Outcomes of Long-Acting Injectable Buprenorphine (Buvidal) in Prisons and After Release: A Scoping Review

Authors Kim Barnett1 Emily Peckham1 Rob Poole1 Pauline Goodlad2 Kate Stalker3 1. Centre for Mental Health and Society, Bangor University. 2. Betsi Cadwaladr University Health Board. 3. Division of Psychology and Mental Health, University of Manchester Abstract Background Substance use often continues during imprisonment and release is often associated with risk factors such as relapse, re-imprisonment, overdose, mortality, reoffending and mental and physical health problems. This highlights the need for effective pharmacological treatment in prison and continuity of care after release. Opioid substitution treatment (OST), primarily buprenorphine or methadone, is the standard medical response for opioid dependence requiring daily adherence. Long-acting injectable buprenorphine (Buvidal) has been introduced in recent years, providing pharmacological coverage from one week to one month. Systematic and scoping reviews have examined Buvidal outcomes in prison and community settings, however, a gap remains in mapping the full depth and breadth of the evidence. This scoping review will map the outcomes and effectiveness of Buvidal for individuals in prison and following release by systematically charting the available evidence. This review aims to identify the gaps in the available evidence to inform future studies. Objective To map the available evidence on the outcomes of long-acting injectable buprenorphine (Buvidal) in prisons and after release. Inclusion Criteria The scoping review will include peer-reviewed, published studies that focus on the effectiveness and outcomes of Buvidal prescribing for adults in prison and post-release. This will include studies reporting stakeholder perceptions where these relate to outcomes and effectiveness. Primary research using qualitative, quantitative, or mixed methods will be included, while non-empirical sources such as editorials, commentaries, protocols, and reviews will be excluded. Methods Searches will be undertaken across the following databases: MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and ASSIA using keywords related to Buvidal, prison settings, and opioid use disorder. Retrieved articles will be managed in Covidence, screening and data extraction will be undertaken independently by two reviewers. Findings will be presented as a narrative synthesis, mapping study characteristics and outcomes across predefined categories, reporting variations by setting or country, and highlighting gaps, strengths, and limitations in the evidence. Keywords Buvidal, long-acting injectable buprenorphine, opioid substitution treatment, opioid use disorder, prison, throughcare. Background The global prison population currently exceeds 11.5 million people (ICPR, 2024). Worldwide, it is estimated that 38.9% (95% CI 31.5 – 46.2) of individuals entering prison present with a drug use disorder (Aebi et al., 2023). Individuals with pre-imprisonment substance use are more likely to continue using substances during incarceration and often experience co-occurring risk factors for re-imprisonment, including mental and physical health problems, a history of trauma, and limited access to education, employment, social support, and successful reintegration into society (Bramley et al., 2020; Favril, 2023; Ford et al., 2024; Jamin et al., 2021; Santo et al., 2022). Post release, individuals experience heightened risks of relapse, overdose, mortality, psychiatric morbidity and reoffending (Chang et al., 2015; Winter et al., 2019; Montanari et al., 2022). This highlights the need for effective pharmacological treatment both in prison and through continuity of care after release to achieve sustained treatment outcomes (Plettinckx et al., 2024; EMCDDA, 2022). Opioid substitution treatment (OST) is the standard medical response for individual’s dependent on opioids, with buprenorphine and methadone being the most commonly prescribed medications (Bell & Strang, 2020; Strang et al., 2020). Traditionally, these treatments are taken daily, requiring consistent patient adherence. However, a long-acting formulation of buprenorphine, Buvidal, has been introduced into prescribing practice in recent years, offering pharmacological effectiveness lasting from one week to one month (Chappuy et al., 2020; Lintzeris & Dunlop, 2025). Although research on Buvidal remains limited, existing studies indicate that it is effective in improving treatment retention and reducing illicit opioid use, as evidenced by a higher number of drug-free urine samples compared to control groups (McMaster & Abeysundera, 2024; Rutrick et al., 2023). Importantly, studies report comparable safety outcomes between Buvidal and standard OST including overdose, adverse events, severe reactions, or mortality (McMaster & Abeysundera, 2024; Williams & Saima, 2023). Research suggests that patients who initiate Buvidal during