Rajinder Shiwach, MD, MRCPsych, discusses how rapid induction with extended-release buprenorphine improves patient retention and maintains comparable efficacy and tolerability to standard induction methods.
In an interview with Pharmacy Times®, Rajinder Shiwach, MD, MRCPsych, a board-certified psychiatrist and medical director at Hickory Trail Hospital in DeSoto, Texas, explains that rapid induction with extended-release buprenorphine (Sublocade; Indivior Inc) demonstrates higher patient retention rates and similar safety and efficacy compared with traditional induction protocols. Shiwach highlights its potential to better serve patients with fentanyl exposure and those with limited social support, groups at particularly high risk of relapse and poor treatment continuity. Shiwach also notes that same-day induction maintains a similar side effect profile while improving treatment engagement and outcomes.
Pharmacy Times: Could you summarize how the rapid induction approach with extended-release buprenorphine differs from the standard induction method pharmacists may be more familiar with?
Rajinder Shiwach, MD, MRCPsych: I think we published the results in JAMA Network Open, and the findings, of course, are that rapid induction has a better retention rate, is equally efficacious, and the side effect profile is no different than with standard induction.
Pharmacy Times: What makes rapid induction particularly beneficial for patients who test positive for fentanyl, and how might pharmacists help identify those who could benefit most?
Shiwach: Yes, we’ve been seeing as clinicians in recent years that this import from China is pretty lethal. We’ve had anecdotal cases where people who have been on heroin, had a period of sobriety, then relapsed, but the heroin tastes different. When we check the urine, it’s adulterated, so everything opioid now seems to be adulterated with fentanyl. The high-risk groups that may benefit are people who are on fentanyl or have moderately severe opioid dependency, or use disorder as we call it through DSM. The other high-risk group would be people who have lower social support, because we feel the motivation of the patient is usually either self-willed or compounded by their next of kin encouraging them to seek sobriety. So, if you can identify people lacking social support, people on fentanyl, or those testing positive for fentanyl along with heroin, those would be the high-risk groups.
Pharmacy Times: From a safety perspective, what should pharmacists know about the tolerability of same-day extended-release buprenorphine induction and the one-week follow-up injection schedule?
Shiwach: Extended-release buprenorphine induction and the 1-week follow-up injection schedule—essentially, there is no difference, except that you’re fast-forwarding the treatment and retaining more patients. The injection site reactions are the same in both groups, as long as the injection procedure and protocol are followed properly. There is essentially no difference in side effects, and you know the results as to how it’s superior in other ways.
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