Trialling in-pharmacy administration of Buvidal began in May 2019, with the aim of reducing the need for daily supervised buprenorphine treatment.

Buvidal is an opioid partial agonist/antagonist and the first long-acting medication approved in the EU for the treatment of opioid dependence in patients who are also receiving medical, social and psychological support. It must be administered by a healthcare professional.

According to manufacturer Camurus, the injection can be administered weekly or monthly for the treatment of opioid dependence in adults and young people aged 16 years and over.

Currently, either oral methadone or buprenorphine tablets are typically prescribed to patients with opioid use disorders, and these must be administered daily and under supervision for the first three months of treatment, according to National Institute for health and Care Excellence (Nice) guidelines.

Shaheen Bhatia, pharmacy manager at P&S Chemist, is administering the Buvidal injection along with trained locum pharmacists, she told C+D last month.

As well as improving outcomes for patients, the injection model can free up pharmacists’ time, as they only have to supervise buprenorphine patients weekly, Ms Bhatia said.

“We do see it as a game changer for supervised treatment,” she added.

How the pilot works

Under the pilot scheme, patients referred from the local drug and alcohol team have a consultation with their doctor. If they agree to be changed from buprenorphine tablets to the injection, an appointment is booked with P&S Chemist.

Ms Bhatia worked with her local clinical commissioning group, local public health team, drug and alcohol charity WDP and Camurus to create a standard operating procedure for the pharmacy.

“We had no model as such to work on, except some Nice guidance, recognising [Buvidal] can be used for substitution treatment,” Ms Bhatia explained. “We also looked at some successful pilots in America and Australia.”

Positive feedback

Although the pilot is still in its early stages, Ms Bhatia said she has received “really good feedback” from patients.

As the injection is administered weekly, it is suitable for patients who find coming into a pharmacy daily “inconvenient”, and reduces the risk of overdoses or “children accidentally ingesting” buprenorphine tablets that have been taken home, she explained.

The injection may also be useful “in a prison setting”, she suggested, as well as for people who are “erratic” and struggle to pick up prescription medication regularly.

Missing out on daily supervision funding

Although this will mean losing out on daily supervision funding, Ms Bhatia stressed that the model “won’t get rid of supervision altogether”, as “new clients will always need that early stage of supervision”.

The pilot is expected to continue for at least one year, and Ms Bhatia said she has already had pharmacists and prescribers from Leeds and Jersey interested in seeing how the model works in practice.

P&S Chemist will also look to trial the service with methadone patients “at a later stage”, she explained.