Go to content

Characteristics, treatment patterns and retention with extended-release subcutaneous buprenorphine for opioid use disorder: a population-based cohort study in Ontario, Canada


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 — 2,366 individuals initiated BUP-ER. The median time to BUP-ER discontinuation was 183 days (interquartile range: 66-428 days) and 52.0% individuals were co-prescribed buprenorphine/naloxone at least once throughout the period of BUP-ER receipt. Among individuals who initiated on a dose of 300 mg BUP-ER and had three or more injections, 18.8% continued to receive only 300 mg doses (N=276 of 1,470). Furthermore, 28.6% of those whose dose was reduced to 100 mg (N=341 of 1,194) had a subsequent dose increase to 300 mg.

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.



Iacono A, Wang T, Tadrous M, Campbell T, Kolla G, Leece P, Sproule B, Kleinman RA, Besharah J, Munro C, Doolittle M, Gomes T. Drug and Alcohol Depend. 2023; Nov 19 [Epub ahead of print].

View Source

Contributing ICES Scientists

Associated Sites