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Hammerslag LR, Talbert J, Slavova S, Lei F, Freeman PR, Marks KR, Fanucchi LC, Walsh SL, Lofwall MR. Utilization of long-acting injectable monthly depot buprenorphine for opioid use disorder (OUD) in Kentucky, before and after COVID-19 related buprenorphine access policy changes. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209391. [PMID: 38740189 DOI: 10.1016/j.josat.2024.209391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/15/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Long-acting injectable buprenorphine (LAI-bup) formulations have advantages over transmucosal buprenorphine (TM-bup), but barriers may limit their utilization. Several policies shifted during the COVID-19 pandemic to promote buprenorphine access. The federal government expanded telemedicine treatment for opioid use disorder and Kentucky (KY) Medicaid lifted prior authorization requirements (PAs) for LAI-bup (i.e., Sublocade®). This retrospective cohort study evaluated changes in LAI-bup access, utilization, and retention before and after these policy changes in KY. METHODS Individual-level TM-bup and LAI-bup dispensing record data from KY's prescription drug monitoring program examined LAI-bup utilization and retention, without a >30-day gap in coverage, for patients starting a new episode of LAI-bup treatment. Two key time periods were examined: pre-policy changes (Apr 1, 2019 - Dec 31, 2019) and post-policy changes (Apr 1, 2020 - Dec 31, 2020). Data on PA requests among Medicaid managed care organizations and availability of LAI-bup Risk Evaluation and Mitigation Strategy (REMS)-certified pharmacies were also obtained. A multivariable Cox proportional hazard regression model analysis compared pre- versus post-policy period treatment discontinuation. RESULTS The number of patients initiating LAI-bup increased from 211 to 481 over the two periods. By the end of the post-policy period, 24.3 % of eligible patients were retained on LAI-bup, versus 12.5 % in the pre-policy change period. The adjusted hazard ratio, comparing discontinuation during the post- versus pre-policy change periods, was 0.70 (95 % confidence interval: 0.55-0.89). There were also more REMS-certified pharmacies and providers in the post-policy change period. CONCLUSIONS LAI-bup access, utilization, and retention increased after several policy changes.
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Affiliation(s)
- Lindsey R Hammerslag
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, United States of America.
| | - Jeffery Talbert
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, United States of America
| | - Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, United States of America
| | - Feitong Lei
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America
| | - Katherine R Marks
- Department of Behavioral Science, College of Medicine, University of Kentucky, United States of America
| | - Laura C Fanucchi
- Department of Internal Medicine, College of Medicine, University of Kentucky, United States of America; Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, United States of America
| | - Sharon L Walsh
- Department of Behavioral Science, College of Medicine, University of Kentucky, United States of America; Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, United States of America
| | - Michelle R Lofwall
- Department of Behavioral Science, College of Medicine, University of Kentucky, United States of America; Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, United States of America
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Heil J, Salzman M, Hunter K, Baston KE, Milburn C, Schmidt R, Haroz R, Ganetsky VS. Evaluation of an injectable monthly extended-release buprenorphine program in a low-barrier specialty addiction medicine clinic. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209183. [PMID: 37879433 DOI: 10.1016/j.josat.2023.209183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Monthly injectable extended-release buprenorphine (XR-BUP) can address several systemic and individual barriers to consistent sublingual buprenorphine treatment for patients with opioid use disorder (OUD). Real-world evaluations of XR-BUP in the outpatient addiction treatment setting are limited. The purpose of this study was to compare 6-month treatment retention and urine drug tests between patients who initiated XR-BUP compared to those who were prescribed but did not initiate XR-BUP in a low-barrier addiction medicine specialty clinic. METHODS We conducted a retrospective cohort study of adults with OUD prescribed XR-BUP between 12/1/2018 and 12/31/2020 in a low-barrier addiction medicine specialty clinic to compare 6-month treatment retention between patients who initiated XR-BUP and those who were prescribed but did not initiate XR-BUP (comparison