Joint working

Project title: Development of an Injectable Buprenorphine Toolkit

Project background: Spectrum Community Health CIC are planning to introduce long-acting buprenorphine injection opioid substitution therapy (OST) across their secure and community estates. To mitigate against the risk of fragmented and poorly executed implementation of a different OST treatment modality, Spectrum Learn and Develop Ltd will work together with Camurus UK Ltd to develop comprehensive and detailed guidance for clinicians working in Spectrum’s secure environments.

Organisations involved: Spectrum Community Health CIC, Spectrum Learn and Develop Ltd and Camurus Ltd. Both parties have contributed approximately equal resources to this project.

Project objectives:

• Make changes to service delivery models at two prison sites to include the administration of injectable buprenorphine
• Provide advice and guidance about the cohort of patients in the secure environment that are most likely to benefit from this formulation
• Capture safety outcomes of Buvidal treatment in the prison setting
• Conduct a cost benefit analysis and overall value of delivery including consideration of societal and economic returns
• Describe procedures for transition between OST treatments
• Understand and describe the implications on service user experience and community perceptions across the service users’ recovery/care pathway
• Optimise continuity of care between community, custodial and hospital settings
• Produce a step-by-step operational guide to support implementation of the pathway in other Spectrum CIC secure and community estates

Benefits to Patients:

• Implementation of a clinically effective care pathway for the introduction of injectable buprenorphine for service users in the prison environment
• Injectable buprenorphine offers potential benefits over daily oral OST to service users whilst in the secure environment as well as upon release:
• Significantly fewer supervised therapy administrations
• Reduces the risk of diversion of medication
• Removes the need to obtain OST prescription immediately upon release to avoid withdrawal
• Improved continuity of care between the criminal justice and community treatment settings

Benefits to Spectrum Learn and Develop Ltd:

• Healthcare employees who will be involved in the administration and delivery of injectable buprenorphine will receive education and training
• Expert health economic modelling, cost analyses and statistical analyses will be provided where required
• Members of the Spectrum Learn and Develop team will be supported by advisors from Camurus Ltd on relevant updates of the RCGP SMAH Certificate in the Management of Drug Misuse Part 1 and Part 2

Benefits to Camurus:

• Increased patient access to opioid dependence treatment, including Camurus’ product, according to national guidelines
• Better understanding of customers’ and service users’ needs in the secure environment
• Faster adoption of good practice guidance for treatment of opioid dependence in secure environments which may be relevant to Camurus Ltd business
• Enhanced reputation as a valued healthcare provider in opioid dependence treatment

Project timelines: the project will start in March 2020 with an expected duration of 12 months.

UK-BUV-2000023 March 2020

Joint working Executive Summary

Project title: Opioid dependence treatment keyworker training programme

Project background: Substance Misuse Management in General Practice (SMMGP) is a professional network that offers training, education and expert support to anyone involved in the treatment of addictions. SMMGP will work together with Camurus Ltd to create and deliver a training package for keyworkers so that they can support patients to make informed decisions regarding treatment selection and their ongoing opioid substitution treatment journey.

Organisations involved: SMMGP and Camurus Ltd. Both parties have contributed approximately equal resources to this project.

Project objectives:

• Design a training programme for keyworkers covering the following:
- Information on prolonged-release buprenorphine including an outline of basic pharmacology, evidence for use, and the role of psychosocial interventions in treatment with prolonged-release formulations
- Misunderstandings regarding prolonged-release formulations
- Information regarding treatment selection of prolonged-release formulations within the range of treatment options
- Motivational techniques for working with clients to support treatment selection, and ongoing treatment journeys which will include prolonged-release formulations
• Design a ‘train the trainer’ module and evaluation aimed at keyworkers who wish to train others within their organisations
• Deliver the keyworker training programme to up to 5 sites in England currently prescribing prolonged-release buprenorphine
• Deliver the ‘train the trainer’ module to interested keyworkers from participating sites
• Assess the impact of the training programme in facilitating informed treatment choices through questionnaires for the key workers and their clients at baseline (prior to taking the course) and after course completion

Benefits to Patients:

• Through providing a high-quality training programme for keyworkers, it is anticipated that patients will receive accurate information on all available treatment options to empower them to make an informed choice of which treatment is suited to their treatment goals

Benefits to Spectrum Learn and Develop Ltd:

• SMMGP will benefit from Camurus’ expertise in prolonged-release buprenorphine formulation in the creation of the training materials

Benefits to Camurus:

• Better understanding of the educational needs of keyworkers at drug treatment services
• Enhanced reputation as a valued healthcare provider in opioid dependence treatment

Project timelines: The project will start in September/October 2020 with an expected duration of 7 months.

UK-BUV-2000093 September 2020

Joint working Executive Summary

Project title: Prolonged release opioid substitution treatment service evaluation in Forth Valley Prisons

Project background: Opioid dependence is a health problem that is disproportionately represented in prisons due to acquisitive crime and illegal substance possession, with prison-based healthcare representing an important opportunity to access treatment (Wright et al., 2020). Pharmacotherapy, mainly with daily oral methadone, is effective but associated with specific limitations in the prison setting, including bullying, exploitation, limiting time for employment and rehabilitation, and diversion and misuse. These latter issues have also resulted in limited access to oral buprenorphine in the prison setting (Wright et al., 2020).

Organisations involved: NHS Forth Valley Health Board and Camurus Ltd. Both parties have contributed approximately equal resources to this project.

Project objectives:
The objective of this joint working project is to conduct a service evaluation in order to assess the use of Buvidal (prolonged release buprenorphine solution for injection) in custodial settings in the Forth Valley Health Board area using the measures set out in section 13 ‘Evaluation of use of Buvidal’ of ‘Guidance for the use of Buvidal for Opiate Substitution Treatment in Prisons during the Covid-19 Pandemic’, with an additional questionnaire to evaluate patient satisfaction and experiences of treatment. The service evaluation will also include assessment of patient satisfaction with continuity of care post-liberation.

Benefits to Patients:

• Increased treatment options for patients at the three prison services
• Buvidal offers potential to minimise the burden, risks and stigma associated with daily administration and to facilitate uninterrupted continuity of opioid substitution treatment post-liberation
• Evaluation of the service may allow for its optimisation and may help inform decision-making on longer-term funding, thereby maintaining patient access to the full range of treatment options beyond the COVID-19 pandemic

Benefits to NHS Forth Valley Health Board:

• Expertise in assessment of treatment outcomes will be provided by Camurus Ltd
• Expertise in statistical analysis and medical writing will be provided by Camurus Ltd

Benefits to Camurus Ltd:

• Increased patient access to Buvidal (prolonged release buprenorphine solution for injection), according to national guidelines
• Better understanding of how Buvidal may be integrated in opioid dependence treatment pathways in the custodial setting
• Enhanced reputation as a healthcare partner in opioid dependence treatment

Project timelines: The project will start in March/April 2021 with an expected duration of 12 months.

UK-BUV-2100031 March 2021