Select the ‘+’ icons to read the findings and discussion for each of the key themes identified within the research:
Key Themes and Findings
Whilst LAIB is increasingly recognised as a valuable treatment option within Scotland’s MAT framework, its rollout has highlighted inconsistencies in access, information provision and service delivery. Most people in treatment reported positive initial experiences of accessing LAIB, but the quality and clarity of information varied, particularly around treatment expectations, potential unwanted effects and broader supports available to them. Peer support and accessible resources were valued but not consistently available to all.
Staff perspectives and service structures sometimes limited access based on abstinence or stability, contrary to guidance promoting a person-centred approach. It is important to consider that people who present with greater complexity may have increased vulnerability to the possible emotional impacts of increased mental clarity that LAIB can provide, for example, those with existing mental health issues or experience of trauma. Therefore widening access should ensure people can make informed decisions about LAIB suitability for them and that people are prepared for titration effects to an optimal dose and are offered the necessary support around emotions returning. Delays in initiation, largely due to service capacity and clinical protocols, further hinder timely access. For LAIB to align fully with the MAT standards, services must improve consistency in early treatment conversations, broaden prescribing capacity, and ensure clear and user-friendly information is available to all people considering LAIB; this will support informed choice and equitable access.
Experiences of choice and autonomy within LAIB treatment vary significantly, with more flexibility reported in community settings than in prisons. Whilst many community participants valued LAIB for reducing pharmacy visits and experiencing less stigma around the treatment compared to other forms of MAT, some expressed limited choice around dosing frequency, treatment administration location, or engagement levels with support staff. In prison settings, individuals often felt LAIB was imposed due to a restricted range of MAT options. This highlights a tension between institutional priorities and personal choice, particularly where alternatives like buprenorphine tablets were preferred by prison residents but were not generally made available to them.
Across both settings, participants linked LAIB to increased autonomy, lifestyle improvements, and reduced stigma in accessing treatment. To meet the MAT standards and deliver broader access to the most appropriate form of MAT for them, it is essential that services expand flexibility of delivery settings, ensure staff are trained to offer the full range of options, and challenge stigma across all forms of MAT.
Experiences of substance use while on LAIB treatment were highly individual, with some participants reporting reduced opiate use due to fewer cravings, whilst others increased or continued use of other substances to manage poor mental health or unwanted effects. Although many participants felt able to discuss ongoing use with staff, follow-up support was inconsistent. This was particularly the case for stimulant use, where interventions were often limited or unavailable. Harm reduction measures such as naloxone and injecting equipment were generally available, but access to a broader range of interventions was inconsistent. There was a demand for safer inhalation equipment despite inhalation pipes being currently unavailable in Scotland.
Gender-related differences emerged, with women less likely to disclose substance use and less likely to report being offered harm reduction interventions. As drug-related harms and deaths amongst women are increasing, gender-informed approaches and dedicated services are urgently needed to ensure effective support for women.
The findings emphasise that whilst LAIB can reduce opioid use, it must be delivered alongside consistent harm reduction, psychosocial support, and trauma-informed care to address the complex reasons behind ongoing substance use. To achieve full implementation of the MAT standards and improve outcomes for specific at-risk populations, it is key that services expand their capacity to provide support to stimulant users, address gender specific needs, and offer tailored harm reduction strategies for all individuals on LAIB.
Participants’ experiences of support whilst on LAIB treatment varied significantly. Support was shaped by factors such as geographic location, service provider, client needs, and individual staff practices. Many individuals valued LAIB’s flexibility and the minimal contact that offered. Others desired more structured and proactive engagement from staff, including regular check-ins and continuity with keyworkers. Positive therapeutic relationships were key to effective support, both in community and custodial settings.
While many received helpful support for mental health and general wellbeing, others experienced inconsistent access, particularly with psychological interventions and recovery planning. Some individuals felt unprepared for unwanted titration related effects, more lasting side effects or the potential emotional impact of increased mental clarity brought by LAIB. As some who reported side effects were on the maximum dose, it would be important to ascertain if people may be experiencing dose-related side effects and would actually benefit from trying a reduction in dose to see if side effects subside. These experiences underline the need for clearer information at treatment inception, with regular reviews offered throughout treatment and opportunity for discussions with individuals about their ability to manage these impacts, what supports they need and what an optimal dose might be for them. Gaps in support for women and the need for clearer communication about available services e.g. advocacy and welfare support were also identified.
Concerns about stopping LAIB and navigating recovery planning reflected broader inconsistencies in care, with some receiving the help they needed, whilst others felt unsupported or unaware of available options. The findings highlight the need for flexible, person-led support models that allow people in treatment to define their own level of involvement and adjust it over time as they require. To align with the MAT standards, it is important services improve support consistency, enhance communication, actively promote wraparound supports, and ensure that all patients receive clear, realistic information about treatment and what to expect.
Participants generally viewed LAIB positively, citing both short-term benefits e.g. rapid stabilisation and reduced cravings, and, longer-term improvements in lifestyle, autonomy, and ability to engage with their wider recovery goals. Many described LAIB as more than a clinical intervention, instead seeing it as an opportunity for an improved quality of life. Reduced stigma when in LAIB treatment was a key theme across community and custodial settings. This tended to centre around the absence of daily pharmacy visits and the perceptions of other forms of MAT, in particular, methadone. This demonstrates a need to address stigma for all forms of MAT and ensure people have access to accurate information about methadone, especially where that may be the
most effective treatment for them.
Not all experiences were positive, with some participants experiencing side effects and emotional challenges linked to increased mental clarity. At times, these experiences could lead to continued substance use or returning to other MAT options. These outcomes highlight the need to address information and support for the people whom LAIB is not effective for, including: thorough pre-treatment discussions, timely mental health support, and flexible, supported exit pathways. There was a clear demand and requirement for wraparound support for LAIB to ensure its success, in particular, mental health and psychosocial supports.
See the slides below to read some of the direct quotations with research participants: