I Fucking Love Depot Bupe! | Kiaran’s Story

Depot bupe is a liquid form of buprenorphine that is injected just underneath the skin, which once inside the body, turns into a solid gel. Injections can be done weekly or monthly. It is like having a big storage full of buprenorphine that slowly streams through a dam wall.

There is not a one-size-fits-all when it comes to Opioid Treatment Programs (OTP). Which OTP medication is most beneficial will be different for different people. Things that can make a difference include the practicalities of accessing the medication (having to get dosed daily can be a deal breaker for some people but not for others) and what you are hoping to gain from the OTP. Some people might be wishing to stabilise dependence while others might want to give up recreational opioid use completely. One of the newer OTP medications is Long Acting Injectable Buprenorphine (LAIB), also called “depot bupe”. Two brands — Buvidal and Sublocade — were approved by the Australian Therapeutic Goods Administration in April 2020. As the name suggests, LAIB is a buprenorphine injection that is needed less frequently than dosing with other OTP medications.

Kiaran told Users News about how depot bupe has benefitted him but might not be the best OTP medication for everyone.

Users News: Can you tell us about your experience with depot bupe. And if you were on any other treatment before that, how do they compare?

Kiaran: Sublingual buprenorphine and depot bupe are poles apart. I’m only talking about my life here, my own experience. Depot bupe is not for everybody. But it was for me.

I was on sublingual buprenorphine that I was picking up at a public clinic and I hated having to go in there every day, especially on the weekend. There were set times, and I used to skip Sundays because it was not easy for me to get to the clinic at the right time on a Sunday. Anyway, one day, I reread an article in Users News about a subcutaneous, once-a-month depot injection of buprenorphine, and I thought, “That looks attractive to me.”

So I went in to my usual dosing day, and I showed the article to my dosing nurse at the time and she told me to go to a particular public clinic that was conducting a trial. “Some people will go straight onto the injection. Some people will go to a chemist’s, getting takeaways, get it all paid for 6 months,” she told me. I ended up getting takeaways at the chemists for 6 months.

I enjoyed that: 4 takeaways a week, all paid for. The chemists were very close to my home, just 2 minutes’ walk. I had to go in monthly to do a really basic questionnaire — my mental health, my physical health — and I was doing urine tests for drugs at the same time, which wasn’t an issue because I wasn’t using at the time on top of my sublingual buprenorphine. At the end of the 6 months, I went back to the public clinic that was conducting the trial and they said, “Well, Kiaran, you’ve now got a choice. You can either go onto the LAIB now, or stay at the chemist’s, keep your takeaways, but you’ll have to pay.”

I thought: “Well, the LAIB was what I signed up for.” I asked for a weekly injection to see how it felt within my body. And it was quite comfortable. There were no withdrawal symptoms. There were no adverse reactions at all. So I went back after that week and I said: “I’ll go onto the monthly now, please.”

I’ve been on monthly LAIB injections now for just over 3 years. As I said, it’s not for everybody. Some people like being on methadone, some people like that opiate effect. I, personally, never did like methadone because I always had anxiety about if I had to come off it. I did a cold turkey detox off the ’done once, and I swore I’d never do it again. So any time I had a chance to go onto treatment, it was always Suboxone or Subutex, either pills or film. I always went down that route.

But when I heard about the monthly injections, I thought: “Yes, I like this. I don’t want to be going to the clinic daily. I want the freedom to do other things.” And with depot bupe, the beauty of it is it’s in your system for a month.

Now I’ve tested this out, very early on in the piece: it’s just a waste of time getting on. And a waste of money. Nothing happens. It’s not dangerous, no precipitative withdrawal, just nothing. Nothing but an empty wallet.

Users News: So the big plus is the freedom of not having to go in every day?

Kiaran: The freedom of not going in every day and the freedom to do other things. I’ve become involved in consumer representation and the campaign to decriminalise the personal possession of drugs and the campaign to expand drug and alcohol treatment facilities. I even addressed the 2019 conference of Australasian Professional Society on Alcohol & other Drugs (APSAD) down in Hobart, as a person with lived experience of being on LAIB. And I’ve since spoken to Justice Health about being prescribed depot bupe in a non-custodial setting.

Users News: When you say it’s not for everyone, what reasons are there why some people might not want to be on it?

Kiaran: Well, once the injection’s in you, there’s no going back for a month — actually no going back for about 5 weeks, because it doesn’t just drop off on Day 28. It’s not like how you can take a dose of sublingual buprenorphine, then 2 or 3 days later get stoned again. That’s not going to happen if you are on LAIB. And as I said, some people like the feeling you get from methadone.

Also, some people like going to the clinic on a daily basis, it’s a social outlet of sorts where you can hook up with friends and stuff. But that wasn’t for me. I wanted to avoid the clinic as much as possible. I’m not good at standing in lines and I know my own triggers.

Users News: So LAIB wouldn’t be good for someone who wants to get treatment to stop using to feel normal but wants the option of still using to get high?

Kiaran: No. LAIB is for if you want to stop.

Users News: Any concluding comments?

Kiaran: I’m really stoked with it. I’m really happy. My life’s changed since being on it. I’m in sort of pre-contemplative mode about finishing a program. It’s been 3 years now, but I’m in no rush. I see the doctor once a month and the script goes for 3 months so every 3 months I get a choice to say “Let’s make this the last script.” I’ve never had to go up on my dose. I’m on the lowest monthly dose, which I think is 64mg.

It's changed my fucking life, but it’s not for everybody.