Enhancing Compliance Through Local Anesthesia in Extended-Release Buprenorphine Therapy: A Report of Two Cases

In recent years, treatment options for opioid use disorder have expanded significantly with the availability of a wide range of medication formulations. Extended-release buprenorphine is a long-acting, injectable medication used to treat moderate-to-severe opioid use disorder by providing a steady, continuous dose of buprenorphine over several weeks. Needle-related anxiety and injection-site pain are frequent adverse events that can significantly impede patient adherence to extended-release buprenorphine therapy. Topical and injectable anesthetics can enhance patient comfort and support greater adherence to the treatment protocol. This report presents two cases detailing a protocol to minimize pain from extended-release buprenorphine injections. This protocol utilizes a combination of topical anesthetic skin refrigerant (vapocoolant spray), local anesthetic, and an alkalizing agent, using specific techniques to minimize discomfort. After achieving adequate local anesthesia, extended-release buprenorphine therapy was well-tolerated, with participants reporting an essentially painless procedure. Topical and injectable anesthetics can improve patient comfort during extended buprenorphine administration, boosting adherence to opioid maintenance therapy.