Long-acting injectable Buprenorphine Evaluation Dissemination event at Lancaster Castle

Post by Rebecca Fish, Hannah Maiden, Euan Lawson, Mark Limmer and Ceu Mateus (Three NIHR Research Schools' Mental Health Programme - Practitioner Evaluation Scheme)

On 11^th March, we held an event to disseminate the findings from our NIHR Three Schools’ Mental Health funded study into the outcomes of Buvidal use in Blackpool. Here we provide a short overview of the study as well as the dissemination event.

Buvidal is the trade name of long-acting injectable buprenorphine (LAIB) which is an opioid agonist treatment and this means it will, in the right dose, block the effect of drugs such as heroin while ensuring people dependent on opioids don’t experience withdrawal symptoms. Administered subcutaneously by a healthcare practitioner either weekly or monthly, this treatment takes away the requirements of daily dosing and the potential inconvenience and stigma of frequent attendance at pharmacies. LAIB has the potential to shift the dynamics of treatment of opioid dependence, but has not so far been extensively researched in community settings.

Why study Buvidal?

NICE guidance (2019) states that LAIB may be an option for where there is a risk of storing medicines at home, those with difficulties getting to daily supervised medication, as well as in custodial settings due to supervision challenges. However, this treatment costs much more than traditional agonist therapies such as methadone.

The Blackpool Evaluation

Buvidal LAIB was implemented in 2020 in Blackpool, a deprived coastal area in the north-west of England with very high drug-related harm. Lancaster University Professor Ceu Mateus along with research team members Professor Mark Limmer, Dr Hannah Maiden, and Dr Euan Lawson put in a successful bid to the NIHR Three Schools for Mental Health for a mixed methods evaluation of this treatment with people who use drugs in Blackpool. The aim of the study was to generate evidence to help local practitioners and national policymakers understand impacts and experiences of LAIB.

Our research question was: What are the experiences and outcomes, (including drug treatment, health and wellbeing, and social outcomes), of people started on Buvidal in Blackpool?

Dr Rebecca Fish was the senior qualitative researcher on the project. The qualitative arm of our evaluation consisted of 23 interviews with 13 service-users, 6 staff and 4 stakeholders. Service-users received a £15 voucher for their time and were asked questions about their experiences and perspectives of Buvidal and thoughts for the future. These questions were designed with input from people with lived experience.

The quantitative part of the evaluation analyses administrative data gathered over time, and it is ongoing at the time of writing. Quantitative researcher David Sudell reported interim findings at the event.

The Blackpool Evaluation Event

We were fortunate to be able to hold our event at Lancaster Castle, a historic and fascinating building. People with diverse interests in drug harm attended, such as representatives from the Office for Health Improvement and Disparities (OHID), various Lived Experience groups, local Public Health departments, academics evaluating LAIB in other universities, and practitioners from local drug treatment services. We were also very fortunate to have Claire Ashmore from the Three Schools’ Mental Health team to join us!

Dr Rebecca Fish presented some of the qualitative findings from her interviews, including quotes and insights from patients and practitioners/stakeholders. There is currently scarce evidence from the practitioner or public health perspective in the existing literature. She discussed the following themes:

• Positive aspects such as changes in lifestyle, reconnecting with family, benefits compared with experience of other treatments
• Challenges such as adjustments due to new clarity of mind, physical side effects, emotional, and mental health issues
• Wraparound support needs such as psychosocial interventions, peer support, and information
• Treatment journey, and thoughts about how to eventually stop Buvidal
• Hopes for the future such as less stigma, gaining employment or volunteering activities

We then welcomed Fran, a service user who was prescribed Buvidal after trying other replacement therapies over a prolonged period of time. Rebecca supported her to tell her story by asking her guiding questions at the front of the room. Fran talked about how she felt when she first tried the treatment, and how her lifestyle and health have benefited.

Judith Mills from Blackpool Council presented her experience of commissioning Buvidal LAIB from a Public Health perspective and about the place-based challenges unique to Blackpool.

Finally, Professor of Adolescent Public Health, Mark Limmer led a discussion with the room with the theme of future priorities for drug treatment services. Participants discussed ideas such as outreach services for LAIB, trauma informed approaches, and the potential for LAIB in detoxification and harm minimization. Suggestions for further research questions included looking at the impact of Buvidal on alcohol and non-opiate drug use.

Next Steps

The project has generated much interest so far, including through contacts following our presentation at the Health Economics conference in Lisbon.  One of the findings from the qualitative interviews demonstrated that people do not have accessible information about what people on LAIB have experienced. We are currently co-producing an illustrated leaflet to address this with two people who have experience of LAIB treatment. We will soon be working on academic publications to share our learning.

We would like to express thanks to the funders at the NIHR Three Schools’ Mental Health. We also send huge thanks to all the people who participated in the research, in particular people with lived experience and staff and other members of Blackpool drug services - who generously gave their time to provide their perspectives and provide access to data, as well as helping recruit people for interview.