Research That Matters: Recovery From Opioid Use Disorder (OUD) After Monthly Long-Acting Buprenorphine Treatment: 12-Month Longitudinal Outcomes From RECOVER, an Observational Study

The RECOVER (Remission from Chronic Opioid Use: Studying Environmental and SocioEconomic Factors on Recovery) study provides longer-term observational data on individuals with moderate-to-severe opioid use disorder (OUD) who had previously participated in clinical trials of monthly extended-release buprenorphine injections (BUP-XR, commercially available as Sublocade).

RECOVER was a 24-month prospective observational study conducted at 35 community-based sites across the United States. This analysis reported outcomes through the first 12 months. The study included 533 participants, of whom 425 completed the 12-month visit. The average age was 42 years, and 66% were male.

Among participants who completed the 12-month visit, 50.8% self-reported sustained opioid abstinence across the observational period, and 68.0% reported past-week abstinence at the 12-month visit. More stringent sensitivity analyses produced lower sustained-abstinence estimates: 45.2% when all available self-reported measures were considered and 32.0% when negative urine drug screens were also required.

Longer BUP-XR exposure during the preceding clinical trials was associated with a greater likelihood of sustained abstinence during RECOVER. After statistical adjustment, the estimated rate of sustained abstinence was 75.3% among participants who had received 12 months of BUP-XR, compared with 24.1% among those who had received no more than two months.

This finding should not be interpreted as demonstrating a causal effect of longer BUP-XR treatment. Treatment duration was not randomized, and participants who continued treatment may have differed from those who discontinued earlier. In addition, 47.7% of participants received some form of substance use disorder treatment during RECOVER, including 38.8% who received pharmacotherapy for OUD.

Participants also reported generally favorable withdrawal, pain, mental health, quality-of-life, and employment outcomes compared with assessments obtained before they entered the preceding BUP-XR trials. These findings broaden the understanding of recovery beyond abstinence alone, while the observational design and continued treatment exposure require careful interpretation.