A service evaluation pilot study of Buprenorphine Long acting injection

Background:

Buprenorphine prolonged-release injection (Buvidal) has a marketing authorisation for treating opioid dependence within a framework of medical, social, and psychological treatment in adults and young people aged 16 years and over. However, Buvidal has not been widely available across the addiction services within the UK. In the context of this situation, a pilot service evaluation of Buvidal in an addiction service in Essex, United Kingdom was carried out.

Methods:

23 patients (Male = 17; Female=6) were followed over a period ranging from 3 to 12 months after having received Buvidal. The profile of these patients are representative of patients found in a typical UK addiction services, i.e., the complexities ranging from moderate to severe on the account of the substances used, co-morbid mental illnesses and psychosocial impairments. A range of parameters was recorded under three main categories, i.e., assessment and review, TOPS data and recovery STAR outcome data. These major categories had further sub-sets of data as outlined below, Assessment and review - COWS, CVAS, CGI, GI, UDS results and  Side-effects. TOPS primarily or Clinical review -  Reported substance use in the last 28 days. Recovery STAR (Patient’s self-reported priority issues) - Likert scale evaluation from 1 to 10 in ascending order of normality with 1 being the most problematic and 10 being the least problematic,  Alcohol, Physical health, Use of time, Social networks,   Drug use, Emotional well-being, Offending, Accommodation, Money and Family. The Likert scale ranged from 0-10, with 10 being patient in total control of the particular domain and 0 being absolutely no control at all.  The relevant data captured on all of these parameters were done asynchronously at various time points for a period of the time these patients were receiving Buvidal, some patients had been receiving Buvidal only for 3 months,  for patients who had been receiving Buvidal for more than a year we analysed only data for a period of up to 12 months.

Results:

There was a significant drop in COWS and CVAS scores by week 2. There was improvement in the CGI and GI scores across the duration of the evaluation period. The UDS results demonstrated that the patients had been consistently receiving Buvidal. The on-top use of opioids showed a downward trend, although the use of stimulants continued to persist in some patients. The psychosocial measures showed a dramatic improvement in most of the patients. Five patients had dropped out due to various reasons including side-effects, incaercaration in prison and having moved out of the area.

Conclusions:

Buprenorphine long acting depot is an effective opiate substitution therapy but it is not widely available across all of the addiction services in the UK, perhaps due to the cost implications. The long term psychosocial benefits would need to be factored in over economic analysis in the short term and eventually it would be a cost-effective intervention.