Implementing novel treatment in opioid addiction – a combined clinical, register, and qualitative study on buprenprphine depot injections

Research problem and specific questions: Opioid use disorder (OUD) is a severe condition with high morbidity and mortality. Access to life-saving opioid agonist therapy (OAT) may be increased with recently developed buprenorphine depot injections. Research regarding their clinical use and long-term effects is however limited. We aim to explore how depot injections impact retention in treatment, medical and psychiatric complications, rehabilitation, and health economy, as well as how they are perceived by patients and treatment staff.

Data and method: Four research questions are explored with epidemiological register-based, health economy and qualitative methods. Data is collected from medical records and combined with national register data. The qualitative study includes interviews and focus groups.

Plan for project realization: The project comprises four studies:
1/ From electronic medical records we will identify and follow all patients up to one year before and after starting depot injections and controls in seven clinics in Sweden, between February 2019 and 2022. Information on diagnosis, medication, drug screens, and emergency visits will be extracted from medical records. We compare patients on depot injection treatment with treatment as usual to explore how depot injection affect treatment retention, safety, and rehabilitation.

2/ Using the national prescribed drug register in the counties where OAT medication is picked up in pharmacies, we will identify and follow patients in OAT over a period of ten years exploring regional differences and impact of depot injections on long term treatment outcomes such as retention to treatment, employment, substance related in- and outpatient visits, criminality, and death. For this end we will link several relevant national registers with the help of the Swedish personal identity number.

3/ Based on results from study 1 and 2 we will analyze the impact on health economy of different strategies to implement depot injections in the clinics.

4/ Using qualitative methods such as interviews and focus groups we will explore how depot injections are perceived by treatment staff and by patients.

Relevance: Judicious use of depot injections can potentially increase treatment access and save lives. Increased knowledge on the individual and societal impact of depot injections in relationship to their cost-effectiveness is of paramount importance for both patients and healthcare providers.