Use of long-acting opioid-addiction treatment increases, but lags other forms

Use of long-acting injectable forms of buprenorphine — the gold-standard for opioid treatment — has grown significantly in New Jersey over the past years, mirroring a national trend.  

However, fewer than 5% of Garden State patients prescribed buprenorphine chose the injectable version of the medication, according to a Rutgers University study published earlier this month in the journal Health Affairs.  

Researchers from Rutgers and Columbia University studied nearly 2.3 million prescriptions for buprenorphine issued nationwide from 2021 through 2024, which showed use of the long-acting injectable form grew from barely 0.5% of all the forms to nearly 4.3% during that time.  

In New Jersey, preference for injectable version rose from 0.7% of all buprenorphine scripts issued to almost 5% in those years, the data shows.  

Co-author Stephen Crystal, director of the Rutgers Center for Health Services Research, said the tenfold increase in injectable use could save lives among those that struggle to stick with daily medications.  

“Sustained levels of medication, potentially reducing cravings for illicit drugs and assured protection for a full month may reduce the risk of overdose, particularly for individuals at high risk, such as those treated for prior overdose or in unstable living situations,” Crystal said in a press release.  

The study, which also looked at changes in health insurance coverage and prescriber practices, showed interest in the injectable varied significantly nationwide, something researchers said likely reflects differences in how insurance plans are designed. As of 2024, use ranged from 0.2% of all buprenorphine prescriptions in Puerto Rico and 0.3% in Nebraska to 10.2% in Ohio and 13.4% in Pennsylvania. 

Clement Chen, a pharmacist with the Northern New Jersey Medication-Assisted Treatment Center of Excellence at Rutgers, agreed the overall increase is positive news, but said injectables remain the choice for a “low percentage of patients” overall.  

Chen said long-acting injectables provide a steadier level of medication than daily doses of buprenorphine, which also comes in tablets and a film patients put under their tongue. Buprenorphine works by reducing drug cravings and blocking the chemical pathway for opiates, making it harder for people to get high if they do use drugs.  

When the U.S. Food and Drug Administration approved the first long-acting injectable buprenorphine in 2018, Chen said experts hoped it would be a “game changer.” It’s an option that makes particular sense for people who have a history of overdoses, are unstably housed, or in the correctional system, he said. 

“This is where the injectable can really buy them time” until a former prisoner is settled, with program support in place, Chen told the New Jersey Monitor.  

People leaving the prison system are at extreme risk of drug overdose, Chen noted, given their reduced tolerance. This is particularly important given the emergence of more high-potency drugs, like fentanyl and carfentanil, he said. 

“We see buprenorphine as a tool to reduce overdose,” Chen said.  

Providers in New Jersey are encouraged to offer injectable forms of buprenorphine, Chen said, “but a lot of patients say no.”  

For some, it’s a fear of needles, Chen said, while others prefer to take a daily buprenorphine dose because it offers flexibility, or reminds them of illicit drug use. Others want the option of selling extra doses if they are short on cash, he said.  

“With the sublingual they can divert. They can’t do that with an injectable,” he said. 

Fatal overdoses have decreased in New Jersey since they peaked in 2022 at nearly 3,200 deaths, according to the latest state data, although recent declines have lagged among Black and Hispanic residents. In 2204, 2,025 people died from drugs here and more than 81,000 sought treatment, including some 30,000 with heroin or other opioid addictions, budget data shows.