From custody to abandonment: Conceptualising Aboriginal people's drug treatment discontinuation after release

Background Release from custody marks a period of acute risk for Aboriginal people receiving opioid agonist treatment, with discontinuation rates nearly five times higher than in non-Aboriginal populations. Yet the contexts and experiences shaping decisions to stop treatment remain poorly understood. Methods This qualitative study examines the experiences of 22 Aboriginal people who discontinued long-acting injectable buprenorphine (LAIB) within 12 weeks of release from custody in New South Wales, Australia. Drawing on Biehl's concept of zones of abandonment alongside Aboriginal scholarship on health and wellbeing, we explore how participants who discontinued navigated the post-release transition. Findings Participants described how release delivered them into zones of social abandonment characterised by homelessness, services withdrawal, and disrupted social ties. In these contexts, participants' priorities shifted to day-to-day needs, active parenting, employment, and intimate relationships, and LAIB's side effects became incompatible with these community goals. Experiences of abandonment was compounded by ongoing intergenerational trauma from colonisation manifested in weakened kinship connections, social networks entangled with drug use, and profound structural disadvantage. While LAIB had achieved critical harm reduction goals during incarceration, prison's institutional structures provided scaffolding for treatment that dissolved upon release. Conclusions Bringing Biehl's framework into dialogue with Aboriginal conceptions of health and kinship, we theorise the post-release environment as a zone of social, structural, and cultural abandonment characterised by the simultaneous withdrawal of institutional supports and the colonial disruption of kinship systems. Through this lens, LAIB discontinuation emerges not as treatment failure, but as a rational response to impossible circumstances