84. Treatment retention in opioid use disorder managed by long-acting injectable Buprenorphine: A scoping review
Main Article Content
Abstract
Treatment retention is a fundamental factor in optimizing outcomes in opioid use disorder (OUD) treatment. Long-acting injectable buprenorphine is one of the medications with superior efficacy in improving patient retention in treatment. This review was conducted to describe retention rates in OUD treatment using long-acting injectable buprenorphine and to examine factors influencing retention. Through the identification and analysis of 22 studies across various settings and populations, the 6-month retention rates were found to range from 65.5% to 86% in clinical trials and from 42.9% to 80.8% in observational studies. Treatment of OUD with long-acting injectable buprenorphine has been shown to be feasible in diverse contexts. However, retention rates are influenced by medication characteristics, patient factors, program implementation features, and health insurance coverage policies. Selecting appropriate patient populations and providing adequate information, counselling, and support before and during treatment, and implementing suitable prescribing models and health insurance policies may help improve retention and enhance the overall effectiveness of long-acting injectable buprenorphine therapy.
Article Details
Keywords
Opioid, buprenorphine, long-acting, injectable, treatment retention
References
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28. Nunes EV, Comer SD, Lofwall MR, et al. Extended-release injection vs sublingual buprenorphine for opioid use disorder with fentanyl use: A post hoc analysis of a randomized clinical trial. JAMA Netw Open. 2024; 7(6): e2417377. doi:10.1001/jamanetworkopen.2024.17377.
29. Farrell M, Shahbazi J, Chambers M, et al. 96-week retention in treatment with extended-release subcutaneous buprenorphine depot injections among people with opioid dependence: Extended follow-up after a single-arm trial. Int J Drug Policy. 2024; 127: 104390. doi:10.1016/j.drugpo.2024.104390.
30. Cheng A, Badolato R, Segoshi A, et al. Perceptions and experiences toward extended-release buprenorphine among persons leaving jail with opioid use disorders before and during COVID-19: an in-depth qualitative study. Addict Sci Clin Pract. 2022; 17(1): 4. doi:10.1186/s13722-022-00288-4.
31. Clay S, Treloar C, Degenhardt L, et al. “I just thought that was the best thing for me to do at this point”: Exploring patient experiences with depot buprenorphine and their motivations to discontinue. Int J Drug Policy. 2023; 115: 104002. doi:10.1016/j.drugpo.2023.104002.
32. Mariani JJ, Mahony A, Iqbal MN, Luo SX, Naqvi NH, Levin FR. Case series: Rapid induction onto long acting buprenorphine injection for high potency synthetic opioid users. Am J Addict. 2020; 29(4): 345-348. doi:10.1111/ajad.13018.
33. Mariani JJ, Mahony AL, Podell SC, et al. Open-label trial of a single-day induction onto buprenorphine extended-release injection for users of heroin and fentanyl. Am J Addict. 2021; 30(5): 470-476. doi:10.1111/ajad.13193.
34. Andrada E, Rodriguez M, Bandalan JH, Dangelo-Kemp D, Johnston L, Wilson H. Retention rates with monthly depot buprenorphine in general practice in Melbourne, Australia. Aust J Gen Pract. 2022; 51(6): 447-451. doi:10.31128/AJGP-07-21-6098.
35. Cotton AJ, Lo K, Kurtz FB, Waldbauer L. Extended-release buprenorphine outcomes among treatment resistant veterans. Am J Drug Alcohol Abuse. 2022; 48(3): 334-337. doi:10.1080/00952990.2021.1992773.
36. Stein MD, VanNoppen D, Herman DS, Anderson BJ, Conti M, Bailey GL. Retention in care for persons with opioid use disorder transitioning from sublingual to injectable buprenorphine. J Subst Abuse Treat. 2022; 136: 108661. doi:10.1016/j.jsat.2021.108661.
37. Galati BM, Wenzinger M, Rogers CE, Cooke E, Kelly JC. Buprenorphine extended-release treatment for opioid use disorder in the postpartum period. Obstet Gynecol. 2023; 142(5): 1148-1152. doi:10.1097/AOG.0000000000005319.
