Tackling Common Barriers to LAI Adoption
While data show that long-acting injectables (LAIs) reduce hospitalization and relapse in patients with schizophrenia, these treatment options still remain underused in clinical practice. In this video, filmed at the 2025 Psych Congress in San Diego, CA, Brittany Albright, MD, MPH, Psych Congress Consultant, explores common barriers that have inhibited the wider spread adoption of LAIs for schizophrenia treatment. From tackling pervasive stigma to addressing practical concerns, Dr Albright offers several ways clinicians can reframe their understanding of these long-acting treatment options in this insightful discussion.
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Read the Transcript
Brittany Albright, MD, MPH: Hi, I'm Dr Brittany Albright and I’m an addiction psychiatrist with Sweetgrass Psychiatry. I'm also an affiliate faculty member at the Medical University of South Carolina.
Psych Congress Network: Despite strong evidence for reducing relapse and hospitalization, LAIs remain underused. What do you see as the biggest barriers to their adoption in everyday practice?
Albright: LAIs are extremely underutilized in our psychiatric community, and there are multiple reasons. Number 1, it's because of stigma. Actually, one of my goals is to remove this term LAI, “long-acting injectable.” We don't use the term LAI for other long-acting treatments, such as ketamine for major depression. That's technically a long-acting injectable, but we wouldn't use that term. Another one I love to talk about is Botox for migraines. That's an injection that people get every 3 months to prevent their migraines. We don't call it an LAI. My hope is that we can start using different language around LAIs and call them “long-acting therapies.” Another great example is esketamine. Esketamine is a long-acting therapy for depression. It can be used as monotherapy just like LAIs can be used as monotherapy for schizophrenia. So that's one barrier.
Another barrier is us clinicians. I fall in that same camp; I used to be in solo private practice—as a physician I'm embarrassed to admit I didn't give long-acting injections in my residency training. We had our wonderful nursing colleagues do that, so when I found myself in private practice and one of my first patients brought her injection to my office and said, “Here give this to me,” I didn't know what to do. I had to learn, talk with pharmacy colleagues, and understand how to safely give an injection. That's why I love conferences like Psych Congress, where we actually have hands-on workshops, where you can learn how to administer an injection.
Another barrier is cost. A lot of our really great long-acting therapies are not generic yet. However, it's not really a cost; many states now are removing medication prior authorizations for long-acting injections in schizophrenia—and insurance companies don't like to pay for a lot. That tells you something if they're willing to invest in long-acting therapies for schizophrenia. It's because it saves them money in the long run as well.
Thank you so much for joining me, and I sincerely hope that all of this was helpful for your clinical practice.
Brittany Albright, MD, MPH, is a Harvard-trained, double board-certified adult and addiction psychiatrist and the founder of Sweetgrass Psychiatry, the largest physician-owned psychiatry practice in South Carolina. After completing her undergraduate studies at Emory University, she earned medical and public health degrees from the University of New Mexico. Dr Albright completed her psychiatry residency at Massachusetts General and McLean Hospitals, where she served as Chief Resident of Addiction Psychiatry. She now serves as an Affiliate Assistant Professor at the Medical University of South Carolina, where she also trained in addiction psychiatry.
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