This article first appeared in the January 2019 edition of the UNSW Medicine Neuroscience, Mental health and Addiction Theme and SPHERE Clinical Academic Group (CAG) newsletter.
An open-label, multicentre, single-arm trial of monthly injections of depot buprenorphine in people with opioid dependence (CoLAB)
What is the significance of the CoLAB project?
The advent of novel extended release depot buprenorphine formulations has the potential to transform opiate substitution therapy in a variety of settings and benefit the lives of people living with opioid dependence. For example, the close level of monitoring conducted with current standard daily sublingual buprenorphine dosing may no longer be required. It is important to understand how this impacts on patient outcomes. In addition, making the shift to injectable treatments has important service- and system-level implications. The CoLAB project will evaluate patient outcomes following the implementation of monthly injection of depot buprenorphine for the treatment of opioid dependence, as well as develop and document the implementation in community-based treatment settings, with an emphasis on the feasibility and practical clinical, regulatory and supply issues in settings representative of Australian clinical practice.
What are the benefits of monthly injections of depot buprenorphine as opposed to current treatment?
In settings such as Australia, where there is a focus on supervised daily sublingual buprenorphine dosing, the reduced frequency of dosing required for a monthly injection of depot buprenorphine may free up service-level resources currently allocated to patient monitoring, and thereby potentially increase treatment capacity. Attendance for supervised dosing on a daily basis is also onerous and restrictive for many patients. Travel may be difficult and daily attendance can be counterproductive to leading a “normalised” life (e.g. working or having a weekend away). Attendance for monthly injections may provide a practical and attractive option, particularly for people living in regional or rural communities. Other potential advantages of depot buprenorphine injections include reduced opportunity for diversion of medication to others, and/or use of buprenorphine by harmful routes of administration, such as injection.
What impact do you imagine the CoLAB project will have?
Experiences gained through this trial will be used to inform models of care and the incorporation of depot buprenorphine injections into national clinical guidelines and training programs for health providers.
How does the project support collaboration across the Neuroscience, Mental Health and Addiction Theme and Clinical Academic Group?
CoLAB tackles the alcohol and drug addictions and their co-morbidities key area of focus for the Theme and CAG. The project is guided by the Investigators and Steering Committee representing lead academics, addiction medicine specialists and other clinicians, and community organisations across multiple state and territory jurisdictions. Regular communications through sub-committees will facilitate bilateral sharing of experience between researchers and clinicians as this new treatment modality is implemented. With a focus on the patient experience and practical implementation of the treatment and its delivery, the research findings should be directly translatable and inform future clinical practice.
You can read more about the CoLAB project here.