38. Iacono A, Wang T, Tadrous M, et al. Characteristics, treatment patterns and retention with extended-release subcutaneous buprenorphine for opioid use disorder: A population-based cohort study in Ontario, Canada. Drug Alcohol Depend. 2024; 254: 111032. doi:10.1016/j.drugalcdep.2023.111032.
39. Hammerslag LR, Talbert J, Slavova S, et al. Utilization of long-acting injectable monthly depot buprenorphine for opioid use disorder in Kentucky, before and after COVID-19 related buprenorphine access policy changes. J Subst Use Addict Treat. 2024; 164: 209391. doi:10.1016/j.josat.2024.209391.
40. Heil J, Salzman M, Hunter K, et al. Evaluation of an injectable monthly extended-release buprenorphine program in a low-barrier specialty addiction medicine clinic. J Subst Use Addict Treat. 2024; 156: 209183. doi:10.1016/j.josat.2023.209183.
41. Mlilo K, Fatema K, Poudel P, Harjanto R, Whitton G. Comparing the effectiveness of depot buprenorphine (buvidal injection) and buprenorphine/naloxone (suboxone) treatment following custody release - a retrospective cohort study. J Subst Use. 2024; 29(3): 257-265. doi:10.1080/14659891.2024.2342313.
42. Perdue M, Hosseini Ghomi R, Rees P, Arzubi E. 5-Day injectable extended-release buprenorphine initiation in non-opioid-tolerant individuals in a carceral setting: A case series. J Addict Med. 2024; 18(4): 335-339. doi:10.1097/ADM.0000000000001387.
43. Neptune A, Kaliamurthy S. The use of extended-release buprenorphine in the treatment of adolescent opioid use disorder: A case series. J Addict Med. 2025; 19(2): 150-154. doi:10.1097/ADM.0000000000001447.
44. O’Connor AM, Cousins G, Durand L, Barry J, Boland F. Retention of patients in opioid substitution treatment: A systematic review. PLoS One. 2020; 15(5): e0232086. doi:10.1371/journal.pone.0232086.
45. National Institute on Drug Abuse. Principles of drug addiction treatment: A research-based guide. 3rd ed. Accessed September 5, 2025. https://nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf.
46. Dao ATM, Nguyen HTT, Nguyen LH. Variation overtime among patients of the six methadone maintenance treatment clinics in Thai Nguyen from 2011 to 2015. Biomed Res Int. 2018; 2018: 9081968. doi:10.1155/2018/9081968.
47. Khue PM, Tham NT, Thanh Mai DT, Thuc PV, Thuc VM, Han PV, Lindan C. A longitudinal and case-control study of dropout among drug users in methadone maintenance treatment in Haiphong, Vietnam. Harm Reduct J. 2017; 14(1):59. doi: 10.1186/s12954-017-0185-7.
48. Montgomery C, Abbasi Y, De Silva D, Gittins R, Jones A, Van Hout MC. Investigating outcomes in a substance use treatment provider: a cross-sectional comparison of long-acting injectable buprenorphine and oral medication for opioid use disorder. BMJ Open. 2025; 15(2): e090736. doi:10.1136/bmjopen-2024-090736.
49. Andraka-Christou B, Simon KI, Bradford WD, Nguyen T. Buprenorphine treatment for opioid use disorder: comparison of insurance restrictions, 2017-21. Health Aff (Millwood). 2023; 42(5): 658-664. doi:10.1377/hlthaff.2022.01513.
50. Nong T, Hodgkin D, Trang NT, et al. A review of factors associated with methadone maintenance treatment adherence and retention in Vietnam. Drug Alcohol Depend. 2023; 243: 109699. doi:10.1016/j.drugalcdep.2022.109699.
2. World Health Organization. Opioid overdose. Published August 29, 2023. Accessed November 28, 2024. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose.
3. National Institute on Drug Abuse. Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it in 2021. Published August 7, 2023. Accessed April 24, 2024. https://nida.nih.gov/news-events/news-releases/2023/08/only-1-in-5-us-adults-with-opioid-use-disorder-received-medications-to-treat-it-in-2021.
