Patient Satisfaction and Resource Utilization Following Introduction of Long-Acting Injectable Buprenorphine (LAIB) in Scottish Prisons.

Abstract

Purpose: To examine patient satisfaction with long-acting injectable buprenorphine (LAIB) as opioid agonist therapy (OAT) during custody, the effect on prisoner behavior and illicit drug use in custody, and the impact on healthcare utilization within OAT programs in Scottish prisons.

Patients and methods: This observational, service evaluation included 134 adult patients (≥18 years) with opioid dependence. Clinically appropriate patients were stabilized on monthly LAIB. The following outcomes were evaluated at 12, 24, and 52 weeks: patient satisfaction using the Treatment Satisfaction Questionnaire for Medication (TSQM), patient-reported craving using a 100 mm visual analog scale (VAS), and opioid withdrawal using the Clinical Opiate Withdrawal Scale (COWS). Patient-reported illicit drug use and disciplinary actions were recorded.

Results: Retention on LAIB for 12 months or until release/transfer was 93.8%. Patient satisfaction with LAIB was high, with median global TSQM scores >80 at all timepoints in the whole population and in those transferred after reduction from high-dose methadone (>30 mg/day). Compared with the first 4 weeks, craving significantly decreased at Weeks 12 and 24; the decrease at Week 52 was not statistically significant. COWS scores were also significantly lower at all timepoints. Levels of illicit drug use and disciplinary actions were low throughout. Healthcare worker contact time saved with LAIB versus methadone was estimated at ~100 minutes per patient monthly. As of June 30, 2024, ~228 hours in total are estimated to have been saved per month across the Forth Valley prison estate.

Conclusion: This service evaluation demonstrates high levels of patient satisfaction with LAIB in the prison setting, with minimal disruption to patient comfort or behavior even during treatment transition. Provision of LAIB has reduced healthcare hours required to deliver OAT medication in the Forth Valley prison estate, allowing the reprioritization of some healthcare resources toward other health-promoting goals.