Long-acting injectable buprenorphine (LAIB), when used as part of medication-assisted treatment (MAT) for opioid use disorder (OUD), may have a positive effect on abstinence from opioids as well as on social determinants of health. A review on the impact of buprenorphine on social determinants of health was recently published in the Journal of Substance Abuse Treatment.
While genetics may predispose individuals to OUD, research also recognizes the influence of social determinants of health. MAT is the gold standard for OUD. It is affordable and has shown to improve health outcomes compared with nonpharmacological interventions and to no treatment at all. However, it has a low retention rate due partly to dosing logistics. LAIB may offer an advantage, as it only needs to be administered weekly or monthly.
The researchers of the current study wanted to explore how the use of LAIB affects employment, inclusion, and other social determinants of health compared with daily administration. Searching PubMed, Embase, and Scopus, the researchers looked for studies from 2010 and later that mentioned buprenorphine and OUD, among other terms. They found 15 studies that met their criteria.
The researchers found that patients treated with LAIB had comparable rates of abstinence and employment as those receiving traditional MAT. Patients treated with LAIB showed reduced risk for intentional or accidental diversion of buprenorphine to others, fewer treatment interruptions, and less time lost and less stigma experienced because of frequent medication collection. Disadvantages include injectable route of administration, reduced support services, and a loss of social connection due to less need to leave home.
Because LAIB is a new treatment, the study may suffer from early reporting bias. The researchers also note that several of the studies included in the review were sponsored by pharmaceutical companies, which could have also contributed to bias.
Despite the limitations, the review offers insight into the importance of treatment with LAIB to “optimize psychosocial outcomes,” the researchers stated. When treating with LAIB, the researchers advise physicians to provide ample educational resources, “to encourage patients’ participation to better enable supported decision-making and development of shared treatment goals.” Physicians must also consider the unique needs of vulnerable populations who may benefit from more support.
Longitudinal, real-world, head-to-head, randomized clinical trials comparing LAIB to current MAT would be of benefit to this area of research.
Martin E, Maher H, McKeon G, Patterson S, Blake J, Chen KY. Long-acting injectable buprenorphine for opioid use disorder: A systematic review of impact of use on social determinants of health [published online ahead of print, 2022 Mar 25]. J Subst Abuse Treat. Published online March 25, 2022. doi:10.1016/j.jsat.2022.108776