fill the gap in literature.

Declaration of interest

K Carroll is a member in trust of CBT4CBT LLC, which makes CBT4CBT available to qualified clinical providers and organizations on a commercial basis. K Carroll works with Yale University to manage any potential conflicts of interest. IL Petrakis has served as a consultant for Alkermes over the past 3 years. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the U.S. Department of Veterans Affairs, Veterans Administration (VA) Mental Illness Research, Education and Clinical Center (MIRECC).