NIDA Leaders: Extended-Release OUD Medication Formulations Could Improve Adherence

Following a strategy that has proven effective for improving adherence to other medications, leaders from the National Institute on Drug Abuse say the key to improving retention rates among patients receiving medication-assisted treatment for opioid use disorder could be extended-release formulations of buprenorphine.

In a commentary published on JAMA Network Open, NIDA director Nora Volkow, MD, and deputy director Wilson Compton, MD, MPE, noted the current struggle to keep patients engaged in MAT for OUD, with between 40% and 50% of those treated with methadone or buprenorphine relapsing within 6 months of initiation.

A recent study by researchers in Australia, meanwhile, found that in a comparison of patients receiving daily sublingual buprenorphine vs. those receiving weekly or monthly extended-release formulations of the medication, the extended-release versions were “well-tolerated, acceptable to patients, and produced generally more positive patient-reported outcomes.” The study also found no difficulty with transitioning patients who had been receiving the oral formulation to extended-release buprenorphine.

Beyond being preferred by patients, extended-release OUD medications could have particular value in settings where patients have difficulty accessing care, such as rural areas and justice facilities. Further, Compton and Volkow noted, extended-release formulations could also be an effective tool in combating the most dangerous aspects of fentanyl.

“By providing more stable plasma buprenorphine levels than oral formulations, extended-release buprenorphine formulations obviate the troughs in plasma levels at the end of the daily dosing period that can trigger relapse,” Compton and Volkow wrote. “Thus, they may have particular value for reducing fentanyl-related overdoses, which can occur with relapse to opioids.”