Why Earlier Conversations About Long-Acting Injectables for Schizophrenia Matter

Bryce Reynolds, MD, at Carolina Outreach is a paid partner of Teva Pharmaceuticals.

One of the biggest paradoxes in schizophrenia care is that some of our most established treatment options are still among the least utilized. Despite years of clinical experience with long-acting injectables (LAIs), many patients don’t hear about LAIs until after they’ve experienced repeated relapses or hospitalizations.^1,2

In my experience, the evidence isn’t the barrier. The bigger challenge lies in knowing when to introduce the conversation, addressing assumptions about how patients will respond and fitting those discussions into the realities of a busy practice. New resources like LongActingImpact.com can help healthcare professionals navigate these conversations. Changing when — and how — we talk about LAIs represents a practical opportunity to support long-term stability for appropriate patients.

Evaluating Oral Continuity in Routine Practice

Assessing adherence to daily oral medication is rarely straightforward. In daily practice, we rely on patient conversations, caregiver input, refill history and clinical judgment — but those don’t always tell the whole story. When a patient’s symptoms begin to worsen or they experience relapse, it can be difficult to know whether we’re seeing inconsistent medication use, an inadequate treatment response, or another clinical issue entirely.

By the time nonadherence becomes apparent, symptoms may already be escalating. Research indicates that approximately 67% of patients prescribed oral antipsychotics become nonadherent or discontinue treatment within the first year, underscoring why supporting consistent treatment remains such an important part of long-term care.³

Why Earlier LAI Conversations Matter

LAIs offer one approach to reducing the uncertainty surrounding daily oral regimens.

Rather than asking patients to make a medication decision every single day, LAIs shift treatment to scheduled clinical visits.⁴ If a scheduled injection is missed, the interruption becomes apparent to the care team, creating an opportunity to reconnect with the patient and address barriers before a prolonged gap in treatment develops.

The goal here isn’t for every patient to choose a LAI. It’s to make sure the conversation happens before a crisis dictates it. Too often, the discussion begins only after multiple relapses have occurred, when it could have been integrated much earlier in the treatment journey.⁵

For many patients, simply understanding that LAIs are a standard treatment option early on makes shared decision-making far more meaningful.

Rethinking Patient Communication

A major barrier I encounter in practice isn’t the medication itself — it’s the assumptions we make before the conversation even begins.

Clinicians often expect patients to resist LAIs because of concerns about injections, stigma, or a perceived loss of autonomy. Yet, I’ve found those assumptions don’t always reflect what patients actually express when they’re engaged in open, collaborative dialogue. When we take the time to explore what matters most to them, the conversation naturally shifts from how a medication is administered to what they hope treatment will help them achieve.

Research also suggests that patient preferences are not static. As patients gain experience with treatment and revisit their options over time, many become more receptive to discussing LAIs. In one study, 76% of patients ultimately accepted a LAI after three or fewer supportive discussions with their healthcare provider, reinforcing the value of revisiting the topic rather than treating an initial “no” as a permanent refusal.¹

In my own practice, the most productive treatment conversations rarely start with the medication itself. They start with simple, open-ended questions that help me understand what matters most to the patient.

For one person, success means maintaining employment. For another, it means returning to school, living independently, strengthening family relationships, or staying out of the hospital. Once those personal priorities are established, discussing how treatment continuity supports those goals becomes a natural next step.

Turning Conversations Into Practice

Translating these concepts into daily patient care doesn’t require a complicated framework. I’ve found three straightforward steps make a significant difference.

Start with the patient’s emotions: Understand how symptoms are affecting the patient emotionally. Asking a simple question such as “How does that make you feel?” can help uncover and acknowledge the fear, frustration or anger they may be experiencing and create an opening for a treatment conversation.

Identify their goals: Clarify what the patient wants to accomplish in their life — whether that means maintaining housing or employment, returning to school, strengthening relationships or improving daily functioning. Once those goals are clear, discuss how treatment options, including LAIs, may help support them.

Offer the option while preserving choice: If a patient is hesitant, respect that response rather than treating it as the end of the conversation. When clinically appropriate, setting a specific timeframe to reassess treatment with an LAI can give patients an opportunity to try something different while preserving their voice in decisions about their ongoing care.

Having practical, accessible tools on hand can make these treatment discussions far easier to initiate and maintain.

Supporting Everyday Clinical Care

To support healthcare providers navigating these conversations, Teva Pharmaceuticals has developed LongActingImpact.com, an educational resource designed specifically for healthcare professionals.

The platform offers resources intended to support practice integration, including:

• An interactive check evaluating common adherence blind spots and patient acceptance myths.
• Practical frameworks for starting discussions, addressing needle hesitation, and revisiting LAIs after initial refusal.
• Concise overviews covering care transitions from inpatient to outpatient settings, initiation protocols, oral supplementation needs, and missed-dose reinitiation guidelines.

Ultimately, improving outcomes in schizophrenia isn’t just about responding to relapse after it occurs. It’s about recognizing opportunities to support patients earlier, engaging them in ongoing discussions about their goals, and ensuring they understand the full range of appropriate treatment options available.

If you are looking for practical strategies to strengthen patient conversations or additional educational resources for your practice, I encourage you to explore LongActingImpact.com.

References:

1. Franzenburg KR, Hansen RT, Suett M, et al. Perspectives of psychiatrists and psychiatric nonphysicians on treating schizophrenia with long-acting injectable antipsychotics: subgroup analysis from the multinational ADVANCE study. Poster presented at: Annual Psych Congress Elevate; May 28-31, 2025; Las Vegas, NV.
2. Franzenburg KR, Hansen RT, Suett M, et al. Country-specific factors influencing patients’ willingness to use a long-acting injectable antipsychotic to treat schizophrenia: patient and caregiver ADVANCE survey results. Poster presented at: Annual Congress of the Schizophrenia International Research Society; March 29-April 2, 2025; Chicago, IL.
3. MacEwan JP, Forma FM, Shafrin J, Hatch A, Lakdawalla DN, Lindenmayer J-P. Patterns of adherence to oral atypical antipsychotics among patients diagnosed with schizophrenia. J Manag Care Spec Pharm. 2016;22(11):1349-1361.
4. American Psychiatric Association. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. 3rd ed. American Psychiatric Association; 2021.
5. Kane JM, Agid O, Castle, DJ, et al. The use of long-acting injectables for people with schizophrenia: consensus panel recommendations for overcoming barriers and implementing treatment. Neurol Ther. 2025;14:2551-2581.

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September 2026

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