(85) Patient Perspectives on Hospital Initiation of Long-Acting Injectable Buprenorphine

Background & Introduction: While methadone and sublingual buprenorphine have been the standard of care to treat opioid use disorder (OUD), a monthly formulation of long-acting injectable buprenorphine (LAIB) was FDA-approved in 2017. Its use so far has been limited to the outpatient setting, typically requiring patients to be stable on sublingual buprenorphine for at least seven days before initiation. Qualitative research on patient experiences with LAIB has mostly been limited to the international setting, with patients generally reporting high levels of satisfaction and improvements in quality of life. This study aims to understand patient motivations to receive LAIB while hospitalized, as well as their experiences with LAIB after discharge. .

Methods: We recruited participants from an outpatient addiction clinic between March 2023 and May 2023, and conducted 17 in-person interviews with patients who received LAIB while hospitalized. Two participants were interviewed in the hospital, for a total of 19 interviews completed. 95% of participants were Black. The median age of participants was 59. Using semi-structured interviews, we assessed patients’ histories of OUD and OUD treatment, motivations for receiving LAIB in the hospital, and experiences with LAIB once discharged. The interviews were recorded and transcribed. Two researchers independently coded the transcripts using an iterative, open-coding approach.

Results: The majority of patients in our study had a decades-long history of intranasal heroin use and reported engagement in multiple forms of OUD treatment throughout that time, including with methadone, sublingual buprenorphine and residential treatment. Most participants were not aware that LAIB was an OUD treatment option before being hospitalized. An increasingly dangerous drug supply containing fentanyl and other adulterants like xylazine was commonly cited as a motivation to start LAIB, with one participant describing that “Down here fentanyl taking people out left and right. You might as well try this (LAIB) here. You try the fentanyl.” Commonly cited disadvantages of LAIB included fear of needles and pain from the injection process. The vast majority of patients we interviewed, however, expressed overall satisfaction with LAIB, commonly citing LAIB’s positive effect in preventing cravings and withdrawal symptoms, and improving energy and appetite. One participant shared that “it feels good to wake up in the morning. I don't be sick. And I've just been in a good mood.” Many participants noted improved family relationships and increased financial stability. The majority of our participants would recommend LAIB to others and some had even referred family and friends to the clinic to start treatment. One participant stated,“You're gonna need to put this on the billboard, put it outside so everybody can see it. Because it's a life changer, you know. It can do wonders for people that want to get off of drugs so bad that don't know how, don't know where to begin.”

Conclusion & Discussion: In this qualitative study of patients with OUD who received LAIB while hospitalized, participants noted high satisfaction with LAIB, citing benefits in many areas of their lives, including increased energy and appetite, improvements in health and more stable family relationships. Our participants’ overall positive experiences with receiving LAIB in the hospital should inform policy-makers and payers to support expansion of this model and find other ways to lower barriers to receiving LAIB.

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