Induction of transdermal buprenorphine (Butrans®) to extended-release buprenorphine subcutaneous injection (Sublocade®) for opioid use disorder: a case series & a qualitative study on the experiences, barriers, and understanding of opioid agonist treatment among youth with opioid use disorder in Vancouver, British Columbia

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Date
2023
Authors
Schneiderman, Hannah
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University College Cork
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The opioid crisis is a profound public health crisis, with devastating impacts on individuals, families, and communities in North America. Vancouver is one of the most affected regions in Canada. To combat the rising opioid overdose epidemic, opioid agonist treatment and harm reduction services have become more readily accessible, and patient centered. The most effective approach to decreasing the morbidity and mortality of people with opioid use disorder is opioid agonist treatment. Initiation of opioid agonist treatment, including buprenorphine and methadone, is a complex and crucial step in care for those beginning pharmacological treatment, as well as those transitioning between medications, as poor treatment retention is largely attributed to discomfort during the induction period due to precipitated withdrawal symptoms. A variety of techniques and protocols have been developed to combat treatment barriers, including rapid micro-induction using sublingual buprenorphine-naloxone; this method eliminates the need for an abstinence period prior to administration of the first dose of buprenorphine/naloxone, and lowers the risk of precipitated withdrawal symptoms. We conducted a case series, involving two patients, that demonstrates the efficacy and safety of a novel induction technique using transdermal buprenorphine (Butrans)®, to extended-release buprenorphine subcutaneous injection (Sublocade®) for the treatment of opioid use disorder, done over a 48-hour period. Both patients experienced minimal withdrawal symptoms throughout induction and no adverse effects. This technique, also called the IPPAS method, has similar advantages to that of rapid micro-induction, in addition to reduced nurse workload, steadier blood level concentrations of buprenorphine, and increased accuracy of dose administration. In addition, this technique is more outpatient friendly with less reliance on patients to time their own doses. There is a need for further research among larger patient populations to assess the safety and efficacy of this induction method using transdermal buprenorphine in different settings and patient demographics, including youth with OUD. A population at increased risk of overdose, with lower rates of accessing pharmacological treatment, are youth (15-24 years old). Since 2018, over 1000 people between the age of 0 to 29 have died from illicit drug toxicity in Canada. Despite the effectiveness of opioid agonist treatment for opioid use disorder, only 2.4% of youth who use opioids receive pharmacological treatment compared to 26.3% of adults who use opioids. Another study found that less than 2% of youth who have suffered from a nonfatal opioid-related overdose received the recommended evidence-based pharmacotherapy. Understanding perceptions of OAT among this highly vulnerable young population is essential in combating barriers and harmful perceptions of treatment that lead to reduced treatment access. Few studies have investigated these perceptions among youth. We conducted a qualitative study involving semi-structured interviews among twelve young people with opioid use disorder at Foundry Vancouver-Granville clinic in Vancouver, British Columbia. The findings of this study highlight the complexities involving individual experiences of initiation and retention of opioid agonist treatment, as well as the unique barriers of treatment that young people with opioid use disorder experience. The four major themes identified during thematic analysis include: preparedness to begin opioid agonist treatment, effects of opioid agonist treatment on personal relationships and social life, navigating the pharmacological treatment options, and the role of the healthcare worker. The data from this qualitative research study on the experiences of pharmacological treatment among youth with opioid use disorder can be used to inform future research efforts, clinical practice, and policy change to improve the treatment and social supports available for young people struggling with opioid misuse. Future research is essential to further develop our understanding of young people, and their experiences seeking and retaining opioid agonist treatment for opioid use disorder.
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Opioid agonist treatment , Opioid use disorder , Perceptions , Youth , Transdermal buprenorphine , Induction
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Schneiderman, H. 2023. Induction of transdermal buprenorphine (Butrans®) to extended-release buprenorphine subcutaneous injection (Sublocade®) for opioid use disorder: a case series & a qualitative study on the experiences, barriers, and understanding of opioid agonist treatment among youth with opioid use disorder in Vancouver, British Columbia. MRes Thesis, University College Cork.