Background: People who use substances often experience stigma in healthcare settings. Opioid agonist treatment (OAT), while effective, is criticised for rigid structures that limit autonomy and reinforce stigma. Long-acting injectable buprenorphine (LAIB) offers an alternative that may reduce these barriers. This study explores the perceived meaning and value of LAIB in supporting recovery.

Methods: A longitudinal qualitative study was conducted in community drug treatment services in Tayside, Scotland. Semi-structured interviews were undertaken with 47 patients (LAIB: n=29; traditional OAT: n=18) and 9 clinicians. Patient participants were invited to up to three interviews over 18 months. Data were analysed using framework analysis informed by the Social Identity Model of Recovery, recovery capital, and locus of control.

Results: Four themes emerged: (i) avoiding unwanted contacts, (ii) pursuing a “normal life,” (iii) planning for the future, and (iv) service-related challenges. LAIB reduced exposure to stigmatising environments and supported autonomy, enabling participants to engage in employment, family life, and travel. Many described renewed hope and proactive future planning. However, reduced service contact and administrative pressures limited holistic, person-centred care.

Conclusions: LAIB can enhance recovery by reducing stigma and increasing autonomy, but its benefits depend on service delivery models. To realise its potential, implementation must prioritise continuity of care and psychosocial support alongside pharmacological treatment.