Patient experience of extended-release buprenorphine treatment: a mixed-methods study of the social determinants of health

Background and aims Extended-release buprenorphine (BUP-XR) improves opioid-use outcomes, but less is known about patients’ social and economic experiences. We examined how social determinants of health varied across 24-week treatment-response trajectories among adults with opioid use disorder receiving BUP-XR.Design Convergent parallel mixed-methods evaluation embedded within a multicenter, phase 3 randomised controlled trial.Setting Four National Health Service addiction treatment clinics in England and Scotland.Participants Forty-nine participants allocated to BUP-XR who completed the 24-week assessment and a qualitative interview.Measurements Substance-use trajectories were derived from TimeLine Follow-Back and urine drug-screen data on opioid, cocaine and benzodiazepine use. Clinical and functional measures provided context. Semi-structured interviews were analysed using Iterative Categorisation and linked at participant level with the quantitative data.Findings Fourteen participants (28.5%) were continuously abstinent from opioids, cocaine and benzodiazepines; 14 (28.5%) were opioid-abstinent but used cocaine and/or benzodiazepines; and 21 (43.0%) used opioids. Those abstinent from all substances described consistent improvements in social bonds, financial stability, employment and disengagement from crime. Those opioid-abstinent but using cocaine and/or benzodiazepines described meaningful but sometimes fragile gains, particularly amid relationship difficulties and relapse triggers. Participants with ongoing opioid use reported more variable experiences, including social isolation, stigma, financial difficulties and employment barriers. Across groups, participants described reduced withdrawal and less disruption from daily dosing, while housing and employment changes were uneven.Conclusion Experiences varied across treatment-response trajectories. BUP-XR created opportunities for improved functioning and social stability, but did not consistently overcome barriers relating to housing, employment and social support.