prison demonstrate greater treatment retention following release (Mlilo et al., 2024; Lee et al., 2021; Woods et al., 2025). In prison settings, Buvidal has been associated with mixed satisfaction outcomes among both patients and healthcare staff (McMaster & Abeysundera, 2024; Neale et al., 2025; Scottish Government, 2021). While OST has proven effective, it is not without limitations, including risks of non-compliance, misuse, diversion, and accidental overdose. The introduction of Buvidal has been proposed as a means of addressing these challenges, with the added advantage of reducing the impact on patients’ daily lives (Williams & Saima, 2023). Although systematic and scoping reviews have examined Buvidal outcomes and effectiveness of Buvidal in the community (Lintzeris & Dunlop, 2025; McMaster & Abeysundera, 2024) and prison settings (Russell et al., 2023; Woods et al., 2025), a gap remains in the literature mapping the breath of the evidence. The aim of this scoping review is to map the outcomes and effectiveness of prescribed Buvidal for individuals in prison and post-release. Comprehensive mapping of existing evidence will allow for identification of research gaps to inform future research (Peters et al., 2020). Aim and Objectives Aim To map and synthesise international evidence on outcomes associated with Buvidal prescribing in prison settings and post-release. Review Questions 1. What outcomes have been measured (e.g., treatment retention, illicit opioid use, overdose, withdrawal, cravings, diversion, re-imprisonment, patient wellbeing and satisfaction and stakeholder perceptions) and are these outcomes reported as primary or secondary? 2. What populations and settings have been studied? 3. What research designs and methodologies have been used? 4. Where are the gaps in the literature? Eligibility Criteria Population/Context The population will include adults aged 18 years and over, of any gender, who are currently in prison or who have been released from prison into the community. Studies reporting perceptions of stakeholders (e.g., healthcare professionals) will be included only if they provide information on the outcomes or effectiveness of Buvidal prescribing in prison or post-release. Individuals imprisoned in other custodial or quasi-custodial settings (e.g. secure units, young offender institutions) will be excluded. Studies in which Buvidal prescribing was initiated solely in the community, rather than during imprisonment, will be excluded. All countries and prison settings will be included. Concept This scoping review will focus on the prescription and administration of Buvidal and related outcomes. Buvidal, a long-acting depot formulation of buprenorphine and administered subcutaneously providing a sustained medication release over the dosing period (Farell et al., 2022). The review will map how Buvidal is prescribed and delivered and the range of outcomes that have been reported in the literature. Types of Studies Included This scoping review will include primary research studies employing qualitative, quantitative, or mixed methods designs that report empirical findings relevant to the review questions. Non-empirical sources, including opinion pieces, editorials, commentaries, letters, conference abstracts, protocols, meta-analysis, and narrative or systematic reviews, will be excluded. Outcomes This scoping review will include studies reporting on outcomes such as treatment retention, illicit opioid use, overdose, withdrawal, cravings, diversion, adverse events, re-imprisonment, patient wellbeing, and satisfaction. Studies reporting perceptions of stakeholders (e.g., healthcare professionals, prison staff) will be included only if they provide information on the outcomes or effectiveness of Buvidal prescribing in prison or post-release. Studies addressing these concepts and the review questions will be included. Methods This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews (Peters et al., 2020). Search Strategy The search strategy will be designed in consultation with a specialist librarian, who will undertake the database searches across the following databases: Medline, Embase, PsycINFO, CINAHL, Scopus, and Assia. The search strategy will be sufficiently broad to capture all studies and will include the keywords: “Buvidal OR Sublocade OR depot buprenorphine OR extended-release buprenorphine” AND “prison OR jail OR correctional OR incarceration” AND “opioid OR opioid-related disorders OR opioid use disorder”. Only studies published in English from database inception to the present will be included. In addition to database searches, the reference lists of included studies and relevant reviews will be checked to identify any additional eligible studies. Identified articles will be uploaded into Covidence after duplicates have been removed in Endnote. Two reviewers will independently screen titles/abstracts and full texts. Disagreements will be resolved by consensus, using a thi