Oesterle, Tyler S.

Background Long-acting injectable buprenorphine (LAI-BUP) is safe and effective, however is underutilized. Little is known regarding how buprenorphine prescribers view LAI-BUP, and which medication attributes they prioritize when selecting opioid use disorder (OUD) treatment. Methods Secondary analysis of a national, cross-sectional survey of U.S. physicians prescribing buprenorphine for OUD. Respondents reported OUD caseload, LAI-BUP use, and importance of medication attributes (eg, efficacy, safety, ease of prescribing, administrative requirements). Providers were categorized as no LAI-BUP use or, among LAI-BUP prescribers, Low vs High use by a median split. Group comparisons used chi-square (or Fisher’s exact) tests for categorical variables and Jonckheere–Terpstra tests for ordinal responses. Results Among 125 respondents, 39 (31.2%) reported no LAI-BUP use. The remaining 86 (68.8%) were split evenly into Low and High use groups (n’s = 43). LAI-BUP use did not differ meaningfully by specialty, region, or practice setting. Greater LAI-BUP use was reported by providers with larger OUD panels. Ratings of medication attributes were uniformly high. Conclusions LAI-BUP remains underused, with uptake highest among clinicians managing larger OUD caseloads. Measured attitudes toward medication attributes did not explain these differences. Future work should assess clinic workflow, staffing, reimbursement, and REMS burden, testing targeted implementation strategies using mixed-methods trials.

Introduction The integration of telehealth into clinical care has increased access to substance use disorder (SUD) treatment. However, drug screen monitoring has largely remained tied to in-person visits, preventing a fully virtual workflow. We evaluated the acceptability, appropriateness, feasibility, and usability of video-observed oral fluid (VOOF) self-collection as an approach to address this implementation gap. Methods Participants receiving SUD treatment in outpatient ( n = 13) or residential ( n = 15) settings completed a video-recorded oral fluid self-collection protocol, followed by the Acceptability of Intervention Measure, Intervention Appropriateness Measure, Feasibility of Intervention Measure, and System Usability Scale. Results Most participants had multiple SUDs ( n = 23, 82.1%), and nearly all had co-occurring mental illness ( n = 27, 96.4%). The majority completed study measures ( n = 23, 82.1%) and returned collection kits ( n = 25, 89.2%). Acceptability, appropriateness, and feasibility all exceeded established thresholds (>3), with respective means of 3.5 (SD 1.1), 3.8 (SD 1.1), and 3.4 (SD 1.3). Usability scores were below average and more variable (mean = 51.8, SD 20.4). Scores did not significantly differ by care setting. Discussion This early-stage pilot found that VOOF self-collection was generally acceptable, appropriate, and feasible among individuals with SUD in real-world care settings. Usability scores were below average, with technical challenges related to video recording and upload likely contributing. Integrating VOOF within digital treatment platforms may streamline the user experience and improve usability while better aligning drug screen monitoring with the growth of telehealth in SUD treatment. This approach may benefit individuals experiencing transportation barriers and those in rural areas who live significant distances from testing sites.