Evolving extended-release subcutaneous buprenorphine (BUP-ER; Sublocade®) treatment patterns in Ontario

Extended-release subcutaneous buprenorphine (BUP-ER) is a medication used to treat opioid use disorder that is given as a once a month depot injection under the skin. Given the novelty and increasing uptake of BUP-ER across Canada, the Ontario Drug Policy Research Network conducted a rapid analysis of evolving treatment patterns.

This analysis reports on people newly initiating BUP-ER between Jan 1 2021 and Dec 31 2024 across Ontario.

Our analysis found:

• • There were 16,590 new BUP-ER treatment starts, which represents a two-fold increase from 2,061 in 2021 to 6,205 in 2024

• • 30% of treatment episodes received a single BUP-ER injection
    • • This has risen over time from 26% in 2021 to 32% in 2021

• • On average during a treatment course:
    • 14% of people had 15-25 days between injections
    • 54% had 26-30 days between injections
    • • 27% had 31-44 days between injections

• • Shorter gaps between injections have become more common, with injections between 15-25 days rising from 10% to 15% over the study period.

• • 38% of people received buprenorphine/naloxone at some point during BUP-ER treatment
    • • 28% were dispensed buprenorphine/naloxone more than 2 weeks after BUP-ER initiation.

These findings suggest that clinicians are increasingly prescribing slightly more frequent injections and/or short-term supplemental oral buprenorphine/naloxone during BUP-ER treatment. This could reflect inadequate duration of BUP-ER dosing among people exposed to the highly potent illicit opioid supply and requires further study.