THE SHOT THAT LASTS A MONTH
We told you about the research trials for a new OTP medication back in UN #87. It’s finally happening! In November 2018, the Australian Therapeutic Goods Administration (TGA) approved Buvidal®, a bupe product to be injected every 2 or 4 weeks.
(Editor’s note: No conflict of interest! This article was NOT written at the request of Camurus (the maker of Buvidal) or anyone else, and User’s News/NUAA did not receive any additional funding for writing it.)
What is it?
Buvidal is a slow-release formulation of buprenorphine. It’s a clear yellow liquid in a pre-filled syringe and comes in two forms; Buvidal® Weekly and Buvidal® Monthly. Depending on which you’re prescribed, you’ll get an injection either weekly or monthly. It’s a slow release, so one injection will hold you for that entire length of time. Buvidal is a buprenorphine-only product like Subutex. It does not contain Naloxone like Suboxone.
Buvidal should be injected slowly and completely into the subcutaneous tissue of different areas (buttock, thigh, abdomen, or upper arm), provided there is enough subcutaneous tissue.
Clinical trials have shown it works better than Suboxone in helping you stay abstinent.
Buvidal has also passed all the safety tests the Australian authorities require. It does have a side effect in some people of skin irritation at the site where it’s injected.
How does it work?
Buvidal is given by subcutaneous injection (some of us know this as “subcut” or “skin popping”). It can be injected into your butt, thigh, abdomen, or upper arm. The injection must be done by a doctor or nurse. The clinical guidelines are still being written, but because it’s an injection you will either need to go to an opioid treatment clinic, or have it done in your prescriber’s specialist or general practice clinic.
Once injected, the liquid turns into a “depot”, which is like a gel that slowly breaks down and releases the buprenorphine. When the buprenorphine is released, it blocks the feel-good effects of other opioids, stops withdrawal, and reduces craving.
Buvidal Weekly comes in 8mg, 16mg, 24mg and 32mg doses. Buvidal Monthly comes in 64mg, 96mg, and 128mg doses.
What are the benefits?
There are many reasons why you might want to consider trying Buvidal.
In short, Buvidal works, it’s safer and can save you time, stress and money.
Buvidal is great for people who would like to be abstinent but find it hard to stop using on methadone and Suboxone. Because there is a low chance that you will feel the effect of opioids once you have Buvidal in your system, you will have made big steps towards abstinence for the next week or month.
The biggest win is that you will only be dosed once a week or once a month (depending on which product you are on), without having to go into battle for your takeaways every time you see your doctor. This will buy you a lot more time and flexibility so you can work, study, raise a family, go on holiday or live in a rural area with a smile on your face.
Another plus is that less dosing means saving money on daily dosing fees. To know exactly how it will affect costs, we need to see how they decide to fund it. For those people dosing at a public clinic for financial reasons but who find it stressful to attend every day because they get triggered by people from their past or people selling pills, or don’t feel safe for some reason, it could mean they can finally move on and still get a free service. That helps everyone because it frees up a place at a public clinic for a newbie at a time they really need that extra support.
Buvidal could also reduce some of the stigma and discrimination that people on the program often face as a result of lack of privacy. No more hanging around a clinic or public appearances at a chemist in a small town to peg you as “one of them”.
Another benefit of Buvidal is it could provide a solution for those who struggle with the responsibility or storage of takeaways. Find it hard to not inject your dose? Getting hassled by people for your takeaways? Worry your kids will get into your supply? Buvidal removes the problems with takeaways (because you don’t get any!) but gives you the advantages of at least 6 takeaways a week! Because Buvidal is administered by a healthcare professional, there’s no risk of people who haven’t been prescribed it (such as children) accidentally taking it.
Is Buvidal for me?
It’s important to remember that different things work for different people – there’s no one-size-fits-all treatment. We think that Buvidal will be great for some people, like those trying to stop using completely or who struggle with regular pickups.
Other people like to be in control and able to skip doses when they want, perhaps so they have the option to still enjoy themselves while on the program. In that case, you might be better off on Suboxone or Subutex.
Trials in prisons have been running for several months. At the moment, it’s hard to get on opiate treatment in jail because of the time and staff needed to dose inmates, as well as fears around diversion and standovers. Buvidal could be a real game changer. Our challenge will be to make sure methadone and Subutex / Suboxone don’t disappear as options.
Can I try it? When can I start?
Buvidal has just been approved for use in Australia, and clinical guidelines are currently being written so everyone knows the rules. There are also decisions being made around how it will be funded. There’s a lot to iron out.
If you’re currently on bupe and stable, you can be transitioned to Buvidal as soon as it’s available. However, Buvidal is still in its ‘trial’ phase in NSW, so its distribution is limited to public clinics for the time being.
People on the trial who like it will be able to stay on it, then other people will have the opportunity to start, or move across from their current form of OTP medication. After that, once any teething problems have been sorted, including finalising guidelines and funding, it will be available through doctors and private clinics, most likely in late-2019.
We advise you to talk to your prescriber about Buvidal if you’re interested in trying it out. It won’t be long til you get the chance!
Depot buperenorphine might be technically injectable, but don’t get any smart ideas! Buvidal and Sublocade are not safe to inject anywhere except under the skin, or by anyone except for a trained health professional.
If you inject depot bupe into your vein or muscle, it will still form a gel depot, so you won’t get the rush of shooting up. If the depot forms in the wrong place, such as in your vein, it could cause serious, life-threatening health problems.
Although there are no ‘takeaways’ with depot bupe, and it must be given by a doctor or nurse, we know that some people have a knack for getting their hands on diverted medication. If you or anyone you know has Buvidal or Sublocade outside a medical setting, do not inject it yourself. It will not get you high and can be harmful if used incorrectly. Instead, dispose of it in a sharps container.
Stay safe out there!
There will be two brands of depot bupe: Buvidal and Sublocade. Buvidal is the one currently being trialed. Sublocade is waiting on final government approval. We understand Sublocade will have different dose sizes and there may be other small differences, but they are essentially the same drug taken the same way. We are guessing it will be down to your doctor and clinic which one they use and that (as usual) we won’t get a choice of brand.
Even prescribers are excited!
“The introduction of Buvidal represents the most significant development in over 15 years of opioid dependence treatment in Australia. The flexibility of weekly and monthly injection depots will make treatment much more convenient for patients, reducing the costs and inconvenience of daily dosing, and should serve to lessen the stigma experienced by many patients” –Professor Nick Lintzeris, Director of Drug & Alcohol Services, South East Sydney Local Health District and the Division of Addiction Medicine, Central Clinical School, University of Sydney.