Cost Analysis of Buprenorphine Extended-Release Injection Versus Sublingual Buprenorphine/Naloxone Tablets in a Correctional Setting.

Incarcerated clients experience high rates of opioid use disorder and overdose. It is critical that opioid agonist treatment (OAT) is provided in correctional facilities. However, few receive OAT due to concerns about diversion, misuse, and safety. Buprenorphine extended-release (BUP-XR), a monthly buprenorphine depot injection, could be especially advantageous in the correctional setting as it can prevent diversion and misuse, saving staff resources and time. An injection of BUP-XR is costly compared with a monthly supply of buprenorphine/naloxone (BUP/NX) tablets. We demonstrate that when factoring in the added costs of medication preparation, administration, monitoring, and personnel, it is more economical to provide BUP-XR than BUP/NX. Other facilities, by utilizing our cost breakdown, can determine whether BUP-XR is economically advantageous at their own facility.

Interrogating Technology-led Experiments in Sustainability Governance.

Solutions to global sustainability challenges are increasingly technology-intensive. Yet, technologies are neither developed nor applied to governance problems in a socio-political vacuum. Despite aspirations to provide novel solutions to current sustainability governance challenges, many technology-centred projects, pilots and plans remain implicated in longer-standing global governance trends shaping the possibilities for success in often under-recognized ways. This article identifies three overlapping contexts within which technology-led efforts to address sustainability challenges are evolving, highlighting the growing roles of: (1) private actors; (2) experimentalism; and (3) informality. The confluence of these interconnected trends illuminates an important yet often under-recognized paradox: that the use of technology in multi-stakeholder initiatives tends to reduce rather than expand the set of actors, enhancing instead of reducing challenges to participation and transparency, and reinforcing rather than transforming existing forms of power relations. Without recognizing and attempting to address these limits, technology-led multi-stakeholder initiatives will remain less effective in addressing the complexity and uncertainty surrounding global sustainability governance. We provide pathways for interrogating the ways that novel technologies are being harnessed to address long-standing global sustainability issues in manners that foreground key ethical, social and political considerations and the contexts in which they are evolving.