The long game

Via was the first state-funded treatment provider to offer long-acting injectable buprenorphine (LAIB) in England and Wales. Here we hear from key stakeholders at Via and Liverpool John Moores University (LJMU) about their latest research into the predictors and outcomes of LAIB vs oral medication, and the life-changing impact LAIB can have on the people it’s prescribed to.

Dr Yasir Abbasi, executive medical director at Via
In 2019, Via worked with our commissioner in the London Borough of Redbridge to successfully pilot the use of long-acting injectable buprenorphine (LAIB).

‘I believe [LAIB] represents a significant step forward in the treatment and recovery from opioid dependence. Since making this treatment available in Redbridge, the feedback from patients has exceeded expectations.’ (Andrew Hardwick, integrated strategic commissioner, London Borough of Redbridge)

By 2023, we were successfully delivering LAIB across six localities, and therefore gathering valuable treatment data that could show the effectiveness and impact of using LAIB in community services. As part of Via’s innovation and research unit, I was keen to explore how we could design an evaluation utilising this data and established a research partnership with Liverpool John Moores University.

Professor Cathy Montgomery, professor of psychopharmacology and health inequalities at Liverpool John Moores University
‘This is one of the first investigations of person-rated outcomes and demographic factors in people prescribed LAIB versus oral MOUD (medications for opioid use disorder)’ (Montgomery, Abbasi, De Silva, et al, 2024).

IN OUR RESEARCH STUDY, WE AIMED TO EXPLORE
–  the factors that influenced the likelihood of an individual being prescribed LAIB
–  whether LAIB has a significant impact on people’s wellbeing and quality of life.

We analysed the treatment data of 501 people accessing Via services between August 2022 and August 2023. Anonymised data was taken from six Via services, and we compared 235 individuals prescribed LAIB with 266 people receiving oral medication. To identify what factors predicted whether someone would be prescribed LAIB, we used available demographic information. To examine whether LAIB had an impact on a person’s wellbeing and quality of life, we compared:
–  The difference in Treatment Outcome Profile (TOP) scores; the change between the first and final recorded TOP scores.
–  Summary TOP scores; the average across all an individual’s TOP scores.

HEADLINE FINDINGS
–  Predictors: People prescribed LAIB were significantly younger, had significantly more treatment episodes and significantly higher rates of employment.

–  Outcomes: The people prescribed LAIB reported significantly higher quality of life. The analysis of the TOPS summary scores also found that those using LAIB reported significantly greater psychological and physical health. 

Devon De Silva, innovation and research unit manager at Via
The objective of Via’s innovation and research unit is to evaluate the interventions that we deliver, ensuring they are evidence-based and make a meaningful difference to the lives of the people we support. To help us better understand the findings from this research, I conducted interviews with three Via clinicians and six people who use our services.

The interviews gave us an insight into the predictors of how people will engage with LAIB and also showcased the real-life positive impact that LAIB can have on people’s quality of life:

PREDICTORS
–  More treatment episodes – due to the limited funding for LAIB, services have to prioritise who they offer it to, and this can include prioritising those ‘struggling with engagement or that are high risk’.
–  High rates of employment – those who are employed may find it difficult to regularly attend a pharmacy, so may also be prioritised.
–  Significantly younger – those who were older appear to be less likely to engage with LAIB: ‘maybe because they’re used to methadone’.

OUTCOMES
Key themes included people:
–  having ‘no sweating, no withdrawal’
–  being able to ‘engage in [their] relationship[s]’ again
–  now ‘having [their] own business… making a profit’
–  feeling ‘normal again’ due to no longer having to go to the pharmacy, a place they’d felt stigmatised
–  having ‘forgotten the fact [they’d] had a drug addiction’

One individual described LAIB as his ‘desperate last chance’ and that he is now ‘able to focus, am clean and can concentrate on… life.’

We’re not saying that LAIB solves every issue or that it’s even suitable for everyone. But what our research and interviews do show is that LAIB can make a significant difference to the lives of the people who are prescribed it.

We believe LAIB should be a treatment option available for people, and that more research is required to help address the challenges of limited funding for LAIB within the sector. Via and LJMU have recently secured additional funding to explore the socio-economic benefits of LAIB, to aid with this ongoing challenge.

INCREASED QUALITY OF LIFE
Quotes from people who were interviewed:

‘With heroin, you wake up needing a fix but now we can lie in bed and have a tea… we can engage in our relationship.’

‘Having to go to the pharmacy all the time… [they] looked down their noses at you and treated you like you’re nothing… [LAIB has] made me normal again.’ 

‘Heroin affected my sleep… I’m now running on my own energy. Buzzing on life.’

‘Ten years ago I was sleeping in my car, now I’ve got my own business, my own house, my partner.’

‘I’ve got a young man with mental health and his mum is his carer. [LAIB] gives them one less thing to worry about.’