In the last of their three-part series on the past , present and future of buprenorphine , Dr Georges Petitjean and Deanne Burch look at the opportunities , and challenges , presented by long-acting Buvidal injections .
The long-acting buprenorphine injection Buvidal was introduced in 2019 , providing an opportunity to treat patients who would benefit from longer-term and stable dosing . Since its introduction , Buvidal has not yet been fully utilised as a treatment option in many drug treatment services .
Despite Buvidal being a welcome additional option within OST prescribing there are perceived difficulties and important considerations with regards to cost , implementation and ensuring equitable access for patients across national drug treatment services .
Long-acting injectable buprenorphine clearly has a place but can present financial challenges and complexities in implementation , as well as pose concerns about continuity of prescribing for patients who move to different areas because of inconsistency in prescribing rates . If long acting injectable buprenorphine is going to become a more common treatment option , then the issues which have been outlined need to be addressed . However , the ongoing exploration of how it may work within drug treatment services
A CONVERSATION WITH DR JAN MELICHAR
Jan K Melichar , MD FRCPsych , is an NHS consultant addiction psychiatrist , visiting senior lecturer at Bath University and visiting professor at the University of South Wales . In 2020 , he put in a successful bid to the Welsh
Government to fund nationwide use of Buvidal . Working together with colleagues , he has rolled it out to more than 1,000 patients and has personally given more than 400 injections to over 100 patients .
in the form of pilots is a positive sign towards its uptake in the future .
Dr Georges Petitjean is the substance misuse medical lead for Inclusion , part of Midlands Partnership NHS Foundation Trust . Deanne Burch is the hepatitis C elimination coordinator for the NHS Addictions Providers Alliance ( NHS APA ). www . inclusion . org / www . nhsapa . org
The authors have not received any financial or other support from pharmaceutical companies and the articles are their own opinion .
What were your fears and expectations when you first began prescribing Buvidal ? To be honest , I was excited to start it as I saw it as a big step forward for many patients . Having worked at getting the most out of buprenorphine for the past two decades , I knew it would be great for settling the peaks and troughs you see with daily dosing . That understanding had led to me to using daily buprenorphine for outpatient detoxification (‘ detoxin-a-box ’) and seeing it as valuable in the opioid analgesia dependency
( OAD ) field . Some OAD patients were on so many short and medium and long-action opioids they were in a constant up and down of opioid effects . So I was very excited about seeing it in action , in terms of smoothing things for people on daily opioids and becoming an amazing detoxification option .
What has been your experience as a clinician ? Much more amazing and unexpected – life-changing for nearly everyone who is on it . Being on Buvidal did more than just
settle the expected daily peaks and troughs – it utterly flattened most people ’ s cravings and settled their anxieties so they simply moved on with their lives . It was as if the daily grind of heroin / methadone / buprenorphine kept them trapped – it was a daily reminder that they were ‘ an addict ’ and all their emotional energy each day went to dealing with that . Being on Buvidal freed them from that and released their recovery capital to simply move on . And this was regardless of which opioid they were on at the start . We recently looked at
the Kaplan-Meier survival curves for them and found , regardless of sex / age / addiction severity or present drug use – were they on methadone / buprenorphine / heroin / codeine / tramadol before Buvidal ? – that four in five benefited . This answers the question , ‘ Who is Buvidal for ?’ – it ’ s for everyone .
What changes have you seen in your service users ? It was , and continues to be , lifechanging for most who try it . It suits at least four in five of those who try it – they stay on it , turn up