Exploring long-acting injectable buprenorphine in rural and coastal contexts: A retrospective cohort study of individuals' outcomes from treatment outcome profile data in an opioid substitution service in Cornwall, South West of England.

Abstract

Medication for opioid use disorder (MOUD) is a key component of harm reduction for individuals with opioid use disorder. Long-acting injectable buprenorphine (LAIB) offers a potential alternative to traditional treatments such as methadone, with possible benefits in adherence and outcomes. This study evaluated the effectiveness of LAIB compared to usual care (methadone) in a rural real-world setting using routinely collected data. This novel retrospective cohort study used secondary data from the National Drug Monitoring System, specifically Treatment Outcome Profiles (TOP). The study was conducted within a community-based MOUD service across multiple sites in Cornwall, a rural and coastal region in Southwest England with reduced relative access. All individuals receiving MOUD between April 2022 and September 2024 were included. The intervention group (n = 73) received LAIB; the control group (n = 465) received methadone. Outcomes assessed included self-reported opioid and non-opioid drug use, injecting behavior, quality of life (QoL), and days in paid employment. LAIB was associated with significantly lower overall drug use (p = 0.014), lower opioid use (p < 0.001), alongside higher QoL scores (p = 0.001). No significant differences were observed in crack or cocaine use, injecting frequency, or paid employment days. This real-world evaluation supports LAIB's potential effectiveness for lower overall drug and opioid use and higher QoL in a rural MOUD service setting. Persistent non-opioid use and limited employment differences highlight the need for integrated psychosocial and structural support. These findings underscore the value of routinely collected data in evaluating service innovations and inform LAIB expansion in underserved areas.