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

Abstract

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. 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. 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. 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.