NSW Health just introduced depot bupe guidelines: Here’s what you need to know
Thursday, 18 July, 2024.
Last week NSW Health published guidelines for depot bupe. While it is intended to provide guidance for health practitioners and prescribers, there’s a lot of useful information in here for those on opioid treatment programs (OTPs). It’s probably the most comprehensive guidelines for depot bupe released globally, so we’ve saved you some time by summarising the key points relevant to NUAA’s community.
What is long-acting injectable buprenorphine?
Long-acting injectable buprenorphone (LAIB), aka depot bupe , is a prescription drug intended to work as a replacement for opioid cravings. It’s different to other methadone and other bupe medications because it’s available as a weekly or monthly injection, which slowly releases the drug into the body during those timeframes. Like all other opioid dependency treatments, the Pharmaceutical Benefits Scheme (PBS) covers depot bupe, meaning it’s a low-cost treatment.
There is no way that people on a depot bupe program can administer the medication themselves at home. In other words: there are no takeaways.
But there are some potential benefits to depot bupe:
With once-a-week or once-a-month injections on the LAIB program, you won’t have to visit pharmacies and clinics as often. This means reduced travel costs and time. It’s also great for people on methadone and sublingual bupe – Subetex and Suboxone – who struggle with keeping up their attendance at dosing sites (pharmacies and clinics).
If or when you stop the depot bupe treatment, research suggests you will have less severe opioid withdrawal symptoms than if you stopped taking methadone or sublingual bupe.
If you find yourself in a hospital or a correctional facility, such as remand or police lock-up, this experience will usually interrupt regular methadone or bupe dosing. This is unlikely to be as much of a problem if you’re on depot bupe due to the lengthy duration of the injection.
A map of some of the NSW community pharmacies that offer depot bupe is available on the NSW Health website. It’s worth contacting the pharmacy first to confirm they offer this treatment before heading over there.
As with other opioid medications, it’s important to be careful using other drugs on the LAIB program, especially alcohol, benzos, antipsychotic medications and certain antidepressants, as this will increase the possibility of adverse effects and overdose. If you turn up seeming intoxicated to a dosing site when you are first starting depot bupe, staff may turn you away and reschedule your appointment for your own safety.
Will I have to switch to depot bupe ASAP?
Just because there are now official guidelines for depot bupe, this doesn’t mean doctors and prescribers will try shift everyone onto this program. It’s written into the guidelines that methadone treatment and daily bupe medications remain available as options for those who prefer or need those treatments. If you have severe live disease, for instance, you may not be ready for depot bupe just yet or maybe you’re hypersensitive to bupe. If a health worker suggests you change to depot bupe and you prefer your current treatment, you should make your feelings known. We know our bodies best!
At Users News, we’ve heard lot of stories about people being shifted onto depot bupe and we know this is the preferred treatment in NSW correctional facilities these days, but you have a right to the medication that works best for you.
We know it’s hard to speak up sometimes. It’s no secret that those who inject drugs face stigma and discrimination in healthcare settings. Written into these guidelines, however, is a pledge that health workers will treat patients with respect and dignity, communicate information in an easy-to-understand way and support their needs. In the AOD sector, this is called “person-centred care”. While things don’t change overnight, it’s worth biting the bullet and voicing your concerns if you’re not happy.
It's also worth knowing that shooting up heroin while you’re on depot bupe won’t do much besides drain your wallet. According to peer stories published in this very publication, you won’t get any of the usual buzz. It’s not like how you can take a dose of sublingual buprenorphine and then 2 or 3 days later you can get stoned again. So depot bupe is great if you want to totally give up recreational opioid use. But if you want the option of using opioids recreationally on top of your OTP, it won’t work with depot bupe injections.
What if I’m pregnant? Can I still go onto LAIB?
Babies exposed to opioids during pregnancy may experience ‘neonatal opioid withdrawal syndrome’ when they’re born. This is a potentially life-threatening condition.
There is currently a lack of research data available on the interactions between depot bupe, on the one hand, and breastfeeding and pregnancy, on the other. Sublingual bupe has an acceptable safety profile and it’s proven to be effective during pregnancy.
For pregnant women, there is a freedom to choose here. The guidelines state that health practitioners should inform patients about the risks and benefits of different opioid treatments.
How will depot bupe impact my work and lifestyle?
Depot bupe may cause drowsiness, dizziness or impaired thinking, especially when you first start the program or when you change your dosage. The worst period is 1 to 4 days after an injection. Accordingly, this treatment option may impair the mental or physical abilities required for dangerous activities such as driving a car or operating machinery. So be careful and when in doubt ask for advice.
If you’re seeking advice about depot bupe, you can call NUAA’s PeerLine. It’s a confidential peer-run phone service dedicated to supporting people who use drugs, who are on the OTP or who are seeking treatment across NSW. Call 1800 644 413 for help or email peerline@nuaa.org.au.
There is also the Opioid Treatment Line (OTL) 1800 642 428, which is available 9:30am to 5:00pm, Monday to Friday (except public holidays). This helpline provides opioid treatment information, referrals and advice.