Long-acting injectable buprenorphine for opioid use disorder: key findings from a longitudinal qualitative study

Background: Long-acting injectable buprenorphine (LAIB) is a relatively new treatment for opioid use disorder. It is available in weekly and monthly injectable formulations that bypass the need for daily dosing. Evidence of the effectiveness and benefits of LAIB is already emerging. Nonetheless, LAIB is a complex medication and not suitable for all people experiencing opioid use disorder. This presentation will summarise key findings from a longitudinal qualitative study of patients’ views and experiences of receiving LAIB. 

Methods: Interviews were conducted with 26 people (18 male; 8 female) with opioid use disorder who were recruited from community drug treatment services in England and Wales. Each person was invited to participate in six semi-structured telephone interviews over a 12-month period starting at treatment initiation. In total, 125 of a possible 156 interviews were completed. All interviews were recorded, transcribed, coded, and analysed using a combination of inductive, deductive, and abductive techniques.

Results: Participants stated that they had enough information and knowledge to decide they wanted LAIB. However, dissatisfaction with current medications, desire for better treatment, and LAIB’s limited availability at the time of recruitment seemed to hinder informed decision-making. Participants described complex combinations of changing negative and positive feelings during the first 72 hours of LAIB treatment and many reported non-prescribed substance use (heroin, crack-cocaine, benzodiazepines and/or cannabis) during the first month of treatment. In the first year, a few participants were taken off LAIB due to late attendance for injections or difficulties adjusting to the medication, a few opted out of LAIB because they did not like the medication’s effects, and one successfully tapered off all treatment. Eleven participants continued on LAIB for the full year and identified positive changes in their substance use and lives more generally, although lack of support from treatment providers was a source of dissatisfaction for some. Participants’ experiences indicated that the first year of treatment could be conceptualised as journey comprising three stages: ‘withdrawal and separation’, ‘transformation’, and ‘engagement’.

Conclusion: Good access to all forms of medication for opioid use disorder is needed so that people have meaningful treatment choices. LAIB is not a panacea for the complex life problems often associated with opioid use disorder. Those providing LAIB should therefore offer regular on-going contact and other forms of non-medical support, so patients have the best opportunity to succeed. People receiving LAIB also need accessible information on the challenges and benefits they are likely to experience in treatment so that they understand what to expect and are prepared. Over time, those who are retained on LAIB are likely to report a range of positive life outcomes in addition to reduced heroin use.