Healthcare staff's perspectives on long-acting injectable buprenorphine treatment: a qualitative interview study

BACKGROUND

Long-acting injectable buprenorphine (LAIB) formulations are a novel treatment approach in opioid agonist treatment (OAT), which provide patients with a steady dose administered weekly or monthly and thus reduce the need for frequent clinic visits. Several studies have analyzed patient experiences of LAIB but the perspective of OAT staff is unknown. This study aimed to explore how healthcare staff working in OAT clinics in Sweden perceive and manage treatment with LAIB.

METHODS

Individual qualitative interviews were conducted with OAT physicians (n = 10) in tandem with nine focus group sessions with OAT nurses and other staff categories (n = 41). The data was analyzed with thematic text analysis.

RESULTS

Five central themes were identified in the data: (1) advantages and disadvantages of LAIB, (2) patient categories that may or may not need LAIB, (3) patients' degrees of medication choice, (4) keeping tabs, control and treatment alliance, and (5) LAIB's impact on risk and enabling environments in OAT. Overall staff found more advantages than disadvantages with LAIB and considered that patients with ongoing substance use and low adherence were most likely to benefit from LAIB. However, less frequent visits were viewed as problematic in terms of developing a treatment alliance and being able to keep tabs on patients' clinical status. Clinics differed regarding patients' degrees of choice in medication, which varied from limited to extensive. LAIB affected both risk and enabling environments in OAT.

CONCLUSIONS

LAIB may strengthen the enabling environment in OAT for some patients by reducing clinic visits, exposure to risk environments, and the pressure to divert medication. A continued discussion about the prerequisites and rationale for LAIB implementation is needed in policy and practice.

"Stop acting like a child - you're immature": The reversed ageism of practicing self-injury as adult women and the reclaiming of our bodies

The practice of self-injury is considered deviant and pathological, and the stereotype of a self-injuring individual is a young, white, middle-class woman. By using an autoethnographic approach, I elucidate how four women and I, aged 35-51, with experiences of self-injury in adulthood, use, internalize, and speak through dominant discourses of self-injury. The practice of self-injury is an embodied one, and self-injury is stereotypically associated with immature, irresponsible, and emotionally unstable young women. As adult women who self-injure, we use and speak through this representation, which, to some extent, affects our self-image and identity as we are often "misrecognized" as full partners in everyday social interaction or when we represent our professions. Still, we resist the idea of self-injury as stemming from immaturity, and we work to reclaim our bodies and agency from the medicalized, ageist assumptions of the practice of self-injury. By doing this, we can also rewrite and transform the meaning of this practice. Our self-inflicted wounds or scars do not define who we are nor our level of maturity, intelligence, and attractiveness. Thus, we acknowledge that we have the right to our own bodies and what we do to that body.