Transition to Extended-release Buprenorphine Injectable Within Seven Days for Opioid Use Disorder Treatment: A Scoping Narrative

Jacky T P Siu; Anthony Lau; James S H Wong; Jessica Machado; Pouya Azar

doi:10.1097/ADM.0000000000001520

Transition to Extended-release Buprenorphine Injectable Within Seven Days for Opioid Use Disorder Treatment: A Scoping Narrative

J Addict Med. 2025 Jun 3. doi: 10.1097/ADM.0000000000001520. Online ahead of print.

Authors

Jacky T P Siu, Anthony Lau, James S H Wong, Jessica Machado, Pouya Azar

PMID: 40459195
DOI: 10.1097/ADM.0000000000001520

Abstract

Background: For patients with opioid use disorder, Sublocade (extended-release buprenorphine; Bup-XR-S) and Buvidal/Brixadi (long-acting buprenorphine; Bup-LA-B) formulations allow for less frequent dosing. Traditional induction with Bup-XR-S requires 7 or more days on transmucosal buprenorphine can delay care and increase disengagement risk. Quicker transition to Bup-XR-S or Bup-LA-B presents a promising strategy. With the prevalence of potent illicit opioids, stabilization within 7 days is critical to prevent overdose and withdrawal. This narrative review assesses outcomes of transitions to long-acting injectable buprenorphine within 7 days of the last sublingual dose.

Methods: A systematic search of MEDLINE and EMBASE was completed through February 14, 2025. Studies involving patients with opioid use disorder who underwent Bup-XR-S and Bup-LA-B transition were included. Data on patient characteristics, buprenorphine dosing, retention rates, and outcomes were extracted and synthesized.

Results: We identified 21 studies, totaling 534 patients, that met our inclusion criteria. For Bup-XR-S studies, 75 patients transitioned to Bup-XR-S within 24 hours. Of patients, 4% experienced withdrawal symptoms requiring additional opioid support. All Bup-LA-B studies reported transitions within 24 hours. Short-term retention (4 wk) exceeded 60%. Adverse events were infrequent and primarily mild, including injection site pain, nausea, and constipation.

Conclusions: Limited descriptive studies suggest transitioning to Bup-XR-S within 7 days appears feasible, well-tolerated, and supports treatment adherence. Following labelled dosing, Bup-LA-B transitions within 24 hours were effective and well-tolerated. While these approaches may help initiate opioid agonist therapy in high-risk populations and mitigate overdose risks, further research is needed to confirm effectiveness and impact on retention.

Keywords: Sublocade; addictions; buprenorphine; opioid agonist therapy; opioid use disorder.