Abstract
How people connect with opioid agonist treatment is an ongoing concern. Extended-release buprenorphine depot (BUP-XR) has been designed with ‘retention’ in mind. It is important to consider what makes a difference to clients in helping them to stay connected to treatment over time.
Methods
We report findings from the third wave of in-depth interviews with participants (n = 26) in the Community Long-Acting Buprenorphine (CoLAB) study, tracing accounts of connection, disconnection and reconnection with BUP-XR since initiation into treatment.
Results
Changing situations in treatment delivery and in people's lives created conditions of possibility for connection and disconnection to treatment. Clients used BUP-XR in different ways. Personalisation of dosing regimens and stretching out of time between doses was common, creating a sense of stability for some. For others, this flexibility potentiated fragility in treatment connection. Disconnection from BUP-XR was common, but frequently this was not the ultimate outcome. Treatment connections were shaped by fluctuating life circumstances, with re-connections imagined, attempted and sometimes realised.
Discussion and conclusions
Clients' accounts reveal the complexities of how ‘long-acting’ treatments are made to work over time. Connecting with treatment in the long-term is a process, contingent on social relations, fluctuating life conditions and systems of care. Rather than treating connection and disconnection as opposites, we suggest seeing these as entangled and fluid elements of an ongoing process. What is needed is an adaptive and emergent conceptualisation of what ‘retention’ in treatment can mean, reflective of how people connect with their treatment and make it work, in practice.
| Original language | English |
|---|---|
| Pages (from-to) | 829-841 |
| Journal | Drug and Alcohol Review |
| Volume | 44 |
| Issue number | 3 |
| Early online date | 17 Feb 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 17 Feb 2025 |
Acknowledgements
The authors thank the study participants for their contribution to research, as well as current and past researchers and staff, and the CoLAB Study Team, with special thanks to Michael Farrell, Louisa Degenhardt, Marianne Byrne and Jeyran Shahbazi from the National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. They also acknowledge the following people: Jude Byrne (Australian Injecting and Illicit Drug Users League, Canberra, Australia); Mahshid Ramadani (Data manager, Kirby Institute, UNSW Sydney, Australia); Madeline News, Zoe Griffin and Zein Ali (research assistants, National Drug and Alcohol Research Centre, UNSW Sydney, Australia); Jason Gascoigne (study coordinator, DASSA, South Australia, Australia); Mariana Nasr, Adelaine Nyau, Rebecca Lewis, Linda Broadbent, Xiu Qin Lim, Raphela Van Der Laan, Natasha Kuller, Jessica Leonard, Tammy Dix, James Buchanan and Duncan Tyson (Clinic staff, DASSA, Adelaide, Australia); Teodora Zanesheva-Karamanlieva (study coordinator, St Vincent's Hospital, Sydney, Australia), Tom Kural and Linda Hotong (Clinic Staff, St Vincent's Hospital, Sydney, Australia); Bonny Puszka (study coordinator, Royal North Shore Hospital, Sydney, Australia); Alison Blazey, Esther Han, Helena Cheung, Bernard Chiuarah, Jenny Trinh Lee, Ariana McCauley, Leanne Walsh, Jan Armstrong, Nouvelle Thwaites and Ivy Kwon (clinic staff, Royal North Shore Hospital, Sydney, Australia); Rachael Skews (study coordinator, Frankston Healthcare, Melbourne, Australia); Lionel Kok, Belinda Smith and Naren Morris (clinic staff, Frankston Healthcare, Melbourne, Australia); Danielle Cassar, Teresa Fitzmaurice (study coordinator, Western Health hospital, Melbourne, Australia), Anthony Hew, Shani Pavia, Dimce Kotevski, Fiona Goodwin, Marcus Forsythe, David Silkoff and Tracy Wrigley (Clinic staff, Western Health Hospital, Melbourne, Australia); Susan Hazelwood and Louise Go (study coordinator, Newcastle Pharmacotherapy Service, Newcastle, Australia); and Michelle Hall, Callen Farmer, Cathy Cochrane, Anthony Winmill, Sally McKenna, Stacey Weedon and Tarun Yadav (Newcastle Pharmacotherapy Service, Newcastle, Australia). They also acknowledge and thank their colleagues on the CoLAB Protocol Steering Committee: Briony Larance, Suzanne Nielsen, Greg Dore, Jason Grebely, Adrian Dunlop, Nicholas Lintzeris, Robert Ali, Marian Shanahan, Mike McDonough, Mark Montebello, Craig Rodgers and Sione Crawford.Funding
