I first became aware of the Long-Acting Injectable Buprenorphine (LAIB) six years ago at The Australasian Professional Society on Alcohol and Other Drugs conference.
I clearly remember thinking, as Professor Nick Lintzeris spoke, what an incredible game changer this could be for the clients at First Step on the pharmacotherapy program, particularly those on stable suboxone (buprenorphine). I was then super disappointed to hear that it had not even begun a trial phase.
Fast forward a few years, and I heard murmurings that the LAIB had passed trials and was being rolled out into the community treatment space. Despite its availability, I, and several of my clients, felt hesitant about something that had only been proven ‘on paper’.
For many clients who had been on pharmacotherapy programs for a long time it presented an enormous decision. On one hand, attending a pharmacy daily or weekly posed a significant risk – they might bump into someone they know, what if they missed a dose, what if they were judged by the pharmacist? On the other hand, moving to a 28 day cycle was intimidating in itself – attending the pharmacy is an important link to their community, and sometimes, the pharmacist might be the most regular human contact some clients have.
We began small by providing it to people initiated elsewhere, or clients who specifically requested it. It was at this point that I met Stacey (not her real name), the patient whose story significantly shifted my opinion of this treatment option.
Stacey is a 59 year-old woman who started using opiates in her mid-teens and had been on the methadone program for more than 20 years. Throughout this time, she had continued to use heroin and it had continued to cause issues in her life. In June 2020, Stacey admitted herself into a residential withdrawal unit to transfer from methadone to the LAIB program, and we picked up the management of this after she left.
When I first met her, she was demanding, unreasonable and difficult to engage with because of her brittle manner. Our time together over the first three months largely consisted of her telling me what was wrong, and what she wanted me to do to fix it.
Then something shifted. Slowly, and quite subtly, at first.
One of the things we speak about at First Step is the idea of ‘incremental whole –of-life improvements’, and this description perfectly described my interactions with Stacey. On paper, she had only had a slight shift – she had remained on pharmacotherapy, albeit a different type and delivery system. But the effect of this in her life was profound.
The first significant change we noticed was attitude. Stacey was more patient, understanding and could recognise situations around her that were affecting more than herself. She was more polite dealing with people, and the staff recognised this.
From there things just seemed to ‘incrementally improve’. Stacey started to dress differently, as she described, “more appropriate for my age”. And she began planning, weeks and months ahead for things, something she had previously been unable to do.
Over the next couple of months, Stacey would excitedly attend appointments, telling me with an enthusiasm I didn’t believe she had, that she was studying for her Learners, with the view of getting her license for the first time.
It is important to note, LAIB is not a ‘miracle cure’. Stacey committed a tremendous amount of hard work to achieve everything that she did. A clever psychiatrist once told me, ‘pills don’t teach skills, but they give the brain a chance to learn them’, and this was never clearer than with Stacey.
It was a humbling experience watching an adult woman’s life change slowly before my eyes, watching her discover new things she had not thought herself capable of previously.