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6. Wakeman SE, Larochelle MR, Ameli O, et al. Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Netw Open. 2020; 3(2): e1920622. doi:10.1001/jamanetworkopen.2019.20622.
7. Weir MA, Slater J, Jandoc R, Koivu S, Garg AX, Silverman M. The risk of infective endocarditis among people who inject drugs: a retrospective, population-based time series analysis. CMAJ. 2019; 191(4): E93-E99. doi:10.1503/cmaj.180694.
8. Cranston K, Alpren C, John B, et al. Notes from the field: HIV diagnoses among persons who inject drugs - Northeastern Massachusetts, 2015-2018. MMWR Morb Mortal Wkly Rep. 2019; 68(10): 253-254. doi:10.15585/mmwr.mm6810a6.
9. Zibbell JE, Asher AK, Patel RC, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health. 2018; 108(2): 175-181. doi:10.2105/AJPH.2017.304132.
10. Fairley M, Humphreys K, Joyce VR, et al. Cost-effectiveness of treatments for opioid use disorder. JAMA Psychiatry. 2021; 78(7): 767-777. doi:10.1001/jamapsychiatry.2021.0247.
11. Lofwall MR, Fanucchi LC. Long-acting buprenorphine injectables: Opportunity to improve opioid use disorder treatment among rural populations. Prev Med. 2021; 152: 106756. doi:10.1016/j.ypmed.2021.106756.
12. La P, Je M, M P, et al. Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study. BMJ. 2020; 368:m772. doi:10.1136/bmj.m772.
13. Maurice D, Marc A, Oscar D, et al. Recommendations for buprenorphine and methadone therapy in opioid use disorder: a European consensus. Expert Opin Pharmacother. 2017; 18(18): 2003-2015. doi:10.1080/14656566.2017.1409722.
14. Priest KC, Gorfinkel L, Klimas J, Jones AA, Fairbairn N, McCarty D. Comparing Canadian and United States opioid agonist therapy policies. Int J Drug Policy. 2019; 74: 257-265. doi:10.1016/j.drugpo.2019.01.020.
15. Shulman M, Wai JM, Nunes EV. Buprenorphine treatment for opioid use disorder: An overview. CNS Drugs. 2019; 33(6): 567-580. doi:10.1007/s40263-019-00637-z.
16. Tompkins CNE, Neale J, Strang J. Opioid users’ willingness to receive prolonged-release buprenorphine depot injections for opioid use disorder. J Subst Abuse Treat. 2019; 104:64-71. doi:10.1016/j.jsat.2019.06.007.
17. Substance Abuse and Mental Health Services Administration. Buprenorphine. Published March 28, 2024. Accessed April 27, 2024. https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/buprenorphine.
18. McMaster J, Abeysundera H. Effectiveness of long-acting buprenorphine - A systematic review. Australas Psychiatry. 2025; 33(2): 235-248. doi:10.1177/10398562241295872.
19. Korthuis PT, King C, Cook RR, et al. HIV clinic-based buprenorphine plus naloxone versus referral for methadone maintenance therapy for treatment of opioid use disorder in HIV clinics in Vietnam (BRAVO): an open-label, randomised, non-inferiority trial. Lancet HIV. 2021; 8(2): e67-e76. doi:10.1016/S2352-3018(20)30302-7.
20. Vietnam Administration for HIV/AIDS Control. Báo cáo kết quả công tác phòng, chống HIV/AIDS năm 2019 và nhiệm vụ trọng tâm năm 2020. Accessed July 28, 2025. https://vaac.gov.vn/upload/anh-bai-viet/tailieu/bao-cao-2019-gui-vpcp-da-nen.pdf?v=1.0.0.
21. PRISMA statement. PRISMA 2020 flow diagram. Accessed January 20, 2025. https://www.prisma-statement.org/prisma-2020-flow-diagram.
22. Frost M, Bailey GL, Lintzeris N, et al. Long-term safety of a weekly and monthly subcutaneous buprenorphine depot (CAM2038) in the treatment of adult out-patients with opioid use disorder. Addiction. 2019; 114(8): 1416-1426. doi:10.1111/add.14636.
