Retention in care for persons with opioid use disorder transitioning from sublingual to injectable buprenorphine

Introduction: In the current overdose epidemic, effective treatments for opioid use disorders (OUD), including innovations in medication delivery such as extended-release formulations, have the potential to improve treatment access and reduce treatment discontinuation. This study assessed treatment retention in a primary care-based, extended-release buprenorphine program.Methods: The study recruited individuals (n = 92) who transitioned from sublingual buprenorphine to extendedrelease buprenorphine (BUP-XR) in 2018-2019. The study defined the primary outcome, treatment retention, as three or more consecutive, monthly BUP-XR injections following the transition to BUP-XR in this retrospective chart review.Results: Participants' mean age was 38 years old and 67% were male. The average duration of sublingual buprenorphine prior to transition was 17.1 (+/- 28.1) months. Three months after transition, 48% of extendedrelease buprenorphine patients had discontinued BUP-XR treatment. Persons with chronic pain were more likely, and those who had used heroin in the past month less likely to continue BUP-XR. Mean months on sublingual buprenorphine prior to BUP-XR initiation was 24.3 (+/- 32.5) months for people who received 3+ postinduction injections compared to only 8.9 (+/- 19.5) months for those who did not (p = .009). Conclusions: Extended-release buprenorphine discontinuation was high in a real-world setting. Retention continues to represent a major obstacle to treatment effectiveness, and programs need interventions with even newer MOUD formulations.