Abstract
Aim: To discuss the use of 6-monthly buprenorphine implants for maintenance treatment of opioid use disorder and the potential clinical implications if approved in Australia.
Data sources: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature and Web of Science were searched using the key terms ‘buprenorphine implant’, ‘opioid dependence’ and ‘Probuphine’ for articles published between January 2000 and August 2017.
Study selection: English-language, peer-reviewed articles were eligible for inclusion if they evaluated the effectiveness of buprenorphine implants for opioid dependence.
Results: After implantation, an initial pulse is followed by an exponential decline to a non-fluctuating buprenorphine plasma concentration sustained over 6 months. In a double-blind randomised controlled trial, buprenorphine implants were non-inferior to low-to-moderate doses of sublingual buprenorphine (SLB) in clinically stable abstinent patients, with 6-month abstinence being superior to SLB. Adverse effects are comparable to established buprenorphine preparations, although local issues from surgical implantation and explantation procedures appear commonplace, necessitating risk evaluation and mitigation strategies. No studies compared implantable buprenorphine to methadone, which retains patients in therapy more effectively than SLB at a fixed and low dose. Implants offer potential cost savings over SLB, with biannual dosing and tamper-proof characteristics poised to address issues such as poor adherence, misuse, diversion and inadvertent exposures.
Conclusion: Buprenorphine implants have expanded the therapeutic repertoire for opioid use disorder, offering greater opportunity for treatment individualisation. Implants are currently indicated for a small subset of patients who have first demonstrated clinical stability on low-to-moderate doses of SLB. Preliminary data highlight their potential to hypothetically supersede existing treatment modalities in appropriately selected candidates.
Data sources: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature and Web of Science were searched using the key terms ‘buprenorphine implant’, ‘opioid dependence’ and ‘Probuphine’ for articles published between January 2000 and August 2017.
Study selection: English-language, peer-reviewed articles were eligible for inclusion if they evaluated the effectiveness of buprenorphine implants for opioid dependence.
Results: After implantation, an initial pulse is followed by an exponential decline to a non-fluctuating buprenorphine plasma concentration sustained over 6 months. In a double-blind randomised controlled trial, buprenorphine implants were non-inferior to low-to-moderate doses of sublingual buprenorphine (SLB) in clinically stable abstinent patients, with 6-month abstinence being superior to SLB. Adverse effects are comparable to established buprenorphine preparations, although local issues from surgical implantation and explantation procedures appear commonplace, necessitating risk evaluation and mitigation strategies. No studies compared implantable buprenorphine to methadone, which retains patients in therapy more effectively than SLB at a fixed and low dose. Implants offer potential cost savings over SLB, with biannual dosing and tamper-proof characteristics poised to address issues such as poor adherence, misuse, diversion and inadvertent exposures.
Conclusion: Buprenorphine implants have expanded the therapeutic repertoire for opioid use disorder, offering greater opportunity for treatment individualisation. Implants are currently indicated for a small subset of patients who have first demonstrated clinical stability on low-to-moderate doses of SLB. Preliminary data highlight their potential to hypothetically supersede existing treatment modalities in appropriately selected candidates.
| Original language | English |
|---|---|
| Pages (from-to) | 41-49 |
| Number of pages | 9 |
| Journal | Journal of Pharmacy Practice and Research |
| Volume | 49 |
| Issue number | 1 |
| Early online date | 17 Jan 2019 |
| DOIs | |
| Publication status | Published - Feb 2019 |
Keywords
- addiction
- opioid dependence
- opioid substitution