23. Andorn AC, Haight BR, Shinde S, et al. Treating opioid use disorder with a monthly subcutaneous buprenorphine depot injection: 12-month safety, tolerability, and efficacy analysis. J Clin Psychopharmacol. 2020; 40(3): 231-239. doi:10.1097/JCP.0000000000001195.
24. Lee JD, Malone M, McDonald R, et al. Comparison of treatment retention of adults with opioid addiction managed with extended-release buprenorphine vs daily sublingual buprenorphine-naloxone at time of release from jail. JAMA Netw Open. 2021; 4(9): e2123032. doi:10.1001/jamanetworkopen.2021.23032.
25. Dunlop AJ, White B, Roberts J, et al. Treatment of opioid dependence with depot buprenorphine (CAM2038) in custodial settings. Addiction. 2022; 117(2): 382-391. doi:10.1111/add.15627.
26. Farrell M, Shahbazi J, Byrne M, et al. Outcomes of a single-arm implementation trial of extended-release subcutaneous buprenorphine depot injections in people with opioid dependence. Int J Drug Policy. 2022; 100: 103492. doi:10.1016/j.drugpo.2021.103492.
27. Macdonald T, Connor P, Edwards J, Hardy M, Kemp D, Johnston L. Real-world retention rates with a long-acting buprenorphine depot in opioid-dependent patients attending private clinics in Australia. Heroin Addict Relat Clin Probl. 2022; 24(2): 19-25
28. Nunes EV, Comer SD, Lofwall MR, et al. Extended-release injection vs sublingual buprenorphine for opioid use disorder with fentanyl use: A post hoc analysis of a randomized clinical trial. JAMA Netw Open. 2024; 7(6): e2417377. doi:10.1001/jamanetworkopen.2024.17377.
29. Farrell M, Shahbazi J, Chambers M, et al. 96-week retention in treatment with extended-release subcutaneous buprenorphine depot injections among people with opioid dependence: Extended follow-up after a single-arm trial. Int J Drug Policy. 2024; 127: 104390. doi:10.1016/j.drugpo.2024.104390.
30. Cheng A, Badolato R, Segoshi A, et al. Perceptions and experiences toward extended-release buprenorphine among persons leaving jail with opioid use disorders before and during COVID-19: an in-depth qualitative study. Addict Sci Clin Pract. 2022; 17(1): 4. doi:10.1186/s13722-022-00288-4.
31. Clay S, Treloar C, Degenhardt L, et al. “I just thought that was the best thing for me to do at this point”: Exploring patient experiences with depot buprenorphine and their motivations to discontinue. Int J Drug Policy. 2023; 115: 104002. doi:10.1016/j.drugpo.2023.104002.
32. Mariani JJ, Mahony A, Iqbal MN, Luo SX, Naqvi NH, Levin FR. Case series: Rapid induction onto long acting buprenorphine injection for high potency synthetic opioid users. Am J Addict. 2020; 29(4): 345-348. doi:10.1111/ajad.13018.
33. Mariani JJ, Mahony AL, Podell SC, et al. Open-label trial of a single-day induction onto buprenorphine extended-release injection for users of heroin and fentanyl. Am J Addict. 2021; 30(5): 470-476. doi:10.1111/ajad.13193.
34. Andrada E, Rodriguez M, Bandalan JH, Dangelo-Kemp D, Johnston L, Wilson H. Retention rates with monthly depot buprenorphine in general practice in Melbourne, Australia. Aust J Gen Pract. 2022; 51(6): 447-451. doi:10.31128/AJGP-07-21-6098.
35. Cotton AJ, Lo K, Kurtz FB, Waldbauer L. Extended-release buprenorphine outcomes among treatment resistant veterans. Am J Drug Alcohol Abuse. 2022; 48(3): 334-337. doi:10.1080/00952990.2021.1992773.
36. Stein MD, VanNoppen D, Herman DS, Anderson BJ, Conti M, Bailey GL. Retention in care for persons with opioid use disorder transitioning from sublingual to injectable buprenorphine. J Subst Abuse Treat. 2022; 136: 108661. doi:10.1016/j.jsat.2021.108661.
