Depot buprenorphine for opioid dependence in prisons in NSW, Australia

AIM: This study is designed to assess the safety and feasibility of long acting injectable depot buprenorphine (Buvidal) for the treatment of adults with opioid use disorder in custodial settings in NSW, Australia. Study primary objectives are to (1) identify unexpected safety and tolerability considerations of depot buprenorphine in adults in custody (2) assess diversion and other non-medical use of depot buprenorphine and the impact on risk of violence and; (3) compare the time and cost associated with administration of depot buprenorphine to standard care.

METHODS: This prospective open-label case comparison trial will compare two depot buprenorphine preparations – Buvidal weekly and monthly depot injections to oral methadone. The study will enrol 120 participants across eight correctional centres in metropolitan and rural NSW, with a mix of adult (male and female) prisoner populations and security classifications. Data will be collected on medical, dosing and correction officer time for a cost consequences analysis comparing depot buprenorphine to oral methadone and sublingual buprenorphine.

RESULTS: Ethical issues and research design challenges in working with the target population will be discussed. Recruitment and baseline data will be presented.

CONCLUSION: In New South Wales (NSW), Australia, the current standard of care for opioid use disorder in correctional settings is daily orally or sublingually administered opioid agonist therapy, which is resource-intensive and associated with medication diversion, particularly of sublingual buprenorphine. While answering critical setting-specific safety and tolerability questions, this study will improve understanding of the potential health economic impact and resource utilization with depot buprenorphine treatment in custodial settings compared to standard care.