Outpatient Initiation of 7-Day Injectable Buprenorphine: A Direct-to-Inject Case Series

Area of Science:

• Addiction Medicine
• Pharmacology

Background:

• Buprenorphine is a key treatment for opioid use disorder (OUD).
• Initiating buprenorphine can be challenging due to potential withdrawal symptoms.
• Long-acting injectable buprenorphine offers a new option for OUD treatment.

Purpose of the Study:

• To assess the feasibility of initiating 7-day long-acting injectable buprenorphine without a sublingual test dose.
• To evaluate patient experiences and treatment retention following direct-to-inject buprenorphine initiation.

Main Methods:

• Retrospective chart review of patients receiving "direct-to-inject" 7-day long-acting injectable buprenorphine.
• Exclusion of patients who received ≥4mg sublingual buprenorphine within 24 hours prior to injection.
• Analysis of patient-reported experiences, return to care, and 7- and 30-day retention rates.

Main Results:

• 21 patients underwent 22 direct-to-inject initiation attempts.
• Most patients (77%) had no preceding buprenorphine dose; 23% had minimal prior exposure.
• Patient experiences ranged from "fine" to "very rough," with most reporting mild to moderate discomfort.
• High treatment retention rates observed: 77% at 7 days and 73% at 30 days post-injection.

Conclusions:

• Direct-to-inject buprenorphine initiation appears generally well-tolerated in an outpatient setting.
• Excellent retention rates suggest feasibility for this novel initiation strategy.
• Further research is warranted to correlate pre-injection factors with post-injection withdrawal experiences.