The dynamics of more-than-human care in depot buprenorphine treatment: A new materialist analysis of Australian patients' experiences.

BACKGROUND: Long-acting injectable depot buprenorphine has become an important treatment option for the management of opioid dependence. However, little is known about patients' experiences of depot buprenorphine and its embodied effects. This qualitative study aims to explore patients' experiences of depot buprenorphine treatment, including how it feels within the body, experiences of dosing cycles across time, and how this form of treatment relies on wider ecologies of care beyond the clinical encounter. METHODS: Participants were recruited from sites in Sydney, regional New South Wales, and Melbourne, Victoria, Australia. Thirty participants (16 men, 14 women) participated in semi-structured interviews. Participants had histories of both heroin and prescription opioid consumption, and opioid agonist therapy including daily dosing of buprenorphine and methadone. RESULTS: Our analysis illuminates: (1) how patients' expectations and concerns about treatment are linked to past embodied experiences of withdrawal and uncertainty about the effectiveness of depot buprenorphine; (2) the diverse meanings patients attribute to the depot buprenorphine substrate 'under the skin'; and, (3) how depot buprenorphine is embedded within wider ecologies of care, such as counselling and social supports. CONCLUSION: Our analysis destabilises commonplace assumptions about a linear, causal relationship between the pharmacological action of depot buprenorphine and experiences of treatment. Instead, it highlights patients' variable experiences of depot buprenorphine, tracing the everyday practices, embodied feelings, expectations and wider networks of care that shape patient experiences. We conclude with some reflections on the implications of our analysis for alcohol and other drug treatment, specifically how they might inform the design of client education materials and care.

"A million other factors killing us": Black women's health and refusing necropolitics-as-usual during COVID-19.

Ongoing social, economic, and political marginalization combined with racialized gender violence has sentenced Black women in the United States to disproportionate harm in the form of premature illness and death. Despite widespread recognition within the medical social sciences, public health, and social work of the health inequities that unevenly impact Black women, as a population, their suffering continues to be overlooked and marginalized in biomedical research, healthcare institutions, and health policy. This omission contributes to the naturalization and normalization of heightened morbidity and mortality of Black women. In this article, we draw from theory on necropolitics, misogynoir, and Black ecologies of care in analyzing findings from semi-structured interviews conducted between February and June 2021 with African American women (n = 16) who were experiencing a chronic health condition or caring for someone with a chronic health condition in Tucson, Arizona. Interviews explored women's healthcare-seeking behaviors, experiences with healthcare providers, and self-care and caregiving during the COVID-19 pandemic. Our findings suggest that necropolitical logics in the form of naturalization and normalization of Black women's suffering - and of the structures that render such suffering - permeated but did not entirely define women's experiences of the pandemic, including how they navigated biomedical spaces and negotiated interactions with healthcare providers, engaged in practices of care (including self-care), and perceived and made meaning of their own health statuses. We advance a Black ecologies of care framework: (1) to make visible and hold accountable necropolitical structures in tabulations of morbidity and mortality; and (2), despite the myriad harms represented in logics of necropolitics-as-usual, to foreground the life-affirming practices by women that persist nevertheless.