EXtended-release Pharmacotherapy for Opioid Use Disorder (EXPO)

Background: Opioid use disorder (OUD), is a prevalent and debilitating psychiatric disorder. The front line, evidence supported, standard-of-care (SOC), pharmacotherapies are daily maintenance with oral methadone hydrochloride (MET) or sublingual buprenorphine (SL-BUP). On average, patients who are able to engage in services prescribing these medications benefit from suppression of drug use, reduce risk of fatal overdose, and access to medical services and psychosocial support. However, a significant minority of patients do not stay in treatment and experience lasting reduction in opioid use and OUD symptoms. Sublocade (Indivior) is an extended-release, injectable depot formulation of buprenorphine (XR-BUP). The aim of the EXPO study is to determine the clinical and economic effectiveness of XR-BUP versus MET or SL-BUP. This is the first head-to-head comparison of XR-BUP and SOC opioid agonist/partial agonist maintenance medications for OUD.

Methods: EXPO is a multisite, pragmatic, parallel group, open-label, superiority randomise control trial in specialist NHS community treatment services in England and Scotland. The study includes a mixed-methods qualitative evaluation. The primary outcome is abstinence from opioids during six months of study treatment. The study also included several patient reported outcomes of changes in OUD and subjective recovery.

Results: Launched in 2019, results from the study will be first presented at Lisbon 2022 and will centre on patient experience and the primary outcome.

Conclusion: EXPO is one of the largest RCT studies of OUD treatment outcomes, with findings of relevance for clinical practice and treatment policy.