Patient-reported outcomes of subcutaneous depot buprenorphine treatment in Australian correctional centres

Treatment perspectives of people with opioid use disorder (OUD), particularly those in custodial settings, are not well documented. A trial of subcutaneous modified-release depot buprenorphine compared to methadone in correctional centres in New South Wales, Australia (the UNLOC-T study) provided an opportunity to document patient reported treatment outcomes in this setting.The UNLOC-T study was a 16-week non-randomised open-label trial. Men and women aged ≥ 18 years of various security classifications with moderate to severe DSM-5 OUD currently serving a custodial sentence of ≥ 6 months were recruited. Patients not in opioid agonist treatment at recruitment commenced depot buprenorphine (n=67); patients already stable on oral methadone treatment were recruited to the comparison arm (n=62). Treatment satisfaction was assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM) V1.4, with higher scores out of 100 indicating greater satisfaction. The Treatment Burden Questionnaire (TBQ) and the Australian Treatment Outcomes Profile (ATOP) (quality of life and health-related outcomes) were administered and drug use and retention in treatment documented. While the mean TSQM global satisfaction score was similar among the depot buprenorphine group compared to the methadone group at week 16 (mean [SE] score, 78.3 [2.3] vs 72.8 [2.3];p=0.19), patients receiving depot buprenorphine scored significantly higher on the convenience sub-scale (p=0.04). Improved outcomes were also observed for treatment burden assessed by the TBQ, where lower scores indicate lower burden: 8.15 [22.1] vs 20.1 [19.5]; (p<0.01). At week 16, depot buprenorphine ATOP physical health (p<0.001), quality of life (p=0.002) and psychological health (p=0.0286) scores were significantly higher than for methadone. Patients inducted and stabilised depot buprenorphine reported high levels of treatment satisfaction. Further, they reported lower treatment burden and increased health and wellbeing compared to patients already receiving methadone. Our results are consistent with an Australian community-based randomised trial where depot buprenorphine patients scored higher on PROs than patients receiving sublingual buprenorphine. The results highlight the importance of PROs in addiction treatment outcome studies.