group). Secondary outcomes included percent of urine toxicology tests negative for non-prescribed opioids. Multivariable logistic regression models evaluated factors associated with 6-month treatment retention and XR-BUP initiation. RESULTS Of the 233 patients prescribed XR-BUP, 148 (63.8 %) identified as non-Hispanic white, 218 (93.6 %) were insured by public insurance (Medicare/Medicaid), and nearly two-thirds were prescribed XR-BUP due to unstable OUD. Approximately 50 % of patients initiated XR-BUP treatment (mean number of injections = 3.7). About 60 % of XR-BUP-treated patients received supplemental sublingual buprenorphine and nearly two-thirds received a 300 mg maintenance dose. Six-month treatment retention was greater in the XR-BUP treatment versus comparison group (70.3 % vs. 36.5 %, p < 0.001). The XR-BUP treatment group had a higher percentage of opioid-negative urine toxicology tests versus the comparison group (67.2 % vs. 36.3 %, p < 0.001). Receipt of XR-BUP was an independent predictor of 6-month treatment retention (OR 5.40, 95 % CI 2.18-13.38). Those prescribed XR-BUP due to unstable OUD had lower odds of treatment retention (OR 0.41, 95 % CI 0.24-0.98) after controlling for receipt of XR-BUP and other variables known to impact retention. CONCLUSIONS XR-BUP improved 6-month treatment retention and resulted in a greater proportion of opioid-negative urine toxicology tests compared to a comparison group of patients who were prescribed but did not initiate XR-BUP. Patients with unstable OUD had lower odds of XR-BUP initiation, suggesting the need for targeted interventions to increase XR-BUP uptake in this high-risk population.
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Affiliation(s)
- Jessica Heil
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Matthew Salzman
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States; Cooper University Health Care, Department of Emergency Medicine, Division of Addiction Medicine and Medical Toxicology, Camden, NJ, United States
| | - Krystal Hunter
- Cooper University Health Care, Cooper Research Institute, Camden, NJ, United States
| | - Kaitlan E Baston
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Christopher Milburn
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Ryan Schmidt
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Rachel Haroz
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States; Cooper University Health Care, Department of Emergency Medicine, Division of Addiction Medicine and Medical Toxicology, Camden, NJ, United States
| | - Valerie S Ganetsky
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States.
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Iacono A, Wang T, Tadrous M, Campbell T, Kolla G, Leece P, Sproule B, Kleinman RA, Besharah J, Munro C, Doolittle M, Gomes T. Characteristics, treatment patterns and retention with extended-release subcutaneous buprenorphine for opioid use disorder: A population-based cohort study in Ontario, Canada. Drug Alcohol Depend 2024; 254:111032. [PMID: 38043224 DOI: 10.1016/j.drugalcdep.2023.111032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Uptake and retention for opioid agonist treatment (OAT) remains low. Novel extended-release formulations may improve OAT accessibility by reducing the frequency of healthcare visits. Our aim was to examine uptake, characteristics, treatment patterns and retention of individuals initiating extended-release subcutaneous buprenorphine (BUP-ER), a monthly injectable OAT. METHODS We conducted a population-based cohort study among adults aged 18+ initiated on BUP-ER between February 3, 2020 and March 31, 2022 in Ontario, Canada. Using administrative health data, we defined continuous BUP-ER use based on repeat injections within a 56-day period and used Kaplan-Meier curves to estimate time on treatment. Among new BUP-ER recipients, we described individual and prescriber characteristics, healthcare utilization and treatment patterns. RESULTS 2366 individuals initiated BUP-ER. The median time to BUP-ER discontinuation was 183 days (interquartile range: 66-428 days) and 52.0% of individuals were co-prescribed buprenorphine/naloxone at least once throughout the period of BUP-ER receipt. Among individuals who initiated on a dose of 300mg BUP-ER and had three or more injections, 18.8% continued to receive only 300mg doses (N=276 of 1470). Furthermore, 28.6% of those whose dose was reduced to 100mg (N=341 of 1194) had a subsequent dose increase to 300mg. CONCLUSIONS On average, people initiating BUP-ER discontinue within the first 6 months of treatment. While BUP-ER is likely providing an important OAT option, the high occurrence of discontinuation, supplementation with buprenorphine/naloxone, and frequent dose increases suggest inadequacy of current dosing recommendations among a proportion of individuals.
