Initiation, retention, and discontinuation of extended-release buprenorphine (BUP-XR) for opioid dependence: A single-arm multi-site trial in Ukraine

BACKGROUND: Opioid agonist therapy (OAT) is an essential tool for reducing illicit opioid use and mortality. Extended-release formulations of buprenorphine (BUP-XR) show promise in improving adherence and increasing treatment uptake, but real-world studies show mixed results. Previous studies of BUP-XR were conducted in high-income countries. This study aims to evaluate BUP-XR initiation, retention and dropout in the context of Ukraine. METHODS: ) between February-July 2023 across 10 cities of Ukraine. Correlates of BUP-XR discontinuation due to OAT dropout and switch to BUP-SL were analyzed using competing risks cluster-robust Cox proportional hazards regression models with time-varying covariates. RESULTS: Despite initial interest, BUP-XR enrollment was low: 273 patients among approximately 2300 eligible agreed to switch to BUP-XR. 80 % received 2 or more, 54 % - 7 or more, and 44 % - 13 or more BUP-XR injections. By the 13th injection, 30 % switched to BUP-SL and 26 % discontinued OAT with distinct set of correlates for the two dropout reasons. 13 % of participants were prescribed supplemental BUP-SL. 74 % of participants starting on the lowest dose (64 mg) had their BUP-XR dose subsequently increased. CONCLUSION: BUP-XR uptake and retention in Ukraine were lower than expected in the volatile wartime context. Availability of take-home dosing may reduce the perceived benefits of BUP-XR. Revising clinical guidelines on BUP-XR dosing, dose adjustment, and supplemental BUP-SL prescriptions may reduce the occurrence of opioid withdrawal and improve retention.