Prolonged release buprenorphine injections can offer much-needed stability to clients and help to improve retention in services, says a new report from researchers at the University of South Wales (USW).
The document, which was commissioned by the Welsh Government, looks at how the prolonged release injections have been implemented in Wales, and whether they live up to initial claims of being a ‘game changer’ in terms of transforming treatment for opioid dependence.
This form of buprenorphine was first recommended for use by NICE in 2019, but rolled out more widely during the COVID epidemic as it only requires weekly or monthly injections instead of daily oral dosing. For many people the prolonged release nature can be ‘life changing’, the researchers say, removing both the need for regular medication collection and reducing the stigma that can ‘come with visible treatment routines’.
The evidence points to lower healthcare costs, good treatment retention, reduced use of opioids, and ‘positive patient experiences’, the document states – particularly among people who had been struggling with daily dosing routines. However, the report is clear that the medication should be offered as part of a ‘wider, person-centred treatment system’ integrated with proper psychological support and meaningful social activity, rather than as a stand-alone solution. Although there were ‘clear benefits’, the overall picture was more complex, the report continues, with some people experiencing challenges during induction and others continuing to use other substances to deal with ‘boredom, isolation or resurfacing trauma’.
While the urgency of COVID had created a ‘unique’ opportunity for the rapid roll out across Wales, the speed of implementation had inevitably resulted in significant variations in terms of funding and delivery, the report states. Availability of resources, staff training and clinical confidence all play a ‘crucial role’ in users’ experiences of the medication, it stresses. Over time prolonged release injections have ‘become recognised not as a cure-all or silver bullet, but as one important element of a broader treatment framework’, it says.
The Welsh Government has ringfenced £3m a year to continue the injections alongside a longer-term full evaluation, with adoption now ‘significantly higher’ in Wales than England. In Finland between 60 and 65 per cent of OST patients are now prescribed prolonged-release injections, the report adds.
‘What comes through very strongly’ is that the injections can offer ‘a sense of stability and breathing space that daily treatments don’t always allow’, said Professor Katy Holloway of USW. ‘For some, it reduces the constant pressure of managing withdrawal and appointments, making it easier to focus on work, relationships, and recovery. But it’s not a silver bullet. The context around the substance use really matters.’
The evaluation ‘reminds us that effective treatment isn’t just about medication’, she continued. ‘It’s about dignity, giving people real options, and addressing the root cause of substance use’, but ‘must be embedded in compassionate, well-resourced, wrapround care, and patient networks and forums.’
Patients tended to use healthcare services ‘less often than those on methadone and oral buprenorphine, which translates into lower healthcare utilisation costs to the NHS,’ added professor of clinical pharmacology at the University of Hertfordshire, Fabrizio Schifano. ‘Indeed, the difference was most marked in relation to use of the ambulance service.’
Report available here