Medication transitions and predictors of illicit substance use during opioid agonist treatment: a three-year follow-up study
In brief
Sublingual buprenorphine shows fewer illicit drug use problems than other OATs
In a three-year Norwegian cohort of 424 opioid-use patients, only 13% switched medications and the proportion on long-acting injectable buprenorphine rose modestly from 17% to 22%. Illicit substance use was lower among those on sublingual buprenorphine, while baseline use predicted later use; discontinuation and mortality were similar across groups.
- Journal
- Addiction science & clinical practice (Q1)
- Published
- 14 August 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Nina Jobling, Kristian Mjåland, Thomas Clausen, Anne Taraldsen Heldal, Birgitte Thylstrup, John-Kåre Vederhus
- PMID
- 42601628
- DOI
- 10.1186/s13722-026-00711-0
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 19 August 2026): Medication transitions and substance use in opioid agonist treatment
Abstract
BACKGROUND: For opioid use disorder (OUD), pharmacological therapy using methadone or buprenorphine, plus psychosocial support, is the most effective opioid agonist treatment (OAT). Long-acting injectable buprenorphine (LAIB) is the newest buprenorphine formulation. This study evaluated LAIB within a naturalistic clinical setting, compared with standard OAT (sublingual buprenorphine and methadone). METHODS: This observational study included patients from an OAT outpatient clinic in Agder County, Norway. Data were extracted from hospital medical records in May 2022. The cohort was followed up in February 2025. Medication-group transitions and outcomes were assessed by examining switching, discontinuation, mortality, and illicit substance use over three years. RESULTS: The study included 424 patients. The LAIB group was significantly younger than the standard OAT groups. During the study period, 13.2% of patients switched medications, increasing the LAIB group from 17% to 22%. Comparable proportions of patients experienced negative outcomes: 10% discontinued treatment, and 4% died. At follow‑up, illicit substance-use problems were less frequent in the sublingual buprenorphine group than the other groups, a finding that appears to have been influenced by differential attrition. Baseline substance use was the strongest predictor of illicit substance use at follow‑up. CONCLUSIONS: The LAIB group slightly increased during the study period. Transitions between medication groups appeared to yield better substance-use outcomes at follow-up in the sublingual buprenorphine group, compared to in other groups. Baseline substance use was the strongest predictor of illicit use at follow‑up, suggesting that individual clinical characteristics may contribute more to outcomes than the specific medication pathway. TRIAL REGISTRATION: Clinical trial: number not applicable.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.