Factors to guide the use of extended-release buprenorphine formulations for specific patient populations

Background: Opioid agonist therapy is first line in the management of opioid use disorder (OUD). Many guidelines support buprenorphine as the optimal treatment due to its preferred safety profile. Extended-release buprenorphine (BUP-XR) is a weekly or monthly subcutaneously administered formulation of buprenorphine. Emerging research has explored the use of BUP-XR in a variety of patient populations to guide clinicians in determining which patients may or may not benefit from BUP-XR. Methods: We conducted a literature review in Medline, PsycInfo and Embase to capture the literature to date on BUP-XR. Abstracts were reviewed, and papers which guided selection of individuals who would or would not benefit from BUP-XR were included. Results: Our search returned 359 articles, and 31 met inclusion criteria. Special populations who may benefit from BUP-XR include individuals experiencing homelessness, incarceration, and medical or psychiatric comorbidity, while caution should be used around pregnancy. Patient preference and patient-centered outcomes were recurring considerations to guide the selection of BUP-XR. Conclusions: Extended-release buprenorphine formulations represent a relatively new tool for managing OUD and may specifically benefit patients undergoing transitions in care. Further research on the comparative effectiveness of extended-release versus daily-dosing formulations and in other populations of interest is needed.