For patients undergoing opioid addiction treatment (ODT), long-acting buprenorphine injection (LAIB) can be a life-changing treatment option.
Since 2020, demand for LAIB has been steadily increasing, replacing older ODTs like methadone, said John Jones MPS, who administers LAIB at his pharmacy in Shortland, NSW.
‘the National Opioid Drug Treatment Statistics – Annual Data Collection It appears that there is He said there was “a huge growth trend in this area”.
But with changes to the ODT programme coming in from 1 July 2023 – including new Pharmaceutical Benefits Scheme (PBS) arrangements that allow LAIB to be funded only by hospital or community pharmacies – pharmacists are likely to manage the lion’s share.
To help pharmacists meet this demand, Australian pharmacist This book examines the pros and cons of LAIB management for both patients and pharmacists, as well as the complexities of running an effective LAIB clinic.
What are the main benefits of LAIB?
To obtain most ODTs, such as methadone or buprenorphine and sublingual naloxone films, patients must visit their community pharmacist up to 30 times per month.
But longer dosing intervals for LAIB It means that patients need to provide a lot. Often, they are allowed to perform work responsibilities, care for children, or even go on vacation.
LAIB is a stable and predictable drug, with Drug withdrawal It has been reported to be associated with less severe symptoms than discontinuation of other antidepressant medications such as sublingual buprenorphine or methadone.
“The risk of conversion is also much lower, and it allows our patients to live a more normal life,” Mr Jones added.
The way LAIB is administered also makes it fully compatible with other treatments offered in a community pharmacy setting.
“Patients tell the pharmacy assistants they are there to get the shot, and then they just sit and wait,” he said. “The dose is marked out in a private area so patients can get any shot, which helps remove some of the stigma associated with other forms of opioid alternatives.”
Giving LAIB doses could also mean less paperwork for pharmacists. “You don’t have to record daily doses like you do with oral forms,” he said.
However, patient consultations on LAIB may take longer. “Because of the longer interval between doses, more information needs to be collected than with daily appointments, including determining patient stability,” Mr Jones said.
Circumstances may also change over a period of months, including deterioration in mental health. “Then pharmacists need to communicate with the wider healthcare team to inform them of what has happened.”
What LAIB options are available?
there Three LAIB products Available now On PBS under the S100 Opioid Dependence List:
- Bovidal Weekly (5-9 day schedule)
- Bovidal Monthly (3-5 week schedule)
- Sublocked (26-42 day schedule).
“Sublocade has a longer dosing interval…so it could be a better option for patients who travel by air,” Mr Jones said. “And “Shelf life at room temperature has been extended from one month to three months.”.’
“But it’s a more challenging dose to administer than Bovidal Because it is much thicker, the size is bigger and the needle gauge is bigger too, so all of these factors have to be taken into consideration.
Who is a suitable candidate for LAIB membership?
Patients whose work and life commitments don’t fit with regular dosing may be good candidates for LAIB, Mr. Jones said.
“Although getting started requires some work, it eliminates the need to come in every day to receive doses,” he said.
Patients who are Sublingual films containing buprenorphine and naloxoneand some patients taking methadone, aThe patient cannot be transferred to LAIB. Appropriate clinical guidelines must be followed carefully.
In Mr Jones’ view, all pharmacies are well placed to administer the LAIB vaccine – provided they have a trained vaccinator on staff (read dadArticle 2023 For a detailed explanation of state and territory regulations on LAIB management).
“It’s a very different type of opioid alternative than what they’re used to, and the demographics of the patients tend to be different as well,” he said. “These patients are dealing with and managing their opioid dependence, and they’re typically working and taking care of children and/or family.”
What do pharmacists need to know?
For those interested in setting up a LAIB clinic, Mr. Jones recommends treating it like any other professional service, such as vaccination.
“Workflow, inventory, legislation and reservation system needs must be taken into account,” he added.
“You can basically take advantage of other services – create a new element called ‘LAIB injection’ and fill in the blanks around it.”
But since LAIB must be injected under the skin, with the risk of serious harm if injected incorrectly, there are some patients that less experienced pharmacists should avoid – at least at first.
“With really thin patients, it’s hard to find enough fat to inject,” he said. “For example, Bovidal “It has to be injected at a 90-degree angle, so for lean patients this may mean it will be injected directly into their muscle.”
While management technology evolves with experience, which can be helped by obtaining some demonstration equipment from the manufacturer, Mr Jones recommends carefully selecting patient demographics at the outset. “Anthropometry is important in these circumstances,” he said.
Communicating with the patient about providing the service in a professional manner is also important for those who may be anxious.
“Gaining trust and providing more context and structure for patients removes some of the concerns associated with other forms of opioid alternatives,” Jones said.
It is essential that LAIB injections are not handled by or directly available to patients. Pharmacists should have procedures in place to prevent this, and ensure that they are not dispensed directly to the patient or caregiver.
What are some useful resources?
Pharmacists interested in LAIB vaccination will be well prepared to do so after attending. Pointed end of LAIB Workshop at PSA24, led by Mr Jones on Sunday 4th August from 1.30pm to 3.30pm.
“There will be some presentations by LAIB management, along with practical examples of how to set up the service, what documentation you need to complete, and other advice on policies and procedures to consider and put into place,” he said.
One-day registration is also available for PSA24. However, to avoid late fees, it is essential to reserve your spot before midnight on July 25. Those unable to attend the conference can also complete the PSA. Long-acting buprenorphine injection (LAIB) administration by pharmacists turn.
