The dynamics of more-than-human care in depot buprenorphine treatment: A new materialist analysis of Australian patients' experiences

Making long-acting treatment work: Tracing connections with extended-release buprenorphine depot through time

INTRODUCTION

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.

'Matters-of-concern' associated with discontinuation of long-acting injectable buprenorphine: Findings from a longitudinal qualitative study

BACKGROUND

Discontinuation of medications such as methadone and buprenorphine amongst patients receiving opioid agonist treatment (OAT) is an international phenomenon. Recent developments in OAT medication include depot-injections of buprenorphine. Circumstances underlying discontinuation of these new formulations of medication are not fully understood from a qualitative perspective.

METHODS

Data derive from a longitudinal qualitative study of patients' experience of long-acting injectable buprenorphine (LAIB), involving semi-structured telephone-interviews held at six-points in time. The relevant dataset for this article consists of 44 interview transcripts, generated from 8 participants who were each affected by discontinuation of LAIB prescriptions (during the first 12-months of treatment). Analyses sought to identify circumstances associated with LAIB discontinuation and data were further situated within a framework of 'evidence making intervention' and associated 'matters-of-concern'. Matters-of-concern relate to the ways in which an intervention is 'made' and constructed through engagement and practice, from the perspective of the recipient.

FINDINGS

In this study, participants experienced either 'discontinuation of LAIB prescriptions by treatment services' or patient-led 'opt-out' from treatment. Matters-of-concern underlying the former were associated with late attendance for scheduled appointments, non-prescribed substance use or receiving a custodial sentence. Matters-of-concern relating to patient-initiated discontinuation were associated with personal circumstances that affected treatment motivation, side-effects (of buprenorphine), a preference to resume heroin use, or because individual treatment goals had been achieved.

CONCLUSION

The assorted matters-of-concern that influence discontinuation of LAIB demonstrate that such OAT is complex and multi-faceted, is neither fixed nor stable, and does not generate universally shared outcome. Experiences of LAIB discontinuation are shaped by a wide range of social, temporal and treatment-related effects that include disconnected therapeutic alliance between patient and treatment providers. In order to maximise the benefits of LAIB it is necessary to develop meaningful therapeutic alliances (notwithstanding policy boundaries) to enable exploration of matters-of-concern during treatment.

The conceptual potential of 'more-than-human care': A reflection with an artisanal fishing village in Brazil

As dominant approaches to biodiversity loss and climate change continue to fail in mitigating current socio-environmental crises, scholars and activists are exploring novel conceptual frameworks to drive transformative change in conservation. Among these, more-than-human care has emerged as a concept at the intersection of feminist debates about care and post-humanist discussions around the more-than-human. Although more-than-human care is increasingly referenced in the literature, it remains sparsely situated in the Global South. This article investigates the concept's potential to articulate care relations that can foster more plural, respectful, and transformative biodiversity conservation practices in local communities. Our research is situated in an artisanal fishing village in Brazil, where we engaged with both human and non-human members of the community to engage with their perspectives on more-than-human care and its relevance to their local concerns. From our analysis, four key dimensions emerged: the vital and everyday nature of caring; the relationality between humans and non-humans; reciprocity; and the fostering of flourishing for as many as possible. Our core argument is that the interaction between community practices and care theory enables new perspectives that center on daily and reciprocal care relations often overlooked in mainstream conservation approaches. By situating the conceptual potential of more-than-human care within the Global South, we underscore its ability to make the invisible visible and to inspire action for transformative change.