Evaluation of Rapid Induction Using Extended-release Buprenorphine in Hospitalized Patients with Opioid Use Disorder
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Publication Date
2025
Keywords
oregon, oaa 2025
Disciplines
Medical Education | Pharmacy and Pharmaceutical Sciences | Substance Abuse and Addiction
Abstract
Abstract: Buprenorphine’s efficacy in treating opioid use disorder (OUD) is well established, markedly reducing opioid use, withdrawal symptoms, and mortality. Nevertheless, traditional sublingual (SL) induction protocols can be protracted and prone to nonadherence, thereby increasing length of hospitalization and healthcare costs. Extended-release buprenorphine (XR-BUP), formulated as a once-monthly subcutaneous injection (marketed as Sublocade® and Brixadi®), maintains consistent plasma concentrations, potentially enhancing adherence and reducing misuse compared to daily formulations. Studies suggest XR-BUP confers higher treatment retention, fewer positive urine drug screens, and improved patient-reported outcomes, including reduced cravings and withdrawal symptoms. In this retrospective cohort study, we sought to evaluate whether rapid inpatient XR-BUP induction decreases hospital length of stay (LOS), 90-day readmission rates relative to SL-BUP, continued opioid use, overdose events, and treatment retention compared to SL-BUP. Data was collected at a tertiary care center in two phases: a pre-implementation SL-BUP cohort (n=26) from January to June 2024, and a post-implementation XR-BUP cohort (n=11) from August 2024 to February 2025. The primary endpoint was LOS, analyzed using two-sample t-tests, while secondary endpoints included readmissions at 30 and 90 days, continued opioid use, and overdose incidence, assessed via chi-square tests and logistic regression. The preliminary results presented a mean LOS of 11.04 days for the SL-BUP group and 5.82 days for the XR-BUP group, suggesting a trend toward shorter LOS in the XR-BUP group. Readmission rates at 90 days were 46.2% (12/26) in the SL-BUP group versus 30.0% (3/10) in the XR-BUP group; logistic regression yielded an odds ratio (OR) of 0.50 (95% CI: 0.30–0.85; p=0.013) in favor of XR-BUP, signifying a 50% decrease in the odds of unplanned readmission. Furthermore, patients receiving XR-BUP had significantly lower odds of continued opioid use (OR 0.33; 95% CI: 0.19–0.57), but overdose events did not differ significantly between groups (OR 1.49; 95% CI: 0.80–2.78; p=0.20). Notably, those who continued to use opioids after discharge were more likely to experience subsequent readmissions, underscoring the potential benefit of strategies that curtail ongoing opioid use. The preliminary results collectively suggest that early administration of XR-BUP could shorten hospital stays, lower readmission rates, and reduce continued opioid use among hospitalized OUD patients. Additional patient enrollment through August 2025 is underway to bolster the dataset and increase statistical power, with final determinations to be made upon completion of the data collection period. A comprehensive cost-effectiveness analysis will also be performed to ascertain whether XR-BUP’s higher acquisition cost is offset by healthcare savings associated with fewer readmissions and shorter length of stay. This study is approved by the Institutional Review Board. Learning Objectives: Evaluate whether initiating XR-BUP during hospitalization reduces length of stay, readmission rates, continued opioid use, overdose incidence, and improves treatment retention compared to traditional SL-BUP induction. Presentation Category: Inpatient Clinical Services
Area of Special Interest
Mental Health
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Behavioral Health
Specialty/Research Institute
Pharmacy
