Jan Melichar

Jan K Melichar, MD FRCPsych, is an NHS Consultant Addiction Psychiatrist, Senior Lecturer (Psychopharmacology, Bath University) and Visiting Professor (University of South Wales). He regularly provides advice to government, industry and commissioners. He previously worked as a Medical Director, founded a Medical Device Start-Up and set-up a Regional Detoxification Unit. He was elected a Fellow of the Royal College of Psychiatrists and serves on the National Executive, Addictions Faculty, of the College. In 2020, as part of Covid-19 developments, he put a successful bid to Welsh Government to fund nationwide use of a long-acting monthly opioid replacement injection (Buvidal). Working together with colleagues, he rolled it out across Wales and has given >400 injections to >100 patients. His research interests include lab-based research to understand what causes the significant benefit of Buvidal and the development of properly researched detoxification and trauma pathways.

“It’s a saviour” – Clients’ experiences of commencing on long-acting buprenorphine

Introduction: Buvidal, a prolonged release treatment for opioid dependence in adults, has recently become used in treatment for opioid dependence in Wales. The aim of this service evaluation was to better understand the experiences of those commencing on Buvidal in order to develop services to meet their needs.

Methodology: Eight participants who were accessing a Community Addiction Service and initiating on Buvidal were recruited via opportunistic sampling and completed three interviews in conjunction with their first three Buvidal injections. Data was thematically analysed and inter-reliability checks were completed.

Results: Thematic analysis identified four main themes; ‘positive impact on life’, ‘holistic support’, ‘Buvidal promotion’ and ‘challenging experiences’. On the whole, participants felt that the positive changes to their life (e.g. clear headedness, being able to engage more in ‘normal life’, breaking rituals and not using illicit opiates) outweighed any challenges faced.

Recommendations: Recommendations for service development included: providing a rapid access stepped approach to psychological support; enhancing the preparation phase of commencing on Buvidal (early introduction of peer-support, preparation checklist and service-user developed information sheet); and to conduct further research to improve the understanding of the experiences of those on Buvidal and shape services accordingly. These recommendations have helped to shape the development of services for Buvidal clients in Wales. It is hoped that further research can facilitate service development as we gain a better understanding of the experiences of those using Buvidal, particularly in relation to their psychological support needs.