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.