Patients report long-acting injectable buprenorphine is an acceptable form of opioid agonist treatment in prison

Prior to 2020, methadone and sublingual buprenorphine-naloxone were the primary opioid against treatment (OAT) formulations available in Australian custodial settings, however, both have potential for diversion [1] and daily treatment administration is resource intensive in these environments [2]. In 2019, we conducted an open-label non-randomised trial (the UNLOC-T study) comparing the safety and tolerability of long-acting injectable buprenorphine (LAIB) and oral methadone in New South Wales prisons and observed a reduction in self-reported opioid use and injecting drug use for those receiving LAIB, with 92% retained at week 16 [3]. We also found that this form of OAT was preferred by health care and custodial providers [4] and that it was less costly due to reductions in staff resourcing required to provide this treatment [5].

In addition, we documented patient reported outcomes throughout the trial, results of which were recently published in Drug and Alcohol Review [6]. The importance of inclusion of the patient perspective in trials of medications for opioid use disorder was highlighted by Compton and Volkow [7], with Lintzeris and colleagues [8] reporting patient reported outcomes rather than abstinence as the primacy outcome in a seminal comparative effectiveness randomised trial of LAIB vs. sublingual buprenorphine-naloxone. We found high levels of treatment satisfaction and improved patient reported outcomes among people stabilised onto LAIB, despite 97% experiencing at least one treatment emergent adverse event [3]. Significant improvements were observed over time in global medication satisfaction scores using the Treatment Satisfaction Questionnaire for Medication (including global satisfaction, effectiveness and side effects subdomain scores), and on the single-item Patient Satisfaction Visual Analogue Scale. Significant improvements were also reported by participants in psychological health (K10, SF-12 and ATOP), quality of life (Total SF-12 and ATOP) and physical health (ATOP).

The use of LAIB for opioid dependent people in custody in New South Wales has increased rapidly, with 45% of patients receiving OAT in custody prescribed LAIB by June 2020 [9]. The current findings are therefore particularly important given that provider preference could be sufficient to expand treatment in this setting, without due consideration of patient perspectives.

Considering the favourable costings, our findings support further scale up to increase coverage of OAT in these settings while maintaining patient safety and satisfaction with treatment. However, we also note the rapid uptake of LAIB in custodial settings from 2020 nationally [10], alongside the growth of the total number of people in OAT in Australia, noting variations by jurisdiction [11]. If the custodial treatment system is initiating more people on OAT, this will have an impact on the number referred for ongoing treatment in the community, which needs to be adequately resourced. Research to assess the impact of the expansion of LAIB in the custodial sector on transition of care to the community, including an examination of patient choice and treatment preference across settings, is clearly warranted.

Adrian Dunlop^1,2,3,4 & Bethany White^4,5,6

¹Drug & Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
²School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
³Healthcare Transformation Research Program, Hunter Medical Research Institute, Newcastle, Australia
⁴Drug & Alcohol Clinical Research & Improvement Network, Sydney, Australia
⁵Edith Collins Centre for Translational Research in Alcohol, Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia
⁶Specialty of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia

Full paper is available Open Access:

White B, Little S, Haber PS, Roberts J, Nolan E, Lintzeris N, Dunlop AJ. Treatment satisfaction and patient reported outcomes among people with opioid use disorder participating in an open-label, non-randomised trial of long-acting injectable buprenorphine treatment in Australian custodial settings. Drug Alcohol Rev. 2025;44:640–8. https://doi.org/10.1111/dar.14005

References

1. Bi-Mohammed Z, Wright NM, Hearty P, King N, Gavin H. Prescription opioid abuse in prison settings: A systematic review of prevalence, practice and treatment responses. Drug Alcohol Depend. 2017;171:122-31.
2. Bandara S, Kennedy-Hendricks A, Merritt S, Barry CL, Saloner B. Methadone and buprenorphine treatment in United States jails and prisons: lessons from early adopters. Addiction. 2021;116:3473-81.
3. Dunlop AJ, White B, Roberts J, Cretikos M, Attalla D, Ling R, et al. Treatment of opioid dependence with depot buprenorphine (CAM2038) in custodial settings. Addiction. 2022;117:382-91.
4. Little S, White B, Moensted M, Butler K, Howard M, Roberts J, et al. Health and correctional staff acceptability of depot buprenorphine in NSW prisons. Int J Drug Policy. 2023;114:103978.
5. Ling R, White B, Roberts J, Cretikos M, Howard MV, Haber PS, et al. Depot buprenorphine as an opioid agonist therapy in New South Wales correctional centres: a costing model. BMC Health Serv Res. 2022;22:1326.
6. White B, Little S, Haber PS, Roberts J, Nolan E, Lintzeris N, et al. Treatment satisfaction and patient reported outcomes among people with opioid use disorder participating in an open-label, non-randomised trial of long-acting injectable buprenorphine treatment in Australian custodial settings. Drug Alcohol Rev. 2025;44:640-8.
7. Compton WM, Volkow ND. Extended-Release Buprenorphine and Its Evaluation With Patient-Reported Outcomes. JAMA Network Open. 2021;4:e219708-e.
8. Lintzeris N, Dunlop AJ, Haber PS, Lubman DI, Graham R, Hutchinson S, et al. Patient-Reported Outcomes of Treatment of Opioid Dependence With Weekly and Monthly Subcutaneous Depot vs Daily Sublingual Buprenorphine: A Randomized Clinical Trial. JAMA Netw Open. 2021;4:e219041.
9. Roberts J, White B, Attalla D, Ward S, Dunlop AJ. Rapid upscale of depot buprenorphine (CAM2038) in custodial settings during the early COVID-19 pandemic in New South Wales, Australia. Addiction. 2021;116:426-7.
10. Bharat C, Chidwick K, Gisev N, Farrell M, Ali R, Degenhardt L. Trends in use of medicines for opioid agonist treatment in Australia, 2013-2022. Int J Drug Policy. 2024;123:104255.
11. Australian Institute of Health and Welfare. National Opioid Pharmacotherapy Statistics Annual Data collection Canberra: Australian Institute of Health and Welfare, 2024. Available from: https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/national-opioid-pharmacotherapy-statistics/contents/summary.