For patients undergoing opioid dependence treatment (ODT), long-acting injectable buprenorphine (LAIB) can be a life-changing treatment option.
John Jones MPS, who prescribes LAIBs at a pharmacy in Shortland, NSW, said he has seen a steady increase in demand for LAIBs since 2020, replacing older ODT therapies such as methadone.
” National Opioid Pharmacotherapy Statistics Annual Data Collection There “There’s a big growth trend in that area,” he said.
However, changes to the ODT programme from 1 July 2023, including new Pharmaceutical Benefits Scheme (PBS) arrangements which will only allow LAIB funding through hospital or community pharmacies, are likely to leave the majority of control to pharmacists.
To help pharmacists meet this demand, Australian Pharmacist We explore the advantages and disadvantages of LAIB administration for both patients and pharmacists, and the complexities of running an efficient LAIB clinic.
What are the main benefits of LAIB?
To receive most ODT therapies, such as methadone, buprenorphine, and naloxone sublingual film, patients must make up to 30 visits per month to their community pharmacist.
However, the administration interval of LAIB is long. Patients have a lot to offer The reduced frequency will allow you to manage work and childcare responsibilities, or go on vacation.
LAIB is a stable and predictable drug. Stopping the drug Symptoms are reported to be milder than those experienced with withdrawal of other ODT medications such as sublingual buprenorphine or methadone.
“The risk of diversion is also significantly reduced, allowing patients to lead more normal lives,” Jones said.
The method of administration of LAIB is fully consistent with other treatments administered in community pharmacies.
“Patients simply tell the pharmacy attendant they’re there to receive an injection, then sit and wait,” he said. “Because the medication is administered in a private space, patients can receive their injection at any time, which helps remove some of the stigma associated with other opioid-altering medications.”
Administering LAIBs also reduces administrative work for pharmacists: “You don’t have to record the dosage every day, like you would with oral medications,” he says.
But seeing patients with LAIB can be time-consuming: “Because the time between doses is longer, we have to gather more information than we would in a daily visit, like making sure the patient’s condition is stable,” Jones says.
Things can change over months, such as a decline in mental status. “When this happens, the pharmacist needs to contact the wider medical team and tell them what’s happened.”
What LAIB options are available?
There is Three LAIB products Available Now Listed on PBS’s S100 Opioid Addiction List:
- Buvidal Weekly (5-9 day schedule)
- Buvidal Monthly (3-5 week schedule)
- Sublocation (Schedule for 26-42 days).
“Sublocade has a longer time between doses, so it may be a better option for patients who fly in and out,” Jones said. “And The shelf life at room temperature has been extended from one month to three months..
“However, the dose Buvidal Because it’s thicker, it’s bigger, the volume is bigger, the needle gauge is bigger, and all of those factors have to be taken into account.”
Who is a suitable candidate for LAIB?
Jones said patients whose work or life commitments prevent them from taking their medication regularly would be good candidates for LAIB.
“It takes a little bit of work to get started, but it saves you having to go in every day for medication,” he said.
the patient Stable with buprenorphine and naloxone sublingual filmand certain patients taking methadone; OneYou can transition to LAIB, just make sure you follow the appropriate clinical guidelines carefully.
In Jones’s view, all pharmacies are suitable to administer LAIB, provided they have trained vaccinators on staff. AP2023 Articles More information on state and local regulations governing LAIB management can be found here.
“This is a completely different kind of opioid replacement medication than what patients are used to, and the patient demographics tend to be different,” he said. “These patients are dealing with and managing their opioid addiction, and they typically have jobs and are caring for their children and family.”
What do pharmacists need to know?
For those interested in setting up a LAIB clinic, Jones recommends approaching it much the same as other specialty services, such as vaccinations.
“Workflow needs, inventory, legislation, booking systems, all need to be considered,” he said.
“You can basically piggyback off of other services and create a new item called ‘LAIB injection’ and fill in the white space around it.”
However, because LAIBs must be injected subcutaneously and there is a risk of serious harm if injected incorrectly, some patients should avoid them, at least initially, and by inexperienced pharmacists.
“If you have a really thin patient, it’s hard to find enough fat to inject,” he says. “For example, Buvidal It has to be injected at a 90-degree angle, so in a thin patient it can go straight into the muscle.”
Dosing technology evolves with expertise, and having demo equipment from manufacturers can help, but Jones recommends carefully selecting patient demographics first. “Anthropometry is key in that situation,” he adds.
Informing patients about the availability of specialized services is also important for patients who may have concerns.
“Giving patients confidence and giving them a little more context and structure removes some of the concerns that come with other forms of opioid substitution therapy,” Jones said.
It is important that LAIB injectables are never handled or accessed directly by patients – pharmacists should have procedures in place to prevent this and ensure they are never administered directly to patients or carers.
What are some helpful resources?
Vaccination pharmacists interested in administering LAIB will be well prepared by attending this seminar. The leading edge of LAIB The workshop will be hosted by Jones at PSA24 on Sunday, August 4th from 1:30 to 3:30pm.
“There will also be a demonstration of how to administer the LAIB, as well as practical examples of how to set up the service, the paperwork that needs to be completed and other tips on policies and procedures that need to be considered and put in place,” he said.
You can also register for just one day of PSA24, but you must book by midnight on July 25th to avoid late fees. If you can’t attend the conference, you can still complete your PSA. Pharmacist-Assisted Administration of Long-Acting Buprenorphine Injection (LAIB) course.
