Extended-release buprenorphine treatment for opioid use disorder: A mixed-methods study of response and experience

Natalie Lowry; Andrew  Mckechnie; Ed Day; Eilish Gilvarry; Fiona Cowden; Rachel Evans; Rosie Locke; Robbie Murray; Rob Vanderwaal; Stacey Johnstone; Zoe Hoare; Mike Kelleher; Luke Mitcheson; John Marsden

doi:10.1111/add.70106

Extended-release buprenorphine treatment for opioid use disorder: A mixed-methods study of response and experience

Natalie Lowry, Andrew Mckechnie, Ed Day, Eilish Gilvarry, Fiona Cowden, Rachel Evans, Rosie Locke, Robbie Murray, Rob Vanderwaal, Stacey Johnstone, Zoe Hoare, Mike Kelleher, Luke Mitcheson, John Marsden

Research output: Contribution to journal › Article › peer-review

1 Downloads (Pure)

Abstract

Background and aims: An investigation of 24 weeks of extended-release buprenorphine(BUP-XR; Sublocade®) treatment for adults with opioid use disorder (OUD). Study aims were to characterise variations in clinical response, investigate personal factors influencing BUP-XR experience and identify opportunities to tailor treatment interventions.Design: A convergent parallel mixed-methods evaluation embedded in a five-centre, phase 3, randomised controlled trial of BUP-XR versus daily oral methadone or sublingual buprenorphine.Setting: Four of five National Health Service addictions treatment clinics in England andScotland from the trial.Participants: Participants were recruited after they completed the 24-week endpoint.Forty-nine participants (31%) from the trial completed the qualitative interview.Measurements: Three outcome measures from the trial’s dataset were used descrip-tively: (1) fortnightly clinic visit administered TimeLine Follow-Back interview and urine drug screen data on use of non-medical opioids, cocaine and benzodiazepines; (2) thefrequency version of the 11-item Craving Experience Questionnaire administered at baseline and endpoint; and (3) the Structured Clinical Interview for DSM-5 disorders for diagnosis of early OUD and cocaine use disorder (CUD) remission. Data visualisation (by heatmap) identified drug use response sub-groups. A topic-guided, semi-structured qualitative interview was analysed by Interactive Categorisation.Findings: Three response sub-groups were identified: Group 1 [14 (28.5%) of 49 participants] had the highest level of response, characterised by continuous abstinence from opioids, cocaine and benzodiazepines, improvements in craving control and mental and physical health in the majority, and a high level of remission and satisfaction with care; Group 2 [14 (28.5%) of 49 participants] had the next level of response, characterised by continuous abstinence from opioids, but some with opioid craving and some with compensatory use of cocaine and benzodiazepine to cope with anxiety and stress; Group 3[21 (43.0%) of 49 participants] were not continuously abstinent from opioids during follow-up, the majority had dual OUD and CUD at trial enrolment, some reported break-through opioid withdrawal symptoms during follow-up, the majority reported improve-ments in mental health, but many reported opioid and cocaine cravings and compensatory use of cocaine and benzodiazepines.Conclusions: There appears to be variation in response and experience of extended-release buprenorphine during the first six months of treatment, depending on substance use and physical health. This highlights the need for tailored treatment plans based on differing individual needs.

Original language	English
Pages (from-to)	1-12
Journal	Addiction
Early online date	20 Jun 2025
DOIs	https://doi.org/10.1111/add.70106
Publication status	E-pub ahead of print - 20 Jun 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1111/add.70106Licence: CC BY

Extended-release buprenorphine_LOWRY_Publishedonline20June2025_GOLD VoR (CC-BY)Final published version, 761 KBLicence: CC BY

Cite this

Lowry, N., Mckechnie, A., Day, E., Gilvarry, E., Cowden, F., Evans, R., Locke, R., Murray, R., Vanderwaal, R., Johnstone, S., Hoare, Z., Kelleher, M., Mitcheson, L., & Marsden, J. (2025). Extended-release buprenorphine treatment for opioid use disorder: A mixed-methods study of response and experience. Addiction, 1-12. Advance online publication. https://doi.org/10.1111/add.70106

