Improving access to opioid treatment is a key policy goal in England. This study examines the implementation of depot buprenorphine (DB), a long-acting injectable alternative to oral treatment, analysing uptake, outcomes, and experiences. Using mixed methods, including national administrative data and case studies across local areas, it explores variation in delivery, factors shaping uptake, and implications for policy and practice.

Evaluation of depot buprenorphine provision in treatment and recovery services in England

Daniel Lee, Alessandro Grosso, William D. Phillips, Jennifer Newbould, Lucy Strang, Katherine I. Morley, Nicola Kalk, Joanne Neale, Jennifer Bostock, Andrew Jones, et al.

ResearchPublished Apr 22, 2026

Cover: Evaluation of depot buprenorphine provision in treatment and recovery services in England
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Includes Annex A. Additional technical details; Annex B. Implementation Research Logic Model

Improving access to and retention in opioid treatment remains a central objective of drug policy in England. As part of the Supplemental Substance Misuse Treatment and Recovery Grant (SSMTRG), local areas have been able to expand the use of depot buprenorphine (DB), a long-acting injectable formulation of opioid substitution treatment. DB offers a potential alternative to daily supervised oral medication and may support engagement for some individuals.

This study examines how DB has been implemented and used within treatment and recovery services in England, and explores associated outcomes and experiences. It focuses on four areas: how DB uptake has evolved over time and across local areas; which groups may benefit most and under what conditions; what unintended consequences may arise from DB provision; and what factors enable or constrain effective uptake in practice.

A mixed-methods approach was adopted. Quantitative analyses draw on national administrative data, including the National Drug Treatment Monitoring System (NDTMS), alongside DB sales data and local spending plans, to characterise uptake and examine associations with treatment and wider outcomes. Qualitative evidence is based on case studies in ten local areas, including interviews and focus groups with people using services, frontline staff and commissioners.

The study provides a contextualised understanding of DB within the broader treatment system, highlighting variation in implementation, the role of wider social factors in shaping outcomes, and key considerations for policy and practice. It also identifies important evidence gaps, particularly in relation to longer-term outcomes and value for money.

Key Findings

Rapid but uneven uptake

  • DB uptake increased markedly following the introduction of SSMTRG funding, with earlier-funded areas showing more sustained growth. However, DB remains a minority treatment option, accounting for around 6.9 per cent of opioid substitution treatment in 2024.

Local variation in delivery and targeting

  • Implementation varied across local areas, reflecting differences in commissioning priorities, funding allocation and workforce capacity. Some areas prioritised individuals in more stable circumstances, while others targeted those with more complex needs or prior difficulties engaging with oral treatment, using DB to support retention and reduce harm.

Determinants of treatment outcomes

  • Favourable outcomes were strongly associated with referral pathways, housing stability and family context. Individuals referred from health or social care or through self/family routes were substantially more likely to remain in or complete treatment than those referred via the criminal justice system. Housing stability was a consistent predictor of positive outcomes.

DB may support engagement for specific groups

  • Qualitative evidence suggests DB can facilitate engagement for individuals facing barriers to daily supervised treatment, including those balancing work or caring responsibilities or with prior disengagement. Reduced pharmacy attendance was associated with greater flexibility, perceived dignity and reduced stigma.

Benefits observed, but uncertainty remains

  • Among DB recipients, reductions in self-reported illicit opioid use and injecting were observed, alongside modest improvements in health and social participation. However, these findings are not causal. High costs, workforce constraints and uncertainty around long-term funding remain key barriers. Reduced service contact and possible unintended substance use among a small minority highlight the need for continued monitoring.

Recommendations

  • National government and local commissioners should consider options for delivering sustained and consistent funding for DB provision.
  • Providers and commissioners should consider how DB provision can be integrated within broader recovery pathways.
  • Providers should consider approaches to maintaining engagement and proactive monitoring for people receiving DB.
  • Commissioners and providers should consider how existing workforce development arrangements can better support DB delivery.
  • National policymakers should consider how to promote greater consistency and equity in the local delivery of DB.
  • National and local policymakers, commissioners and researchers should consider how to strengthen the evidence base and data infrastructure for DB.

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Lee, Daniel, Alessandro Grosso, William D. Phillips, Jennifer Newbould, Lucy Strang, Katherine I. Morley, Nicola Kalk, Joanne Neale, Jennifer Bostock, Andrew Jones, Tom Ling, Tim Millar, John Strang, Jon Sussex, and Mehdi Shiva, Evaluation of depot buprenorphine provision in treatment and recovery services in England. Santa Monica, CA: RAND Corporation, 2026. https://www.rand.org/pubs/research_reports/RRA4735-6.html.
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This work was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme and conducted by RAND Europe.

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