37. Galati BM, Wenzinger M, Rogers CE, Cooke E, Kelly JC. Buprenorphine extended-release treatment for opioid use disorder in the postpartum period. Obstet Gynecol. 2023; 142(5): 1148-1152. doi:10.1097/AOG.0000000000005319.
38. Iacono A, Wang T, Tadrous M, et al. Characteristics, treatment patterns and retention with extended-release subcutaneous buprenorphine for opioid use disorder: A population-based cohort study in Ontario, Canada. Drug Alcohol Depend. 2024; 254: 111032. doi:10.1016/j.drugalcdep.2023.111032.
39. Hammerslag LR, Talbert J, Slavova S, et al. Utilization of long-acting injectable monthly depot buprenorphine for opioid use disorder in Kentucky, before and after COVID-19 related buprenorphine access policy changes. J Subst Use Addict Treat. 2024; 164: 209391. doi:10.1016/j.josat.2024.209391.
40. Heil J, Salzman M, Hunter K, et al. Evaluation of an injectable monthly extended-release buprenorphine program in a low-barrier specialty addiction medicine clinic. J Subst Use Addict Treat. 2024; 156: 209183. doi:10.1016/j.josat.2023.209183.
41. Mlilo K, Fatema K, Poudel P, Harjanto R, Whitton G. Comparing the effectiveness of depot buprenorphine (buvidal injection) and buprenorphine/naloxone (suboxone) treatment following custody release - a retrospective cohort study. J Subst Use. 2024; 29(3): 257-265. doi:10.1080/14659891.2024.2342313.
42. Perdue M, Hosseini Ghomi R, Rees P, Arzubi E. 5-Day injectable extended-release buprenorphine initiation in non-opioid-tolerant individuals in a carceral setting: A case series. J Addict Med. 2024; 18(4): 335-339. doi:10.1097/ADM.0000000000001387.
43. Neptune A, Kaliamurthy S. The use of extended-release buprenorphine in the treatment of adolescent opioid use disorder: A case series. J Addict Med. 2025; 19(2): 150-154. doi:10.1097/ADM.0000000000001447.
44. O’Connor AM, Cousins G, Durand L, Barry J, Boland F. Retention of patients in opioid substitution treatment: A systematic review. PLoS One. 2020; 15(5): e0232086. doi:10.1371/journal.pone.0232086.
45. National Institute on Drug Abuse. Principles of drug addiction treatment: A research-based guide. 3rd ed. Accessed September 5, 2025. https://nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf.
46. Dao ATM, Nguyen HTT, Nguyen LH. Variation overtime among patients of the six methadone maintenance treatment clinics in Thai Nguyen from 2011 to 2015. Biomed Res Int. 2018; 2018: 9081968. doi:10.1155/2018/9081968.
47. Khue PM, Tham NT, Thanh Mai DT, Thuc PV, Thuc VM, Han PV, Lindan C. A longitudinal and case-control study of dropout among drug users in methadone maintenance treatment in Haiphong, Vietnam. Harm Reduct J. 2017; 14(1):59. doi: 10.1186/s12954-017-0185-7.
48. Montgomery C, Abbasi Y, De Silva D, Gittins R, Jones A, Van Hout MC. Investigating outcomes in a substance use treatment provider: a cross-sectional comparison of long-acting injectable buprenorphine and oral medication for opioid use disorder. BMJ Open. 2025; 15(2): e090736. doi:10.1136/bmjopen-2024-090736.
49. Andraka-Christou B, Simon KI, Bradford WD, Nguyen T. Buprenorphine treatment for opioid use disorder: comparison of insurance restrictions, 2017-21. Health Aff (Millwood). 2023; 42(5): 658-664. doi:10.1377/hlthaff.2022.01513.
50. Nong T, Hodgkin D, Trang NT, et al. A review of factors associated with methadone maintenance treatment adherence and retention in Vietnam. Drug Alcohol Depend. 2023; 243: 109699. doi:10.1016/j.drugalcdep.2022.109699.