@article{b6dc7b51266d4e978aa14f6dd149fe5a,

title = "Extended-release buprenorphine treatment for opioid use disorder: A mixed-methods study of response and experience",

abstract = "Background and aims: An investigation of 24 weeks of extended-release buprenorphine(BUP-XR; Sublocade{\textregistered}) treatment for adults with opioid use disorder (OUD). Study aims were to characterise variations in clinical response, investigate personal factors influencing BUP-XR experience and identify opportunities to tailor treatment interventions.Design: A convergent parallel mixed-methods evaluation embedded in a five-centre, phase 3, randomised controlled trial of BUP-XR versus daily oral methadone or sublingual buprenorphine.Setting: Four of five National Health Service addictions treatment clinics in England andScotland from the trial.Participants: Participants were recruited after they completed the 24-week endpoint.Forty-nine participants (31%) from the trial completed the qualitative interview.Measurements: Three outcome measures from the trial{\textquoteright}s dataset were used descrip-tively: (1) fortnightly clinic visit administered TimeLine Follow-Back interview and urine drug screen data on use of non-medical opioids, cocaine and benzodiazepines; (2) thefrequency version of the 11-item Craving Experience Questionnaire administered at baseline and endpoint; and (3) the Structured Clinical Interview for DSM-5 disorders for diagnosis of early OUD and cocaine use disorder (CUD) remission. Data visualisation (by heatmap) identified drug use response sub-groups. A topic-guided, semi-structured qualitative interview was analysed by Interactive Categorisation.Findings: Three response sub-groups were identified: Group 1 [14 (28.5%) of 49 participants] had the highest level of response, characterised by continuous abstinence from opioids, cocaine and benzodiazepines, improvements in craving control and mental and physical health in the majority, and a high level of remission and satisfaction with care; Group 2 [14 (28.5%) of 49 participants] had the next level of response, characterised by continuous abstinence from opioids, but some with opioid craving and some with compensatory use of cocaine and benzodiazepine to cope with anxiety and stress; Group 3[21 (43.0%) of 49 participants] were not continuously abstinent from opioids during follow-up, the majority had dual OUD and CUD at trial enrolment, some reported break-through opioid withdrawal symptoms during follow-up, the majority reported improve-ments in mental health, but many reported opioid and cocaine cravings and compensatory use of cocaine and benzodiazepines.Conclusions: There appears to be variation in response and experience of extended-release buprenorphine during the first six months of treatment, depending on substance use and physical health. This highlights the need for tailored treatment plans based on differing individual needs. ",

author = "Natalie Lowry and Andrew Mckechnie and Ed Day and Eilish Gilvarry and Fiona Cowden and Rachel Evans and Rosie Locke and Robbie Murray and Rob Vanderwaal and Stacey Johnstone and Zoe Hoare and Mike Kelleher and Luke Mitcheson and John Marsden",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.",

