Feasibility of direct induction onto long-acting injectable buprenorphine

When first introduced, induction onto long-acting injectable buprenorphine (LAIB) required a period of stabilization on sublingual buprenorphine, presenting a key treatment barrier for some patients. Recent regulatory changes allow for direct induction on a low-dose weekly LAIB preparation, yet few studies have examined direct induction onto higher dose weekly and monthly LAIB formulations. To address this gap, this case series reports on 129 patients who were commenced directly onto any LAIB preparation.

A retrospective audit and analysis of the electronic medical record at an urban low-threshold primary healthcare service providing care to a marginalized population of people who inject drugs in Melbourne, Victoria. The study extracted data for all patients who were commenced directly onto LAIB between 1st January 2024 to 31st December 2024.

The study identified patients (n = 129) commenced directly onto any formulation of LAIB. Four patients (3 %) experienced precipitated withdrawal post direct induction onto LAIB, requiring unplanned medical review and symptomatic management but not hospitalization. No other adverse reactions were identified. Most (n = 85, 65.9 %) returned for their next LAIB dose with 57.4 % (n = 74) retained in LAIB treatment at three months.

This case series provides evidence that direct induction onto LAIB is feasible with rates of precipitated withdrawal similar to those previously reported for sublingual buprenorphine induction. Given the benefits of direct induction, in suitably screened patients this could be considered to be a preferred method of LAIB induction.