Position statement: Long-acting injectable buprenorphine for opioid substitution therapy

The illicit use of drugs, particularly opiates, causes significant social and healthcare issues within Scotland as it does in other parts of the UK and Europe. For Scotland in 2019 the drug-induced death rate was 318 per million population aged 15–64. This was higher than any other European country, the next highest being 77 deaths per million population in both Sweden and Norway. The corresponding rate for the UK is not available but the figure for Scotland, England and Wales combined was 76 deaths per million population. Use of opioids contributed to around 90% of drug deaths in 2020 in Scotland.

Opioid substitution therapy (OST) has been shown to be a safe and effective treatment for addressing opioid dependence and provides the opportunity to engage people with other health and psychosocial interventions. While both oral methadone and oral buprenorphine formulations are recommended OST drug choices in opioid-dependent individuals, long-acting injectable buprenorphine has been available in Scotland since 2019 for weekly or monthly administration as OST within a framework of medical, social and psychological support in patients for whom methadone is not suitable and for whom the use of buprenorphine is considered appropriate. The injectable formulation may be more convenient for individuals who have complex lifestyles, may find difficulties in attending daily visits for supervised treatment or:

• travel abroad  
• have work or study commitments
• have mobility issues
• live in rural areas where access to community pharmacies will be difficult
• have regular release from custody on license for short periods.

Remit and Target Users

This position statement includes:

• statutory advice from the summary of product characteristics (SmPC) and the Scottish Medicines Consortium (SMC)
• consensus statements developed by a multidisciplinary working group of clinical and non-clinical stakeholders using a formal Delphi process
• links to published guidance on long-acting injectable buprenorphine.

How this position statement was developed

This position statement was developed using a focused literature search to identify published guidance on long-acting injectable buprenorphine and reference to the associated SmPC and SMC advice. A range of points was extracted from the published guidance and developed into key statements using a formal three-stage Delphi consensus methodology. Assurance was provided in the form of invited peer review performed by a panel of experts in the management of opioid dependence in Scotland and open consultation.

Keeping up to date

This position statement was published in 2022 and will be considered for review based on a range of factors, including emergence of new evidence and alignment with Scottish Government initiatives, in consultation with the commissioning body. The review history, and any updates to the position statement in the interim period, will be noted in the review report.

Current < 3 years