Substitution therapy: Depot preparations provide quality of life

Substitution therapy is an important element in the treatment of opioid-dependent individuals. In addition to traditional daily medications, depot medications are now also available, allowing for long-term drug release and eliminating the need for daily visits to the doctor's office. Brigitte Ingenhaag-Marten, an internist and addiction medicine specialist, explained the associated advantages and challenges at the annual meeting of the Federal Association of Pharmacists (BVVA) in Mainz in early June.

In her general practice in Flamersheim, which specializes in substitution therapy, she currently cares for 75 patients undergoing drug replacement therapy. 25 of them receive a depot preparation containing buprenorphine. "The patients have a significantly improved quality of life; they can better balance work and life," the doctor explained. The depot injection eliminates the need to come to the practice every day to receive the medication.

Buprenorphine is an analgesic with partial agonist activity at the µ-opioid receptor. It is approved for both pain management and substitution therapy for opioid addiction. As a partial agonist, buprenorphine does not achieve the maximum analgesic effect of morphine. A key factor in substitution therapy is that the drug binds long-lastingly and reversibly to µ-opioid receptors in the central nervous system, which reduces patients' cravings for opioids over a longer period of time.

Buprenorphine has long been used in sublingual tablet form for substitution therapy (Subutex®). For several years, depot preparations for weekly or monthly subcutaneous injections have also been available. Buvidal® depot injection solution from the Swedish company Camurus was approved in the EU in November 2018, followed by Subutex® depot injection solution from the British company Indivior in 2021.