The authors thank the study participants for their contribution to research, as well as current and past researchers and staff, and the CoLAB Study Team, with special thanks to Michael Farrell, Louisa Degenhardt, Marianne Byrne and Jeyran Shahbazi from the National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. They also acknowledge the following people: Jude Byrne (Australian Injecting and Illicit Drug Users League, Canberra, Australia); Mahshid Ramadani (Data manager, Kirby Institute, UNSW Sydney, Australia); Madeline News, Zoe Griffin and Zein Ali (research assistants, National Drug and Alcohol Research Centre, UNSW Sydney, Australia); Jason Gascoigne (study coordinator, DASSA, South Australia, Australia); Mariana Nasr, Adelaine Nyau, Rebecca Lewis, Linda Broadbent, Xiu Qin Lim, Raphela Van Der Laan, Natasha Kuller, Jessica Leonard, Tammy Dix, James Buchanan and Duncan Tyson (Clinic staff, DASSA, Adelaide, Australia); Teodora Zanesheva-Karamanlieva (study coordinator, St Vincent's Hospital, Sydney, Australia), Tom Kural and Linda Hotong (Clinic Staff, St Vincent's Hospital, Sydney, Australia); Bonny Puszka (study coordinator, Royal North Shore Hospital, Sydney, Australia); Alison Blazey, Esther Han, Helena Cheung, Bernard Chiuarah, Jenny Trinh Lee, Ariana McCauley, Leanne Walsh, Jan Armstrong, Nouvelle Thwaites and Ivy Kwon (clinic staff, Royal North Shore Hospital, Sydney, Australia); Rachael Skews (study coordinator, Frankston Healthcare, Melbourne, Australia); Lionel Kok, Belinda Smith and Naren Morris (clinic staff, Frankston Healthcare, Melbourne, Australia); Danielle Cassar, Teresa Fitzmaurice (study coordinator, Western Health hospital, Melbourne, Australia), Anthony Hew, Shani Pavia, Dimce Kotevski, Fiona Goodwin, Marcus Forsythe, David Silkoff and Tracy Wrigley (Clinic staff, Western Health Hospital, Melbourne, Australia); Susan Hazelwood and Louise Go (study coordinator, Newcastle Pharmacotherapy Service, Newcastle, Australia); and Michelle Hall, Callen Farmer, Cathy Cochrane, Anthony Winmill, Sally McKenna, Stacey Weedon and Tarun Yadav (Newcastle Pharmacotherapy Service, Newcastle, Australia). They also acknowledge and thank their colleagues on the CoLAB Protocol Steering Committee: Briony Larance, Suzanne Nielsen, Greg Dore, Jason Grebely, Adrian Dunlop, Nicholas Lintzeris, Robert Ali, Marian Shanahan, Mike McDonough, Mark Montebello, Craig Rodgers and Sione Crawford. Open access publishing facilitated by University of New South Wales, as part of the Wiley - University of New South Wales agreement via the Council of Australian University Librarians. The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article. This study was supported by an Externally Sponsored Collaborative Research grant from Indivior PLC. Indivior contributed to the study design and analysis plan of the clinical parent study [ 16 ] (Farrell et al., 2022) but not this qualitative study; Indivior had no role in collection, analysis and interpretation of data, in the writing of the manuscript or in the decision to submit the manuscript for publication. The Centre for Social Research in Health at the UNSW Sydney is supported by a grant from the Australian Government Department of Health. The views expressed in this publication do not necessarily represent the position of the Australian Government.
| Funders | Funder number |
|---|---|
| Bonny Puszka | |
| Susan Hazelwood and Louise | |
| Belinda Smith and Naren Morris | |
| Teodora Zanesheva-Karamanlieva | |
| Department of Health and Aged Care, Australian Government | |
| Jason Gascoigne | |
| Newcastle Pharmacotherapy Service, Newcastle, Australia) | |
| Lionel Kok | |
| DASSA | |
| Australian University Librarians | |
| Tom Kural and Linda Hotong | |
| National Drug and Alcohol Research Centre | |
| Newcastle Pharmacotherapy Service | |
| University of New South Wales |
Keywords
- extended-release buprenorphine depot
- long-acting injectable buprenorphine
- opioid agonist treatment
- qualitative study
- treatment retention
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Health(social science)