year = "2025",

month = jun,

day = "20",

doi = "10.1111/add.70106",

language = "English",

pages = "1--12",

journal = "Addiction",

issn = "1360-0443",

publisher = "Wiley-Blackwell Publishing Ltd",

}

TY - JOUR

T1 - Extended-release buprenorphine treatment for opioid use disorder

T2 - A mixed-methods study of response and experience

AU - Lowry, Natalie

AU - Mckechnie, Andrew

AU - Day, Ed

AU - Gilvarry, Eilish

AU - Cowden, Fiona

AU - Evans, Rachel

AU - Locke, Rosie

AU - Murray, Robbie

AU - Vanderwaal, Rob

AU - Johnstone, Stacey

AU - Hoare, Zoe

AU - Kelleher, Mike

AU - Mitcheson, Luke

AU - Marsden, John

PY - 2025/6/20

Y1 - 2025/6/20

N2 - Background and aims: An investigation of 24 weeks of extended-release buprenorphine(BUP-XR; Sublocade®) treatment for adults with opioid use disorder (OUD). Study aims were to characterise variations in clinical response, investigate personal factors influencing BUP-XR experience and identify opportunities to tailor treatment interventions.Design: A convergent parallel mixed-methods evaluation embedded in a five-centre, phase 3, randomised controlled trial of BUP-XR versus daily oral methadone or sublingual buprenorphine.Setting: Four of five National Health Service addictions treatment clinics in England andScotland from the trial.Participants: Participants were recruited after they completed the 24-week endpoint.Forty-nine participants (31%) from the trial completed the qualitative interview.Measurements: Three outcome measures from the trial’s dataset were used descrip-tively: (1) fortnightly clinic visit administered TimeLine Follow-Back interview and urine drug screen data on use of non-medical opioids, cocaine and benzodiazepines; (2) thefrequency version of the 11-item Craving Experience Questionnaire administered at baseline and endpoint; and (3) the Structured Clinical Interview for DSM-5 disorders for diagnosis of early OUD and cocaine use disorder (CUD) remission. Data visualisation (by heatmap) identified drug use response sub-groups. A topic-guided, semi-structured qualitative interview was analysed by Interactive Categorisation.Findings: Three response sub-groups were identified: Group 1 [14 (28.5%) of 49 participants] had the highest level of response, characterised by continuous abstinence from opioids, cocaine and benzodiazepines, improvements in craving control and mental and physical health in the majority, and a high level of remission and satisfaction with care; Group 2 [14 (28.5%) of 49 participants] had the next level of response, characterised by continuous abstinence from opioids, but some with opioid craving and some with compensatory use of cocaine and benzodiazepine to cope with anxiety and stress; Group 3[21 (43.0%) of 49 participants] were not continuously abstinent from opioids during follow-up, the majority had dual OUD and CUD at trial enrolment, some reported break-through opioid withdrawal symptoms during follow-up, the majority reported improve-ments in mental health, but many reported opioid and cocaine cravings and compensatory use of cocaine and benzodiazepines.Conclusions: There appears to be variation in response and experience of extended-release buprenorphine during the first six months of treatment, depending on substance use and physical health. This highlights the need for tailored treatment plans based on differing individual needs.

AB - Background and aims: An investigation of 24 weeks of extended-release buprenorphine(BUP-XR; Sublocade®) treatment for adults with opioid use disorder (OUD). Study aims were to characterise variations in clinical response, investigate personal factors influencing BUP-XR experience and identify opportunities to tailor treatment interventions.Design: A convergent parallel mixed-methods evaluation embedded in a five-centre, phase 3, randomised controlled trial of BUP-XR versus daily oral methadone or sublingual buprenorphine.Setting: Four of five National Health Service addictions treatment clinics in England andScotland from the trial.Participants: Participants were recruited after they completed the 24-week endpoint.Forty-nine participants (31%) from the trial completed the qualitative interview.Measurements: Three outcome measures from the trial’s dataset were used descrip-tively: (1) fortnightly clinic visit administered TimeLine Follow-Back interview and urine drug screen data on use of non-medical opioids, cocaine and benzodiazepines; (2) thefrequency version of the 11-item Craving Experience Questionnaire administered at baseline and endpoint; and (3) the Structured Clinical Interview for DSM-5 disorders for diagnosis of early OUD and cocaine use disorder (CUD) remission. Data visualisation (by heatmap) identified drug use response sub-groups. A topic-guided, semi-structured qualitative interview was analysed by Interactive Categorisation.Findings: Three response sub-groups were identified: Group 1 [14 (28.5%) of 49 participants] had the highest level of response, characterised by continuous abstinence from opioids, cocaine and benzodiazepines, improvements in craving control and mental and physical health in the majority, and a high level of remission and satisfaction with care; Group 2 [14 (28.5%) of 49 participants] had the next level of response, characterised by continuous abstinence from opioids, but some with opioid craving and some with compensatory use of cocaine and benzodiazepine to cope with anxiety and stress; Group 3[21 (43.0%) of 49 participants] were not continuously abstinent from opioids during follow-up, the majority had dual OUD and CUD at trial enrolment, some reported break-through opioid withdrawal symptoms during follow-up, the majority reported improve-ments in mental health, but many reported opioid and cocaine cravings and compensatory use of cocaine and benzodiazepines.Conclusions: There appears to be variation in response and experience of extended-release buprenorphine during the first six months of treatment, depending on substance use and physical health. This highlights the need for tailored treatment plans based on differing individual needs.

UR - http://www.scopus.com/inward/record.url?scp=105008457326&partnerID=8YFLogxK

U2 - 10.1111/add.70106

DO - 10.1111/add.70106

M3 - Article

SN - 1360-0443

SP - 1

EP - 12

JO - Addiction

JF - Addiction

ER -

Extended-release buprenorphine treatment for opioid use disorder: A mixed-methods study of response and experience

Abstract

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this