GAO report: Lower incidents of diversion with injectable buprenorphine

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A U.S. General Accounting Office study of injectable buprenorphine found that the one- to six-month injections lower a patient’s likelihood of diversion, but require more coordination between a patient’s health care providers.

As part of the SUPPORT Act, the GAO was directed to study injectable or implanted controlled substances to treat opioid use disorder by Congress. In 2018, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that about 25 percent of the estimated 2 million people with OUD had received some form of substance use treatment in the prior year. According to the U.S. Department of Health and Human Services, of which SAMHSA is a part, expanding access to injectable or implanted medication-assisted treatment for OUD would reduce deaths due to opioid use.

Buprenorphine is used to treat OUD because it reduces or eliminates OUD withdrawal symptoms and blunts the effects of opioids, such as euphoria, nausea, and slowed breathing. The GAO reported that about 7,250 prescriptions were issued for injectable or implantable buprenorphine in 2019, compared to over 700,000 prescriptions for oral forms of the drug.

In the cases of injectable or implantable buprenorphine, the GAO found that patients were less likely to skip or stop their medication-assisted treatment, otherwise known as diversion. The GAO found that administering the drug as an injectable or implantable was relatively easy.

“To ensure patient safety when injectable and implantable buprenorphine is used, the Food and Drug Administration (FDA) within HHS has also required drug companies to establish risk evaluation and mitigation strategies to help ensure the benefits of these medications outweigh their risks. Providers and pharmacies must follow a number of specific steps based on federal requirements when providing treatment with injectable and implantable buprenorphine,” the report said. “Representatives GAO interviewed from provider groups and pharmacies said they did not find the steps involved in treating patients to be difficult overall. However, they stated that careful and timely coordination with each other and patients is needed at key steps of the process to ensure that the patient receives treatment. Representatives from provider groups and pharmacies reported that the risk of diversion of injectable and implantable buprenorphine is low.”

Additionally, although the drug is in itself a controlled substance, the GAO found that because of the nature of its administration, it is unlikely to find its way onto the black market.

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