Treatment of opioid dependence with depot buprenorphine (CAM2038) in custodial settings.
Buprenorphine
CAM2038
depot
opioid use disorder
prisoners
prisons
safety
slow-release
subcutaneous
Journal
Addiction (Abingdon, England)
ISSN: 1360-0443
Titre abrégé: Addiction
Pays: England
ID NLM: 9304118
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
revised:
21
04
2021
received:
16
02
2021
accepted:
16
06
2021
pubmed:
30
6
2021
medline:
2
2
2022
entrez:
29
6
2021
Statut:
ppublish
Résumé
Opioid agonist treatment is effective but resource intensive to administer safely in custodial settings, leading to significant under-treatment of opioid dependence in these settings world-wide. This study assessed the safety of subcutaneous slow-release depot buprenorphine in custody. Open-label, non-randomized trial. Correctional centres in New South Wales, Australia. Sixty-seven men and women, aged ≥ 18 years of various security classifications with a diagnosis of moderate to severe DSM-5 opioid use disorder currently serving a custodial sentence of ≥ 6 months were recruited between November 2018 and July 2019. Patients not in opioid agonist treatment at recruitment commenced depot buprenorphine; patients already stable on oral methadone treatment were recruited to the comparison arm. Depot buprenorphine (CAM2038 weekly for 4 weeks then monthly) and daily oral methadone. Safety was assessed by adverse event (AE) monitoring and physical examinations at every visit. Participants were administered a survey assessing self-reported diversion and substance use at baseline and weeks 4 and 16. Retention in depot buprenorphine treatment was 92.3%. Ninety-four per cent of patients reported at least one adverse event, typically mild and transient. No diversion was identified. The prevalence of self-reported non-prescribed opioid use among depot buprenorphine patients decreased significantly between baseline (97%) and week 16 (12%, odds ratio = 0.0035, 95% confidence interval = 0.0007-0.018, P < 0.0001). This first study of depot buprenorphine in custodial settings showed treatment retention and outcomes comparable to those observed in community settings and for other opioid agonist treatment used in custodial settings, without increased risk of diversion.
Sections du résumé
BACKGROUND AND AIMS
Opioid agonist treatment is effective but resource intensive to administer safely in custodial settings, leading to significant under-treatment of opioid dependence in these settings world-wide. This study assessed the safety of subcutaneous slow-release depot buprenorphine in custody.
DESIGN
Open-label, non-randomized trial.
SETTING
Correctional centres in New South Wales, Australia.
PARTICIPANTS
Sixty-seven men and women, aged ≥ 18 years of various security classifications with a diagnosis of moderate to severe DSM-5 opioid use disorder currently serving a custodial sentence of ≥ 6 months were recruited between November 2018 and July 2019. Patients not in opioid agonist treatment at recruitment commenced depot buprenorphine; patients already stable on oral methadone treatment were recruited to the comparison arm.
INTERVENTION AND COMPARATOR
Depot buprenorphine (CAM2038 weekly for 4 weeks then monthly) and daily oral methadone.
MEASUREMENTS
Safety was assessed by adverse event (AE) monitoring and physical examinations at every visit. Participants were administered a survey assessing self-reported diversion and substance use at baseline and weeks 4 and 16.
FINDINGS
Retention in depot buprenorphine treatment was 92.3%. Ninety-four per cent of patients reported at least one adverse event, typically mild and transient. No diversion was identified. The prevalence of self-reported non-prescribed opioid use among depot buprenorphine patients decreased significantly between baseline (97%) and week 16 (12%, odds ratio = 0.0035, 95% confidence interval = 0.0007-0.018, P < 0.0001).
CONCLUSIONS
This first study of depot buprenorphine in custodial settings showed treatment retention and outcomes comparable to those observed in community settings and for other opioid agonist treatment used in custodial settings, without increased risk of diversion.
Identifiants
pubmed: 34184798
doi: 10.1111/add.15627
pmc: PMC9291502
doi:
Substances chimiques
Analgesics, Opioid
0
Narcotic Antagonists
0
Buprenorphine
40D3SCR4GZ
Methadone
UC6VBE7V1Z
Banques de données
ANZCTR
['ACTRN12618000942257']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
382-391Informations de copyright
© 2021 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.
Références
Drug Alcohol Depend. 2017 Feb 01;171:122-131
pubmed: 28086177
Addiction. 2017 Aug;112(8):1408-1418
pubmed: 28160345
Addiction. 2017 Oct;112(10):1725-1739
pubmed: 28543749
J Subst Abuse Treat. 2019 Apr;99:32-43
pubmed: 30797392
JAMA Intern Med. 2018 Jun 1;178(6):764-773
pubmed: 29799968
Lancet. 2019 Feb 23;393(10173):778-790
pubmed: 30792007
Drug Alcohol Depend. 2006 Sep 15;84(2):160-6
pubmed: 16487668
Am J Drug Alcohol Abuse. 2012 Nov;38(6):559-66
pubmed: 22783917
Epidemiol Rev. 2018 Jun 1;40(1):58-69
pubmed: 29860343
BMJ Open. 2014 Apr 02;4(4):e004666
pubmed: 24694626
Drug Alcohol Rev. 2014 Jan;33(1):33-42
pubmed: 24206571
Drug Alcohol Depend. 1998 Aug 1;51(3):253-63; discussion 267-8
pubmed: 9787998
Lancet. 2016 Sep 10;388(10049):1089-1102
pubmed: 27427453
Drug Alcohol Depend. 2014 Nov 1;144:254-8
pubmed: 25305714
Addiction. 2022 Feb;117(2):382-391
pubmed: 34184798
Drug Alcohol Rev. 2016 Jan;35(1):76-82
pubmed: 26331899
Drug Alcohol Depend. 2020 Mar 1;208:107858
pubmed: 32050112
Addiction. 2019 Aug;114(8):1416-1426
pubmed: 31013390
Addiction. 2010 Sep;105(9):1545-54
pubmed: 20579009
Addiction. 2015 Dec;110(12):1975-84
pubmed: 26212260
JAMA. 2020 Aug 11;324(6):602-603
pubmed: 32639537
Drug Alcohol Depend. 2014 Sep 1;142:33-40
pubmed: 24962326
Expert Opin Drug Deliv. 2019 Sep;16(9):907-914
pubmed: 31364884