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Affiliation(s)
- Anita Iacono
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Tianru Wang
- ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Mina Tadrous
- University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Women's College Hospital, 76 Grenville St Toronto, Ontario M5S 1B2, Canada
| | - Tonya Campbell
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, British Columbia V8N 5M8, Canada
| | - Pamela Leece
- Women's College Hospital, 76 Grenville St Toronto, Ontario M5S 1B2, Canada; University of Toronto Department of Family and Community Medicine, 500 University Ave, Toronto, Ontario M5G 1V7, Canada; Public Health Ontario, 480 University Ave #300, Toronto, Ontario M5G 1V2, Canada; University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada
| | - Beth Sproule
- University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario M5T 1R8, Canada; University of Toronto Department of Psychiatry, 250 College Street 8th floor, Toronto Ontario M5T 1R8, Canada
| | - Robert A Kleinman
- Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario M5T 1R8, Canada; University of Toronto Department of Psychiatry, 250 College Street 8th floor, Toronto Ontario M5T 1R8, Canada
| | - Jes Besharah
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; University of Toronto Institute for Health Policy, Management and Evaluation, 155 College St 4th Floor, Toronto Ontario M5T 3M6, Canada; Women's College Hospital, 76 Grenville St Toronto, Ontario M5S 1B2, Canada; Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario M5T 1R8, Canada; University of Toronto Department of Psychiatry, 250 College Street 8th floor, Toronto Ontario M5T 1R8, Canada; Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, British Columbia V8N 5M8, Canada; University of Toronto Department of Family and Community Medicine, 500 University Ave, Toronto, Ontario M5G 1V7, Canada; Public Health Ontario, 480 University Ave #300, Toronto, Ontario M5G 1V2, Canada; University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada; Ontario Drug Policy Research Network Lived Experience Advisory Group, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Charlotte Munro
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; University of Toronto Institute for Health Policy, Management and Evaluation, 155 College St 4th Floor, Toronto Ontario M5T 3M6, Canada; Women's College Hospital, 76 Grenville St Toronto, Ontario M5S 1B2, Canada; Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario M5T 1R8, Canada; University of Toronto Department of Psychiatry, 250 College Street 8th floor, Toronto Ontario M5T 1R8, Canada; Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, British Columbia V8N 5M8, Canada; University of Toronto Department of Family and Community Medicine, 500 University Ave, Toronto, Ontario M5G 1V7, Canada; Public Health Ontario, 480 University Ave #300, Toronto, Ontario M5G 1V2, Canada; University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada; Ontario Drug Policy Research Network Lived Experience Advisory Group, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - McCaffrey Doolittle
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; University of Toronto Institute for Health Policy, Management and Evaluation, 155 College St 4th Floor, Toronto Ontario M5T 3M6, Canada; Women's College Hospital, 76 Grenville St Toronto, Ontario M5S 1B2, Canada; Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario M5T 1R8, Canada; University of Toronto Department of Psychiatry, 250 College Street 8th floor, Toronto Ontario M5T 1R8, Canada; Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, British Columbia V8N 5M8, Canada; University of Toronto Department of Family and Community Medicine, 500 University Ave, Toronto, Ontario M5G 1V7, Canada; Public Health Ontario, 480 University Ave #300, Toronto, Ontario M5G 1V2, Canada; University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada; Ontario Drug Policy Research Network Lived Experience Advisory Group, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; University of Toronto Institute for Health Policy, Management and Evaluation, 155 College St 4th Floor, Toronto Ontario M5T 3M6, Canada.
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Cuperfain AB, Katznelson G, Costa T, Wong P, Beyraghi N, George TP, Lofwall MR, Chopra N. Factors to guide the use of extended-release buprenorphine formulations for specific patient populations. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2174908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Ari B. Cuperfain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gali Katznelson
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tianna Costa
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Wong
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Narges Beyraghi
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Tony P. George
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Michelle R. Lofwall
- Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Nitin Chopra
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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