A Comparison of Buprenorphine Implants with Sublingual Buprenorphine Among Abstinent Adults with Opioid Use Disorder

The effectiveness of sublingual buprenorphine treatment for opioid use disorder (OUD) may be limited by medication adherence. Diversion, and unintentional pediatric exposure are also of concern. Buprenorphine implants may address these problems. Researchers conducted a 6-month non-inferiority, double-blind, double-dummy, active-controlled, randomized trial of buprenorphine implants versus sublingual buprenorphine. Participants were 18–65 years old and had received sublingual buprenorphine for ≥24 weeks at a stable dose of ≤8 mg/day before enrollment, with no illicit opioid-positive urine samples for ≥90 days prior to study entry. Response to treatment was defined as ≥4 of 6 months without illicit opioid use, based on monthly urine testing (plus 4 random tests) and self-report.

• The proportion of responders was 81/84 (96.4%) in the implant and 78/89 (87.6%) in the sublingual buprenorphine group, indicating non-inferiority of implants.
• Over 6 months, 86% of those who received implants and 72% of those who received sublingual buprenorphine maintained opioid abstinence.
• In sensitivity analyses including all 177 participants (with missing samples imputed as positive), 70/87 (81%) in the implant and 60/90 (67%) in the sublingual buprenorphine group were opioid abstinent.

Comments:

This study supports the use of buprenorphine implants for long-term treatment among a subset of adult patients with OUD – those who are stabilized on sublingual buprenorphine for ≥24 weeks at a dose of ≤8 mg/day. The study population was primarily white, employed, had non-medical use of prescription opioids, and were clinically stable on a relatively modest dose of buprenorphine with abstinence of ≥90 days prior to enrollment, limiting generalizability of the results.

Nicolas Bertholet, MD, MSc

Reference:

Rosenthal RN, Lofwall MR, Kim S, et al. Effect of buprenorphine implants on illicit opioid use among abstinent adults with opioid dependence treated with sublingual buprenorphine: a randomized clinical trial. JAMA. 2016;316(3):282–290.