Long-acting buprenorphine injectables: Opportunity to improve opioid use disorder treatment among rural populations.

The opioid epidemic continues with escalating overdose deaths only exacerbated by the coronavirus pandemic, despite having efficacious medication treatments for opioid use disorder (MOUD). Most persons with OUD remain undiagnosed, without ever receiving MOUD, and even those who initiate MOUD, retention is infrequently longer than 6 months (Williams et al., 2019). Treatment access remains particularly problematic in rural areas (Ghertner, 2019). There are two new injectable long-acting buprenorphine formulations (LAB) that were recently approved in the United States and abroad (Lofwall et al., 2018, Walsh et al., 2017, Haight et al., 2019). They hold promise to improve treatment access and retention and may be particularly attractive during a pandemic in order to minimize provider and pharmacy contacts (Roberts et al., 2020) and help improve access to care in rural areas. There are several ongoing evaluations of these LAB injectables in large multi-site randomized clinical trials sponsored by the National Institute on Drug Abuse in settings with special populations that exist in both urban and rural settings. Understanding the potential clinical benefits of these new LAB medications, with particular attention to how they can address unmet treatment needs within the care continuum is essential to successful implementation in the complex healthcare system.