On the 27th January 2021, Drugs Research Network Scotland (DRNS) was pleased to host a virtual knowledge exchange event discussing Long Acting Injectable Buprenorphine. Delivered in partnership with colleagues from NHS Lanarkshire and NHS Lothian, the two-hour event was designed to share experiences and knowledge of the treatment.
The session included a series of presentations from practitioners who already provide this treatment. An interactive, group session followed the presentations, providing an opportunity for attendees to ask questions and contribute to discussion. The event was fully subscribed, with around 65 individuals attending, including academic researchers, NHS colleagues and third sector service providers. This report provides a summary of the presentations, and access to slides, as well as some key points highlighted within the group discussion.
Presentations
Welcome & introduction: Dr Duncan Stewart, Consultant Addiction Psychiatrist, NHS Lothian
Pilot report Greater Glasgow & Clyde: NHS GGC Alcohol Drug Recovery Services: Dr Trina Ritchie, Lead Clinician and Senior Medical Officer & Jennifer Kelly, Specialist Pharmacist
Trina and Jennifer provided an overview of the current progress in Greater Glasgow and Clyde, with currently over 200 patients in treatment with long acting injectable buprenorphine. A questionnaire completed by 34 individuals in treatment for more than three months found that 85% were ‘extremely satisfied’ with the treatment, with the remaining 15% stating ‘very satisfied’. Access their slides here to read the full results:
Pilot report Lanarkshire – NHS Lanarkshire Pilot: Elizabeth Marr, Senior Clinical Pharmacist & Dr Ed Stewart, General Practitioner
The NHS Lanarkshire pilot commenced in January 2020 with 15 patients. Liz Marr & Ed Stewart provided an overview of the eligibility criteria used for patient selection, demographics of those receiving treatment as well as the pilot results. One benefit reported by a patient related to the ability to arrange ongoing arrangements for employment. Read more from their presentation here:
Pilot report Lothian – West Lothian Community Addictions Service: Amy Martin, ST5 General Adult Psychiatry
An insight into long acting injectable buprenorphine uptake in West Lothian was presented by Amy Martin. Amy discussed some of the challenges faced in implementing this treatment, including issues around homelessness and reduced engagement with key workers between injections. However, she went on to show that out of 88 patients starting the treatment in March 2020, 72 were still currently receiving long acting injectable buprenorphine. Access her full presentation here:
Pilot report Prisons – Long acting injectable buprenorphine: Experience from a prison pilot in Scotland: Tom Byrne, National Prisons Pharmacy Advisor
Tom presented results on the delivery of injectable buprenorphine in prisons within Forth Valley. 61 patients requested conversion to long acting injectable buprenorphine from their current opioid dependence treatment following a consultation. Tom provided some key learning and tips from the experience in prisons including to ensure staff concerns are addressed through the provision of suitable training, as well as the importance of gaining continued feedback from peer groups and those with lived experience. Read the full presentation here:
Pilot report Tayside: Karen Melville, Lead Pharmacist & Sarah Donaldson, Specialist Pharmacist
The pilot in Tayside is currently delivered across HMP Perth/Castle Huntly, within the community, as well as a clinical trial in Dundee. Karen and Sarah gave insight into challenges faced, including the impact of COVID-19, along with the successes achieved with the implementation in both prison and community settings. Slides here:
Homelessness project – Exploring the potential of long acting depot buprenorphine injections for people who use drugs and are homeless: Tania Brown, Research Assistant, Salvation Army Centre for Addiction Services and Research
Tania provided an overview into the provision of buprenorphine amongst people who are homeless or at risk of homelessness. The presentation included quotes from service users about their experiences of the treatment. Access slides here:
Pharmacy Model – Buvidal’s introduction into Blackpool: Colin Fearns, Head of Medicines Management, Delphi Blackpool
In this presentation, Colin covered the patient selection criteria, dispensing and administration model, as well as clinical experiences and challenges of delivering long acting injectable buprenorphine within the Blackpool service. His full presentation can be accessed here:
Group discussion
During the event, attendees were provided access to Padlet which is a virtual collaboration tool. This software allows anyone with the link to post comments, opinions or ideas in relation to the topic being discussed. The Padlet board for this event included question prompts to stimulate discussion. Below provides a summary of questions and related comments received from the event attendees.
What are the benefits of treatment?
- Physical and mental health improved
- Patients ‘feel better’
- Potential protectant effect from opioid overdose
- Allows patients to hold down jobs, ability to work extra hours or unplanned shifts without worrying about making pharmacy pickup
- Potential to reduce situations where illicit drugs may be encountered
- Could release nursing time in custodial environments to dedicate to other interventions
- Provides new choice for patients
- Stability for patients, reduced peaks and troughs
- Less cravings and on top use
- Contact at pharmacy – less stigma and approaches from others to offer other substances
What are the barriers to delivery of treatment?
- Home Office Licences – appear to be an issue in various sites. Can suggestions be made to appropriate authorities that Addiction services should easily obtain licences? Cost of licences is prohibitive too
- Acceptance on all formularies. Some health boards haven’t yet included this in their formularies (inequity of access, postcode lottery)
- Some patients cannot deal with a clear head, exacerbates mental health issues
- Lack of prescriber resource limits speed of rollout. Need for two members of staff
- Access at all treatment sites
What are the practical challenges and logistical issues with delivering treatment?
- Patients attending on correct days when clinics running
- Resource issue – need for two members of staff
- Open access to long acting injectable buprenorphine from different forms of OST
- Clinical lead team willing to engage in treatment options and use long acting injectable buprenorphine
- Need to build a network of community provision – community pharmacy?
- Storage and supply, to have on premises need home office licences
Which population should we ‘target’ to offer treatment?
- People in prison. There is potential for long acting injectable buprenorphine to be hugely beneficial for prisoners, if successful for the individual it can make transitioning into the community less challenging. Prison staff could benefit from knowledge on this subject, and would allow for better support to prisoners
- Homeless population
- There should be no restrictions – treatment seems to be equally effective for chaotic and stable patients
Additional comments
Observations regarding administering long acting injectable buprenorphine: A large needle is used so a frim pinch of flesh to inject is required; avoid injecting where a patient’s usual waistband sits; inform patient that a lump at injection site is likely for a few weeks as the crystal ‘gel’ capsule dissolves; it will take 3-5 injections to reach a steady state – e.g. around 3 months.