Abstract：
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.
RESULTS: 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.
CONCLUSIONS: 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.
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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：在接受阿片类药物激动剂治疗（OAT）的患者中，停用美沙酮和丁丙诺啡等药物是一个国际现象。OAT药物的最新发展包括丁丙诺啡的储库注射。从定性的角度来看，这些新药物配方停药的潜在情况尚未完全理解。
方法：数据来自对患者使用长效注射用丁丙诺啡（LAIB）的纵向定性研究，涉及在六个时间点举行的半结构化电话面试。本文的相关数据集包括44份采访成绩单，由8名参与者产生,这些参与者均因终止LAIB处方(在治疗的前12个月期间)而受到影响.分析试图确定与LAIB中止相关的情况，数据进一步位于“证据干预”和相关“关注事项”的框架内。关注事项涉及通过参与和实践“进行”和构建干预的方式，从收件人的角度来看。
结果：在这项研究中，参与者经历了治疗服务中断LAIB处方或患者主导的治疗选择退出.前者背后的关注事项与定期任命的迟到有关，非处方物质使用或接受监禁判决。与患者开始停药有关的关注事项与影响治疗动机的个人情况有关，副作用（丁丙诺啡），倾向于恢复使用海洛因，或者因为个人治疗目标已经实现。
结论：影响LAIB终止的各种关注事项表明，这种OAT是复杂和多方面的，既不固定也不稳定，并且不会产生普遍共享的结果。LAIB中断的经历是由广泛的社会因素塑造的，时间和治疗相关的影响，包括患者和治疗提供者之间脱节的治疗联盟。为了最大限度地发挥LAIB的好处，有必要发展有意义的治疗联盟（尽管有政策界限），以便在治疗期间探索关注的问题。
方法：数据来自对患者使用长效注射用丁丙诺啡（LAIB）的纵向定性研究，涉及在六个时间点举行的半结构化电话面试。本文的相关数据集包括44份采访成绩单，由8名参与者产生,这些参与者均因终止LAIB处方(在治疗的前12个月期间)而受到影响.分析试图确定与LAIB中止相关的情况，数据进一步位于“证据干预”和相关“关注事项”的框架内。关注事项涉及通过参与和实践“进行”和构建干预的方式，从收件人的角度来看。
结果：在这项研究中，参与者经历了治疗服务中断LAIB处方或患者主导的治疗选择退出.前者背后的关注事项与定期任命的迟到有关，非处方物质使用或接受监禁判决。与患者开始停药有关的关注事项与影响治疗动机的个人情况有关，副作用（丁丙诺啡），倾向于恢复使用海洛因，或者因为个人治疗目标已经实现。
结论：影响LAIB终止的各种关注事项表明，这种OAT是复杂和多方面的，既不固定也不稳定，并且不会产生普遍共享的结果。LAIB中断的经历是由广泛的社会因素塑造的，时间和治疗相关的影响，包括患者和治疗提供者之间脱节的治疗联盟。为了最大限度地发挥LAIB的好处，有必要发展有意义的治疗联盟（尽管有政策界限），以便在治疗期间探索关注的问题。
