Methadone maintenance treatment as social control: Analyzing patient experiences

Abstract

Methadone maintenance treatment (MMT) is a harm reduction approach for persons who wish to stop using opioids and is rather effective if used for a minimum of 12 months. Notably, research demonstrates that many persons enrolled in MMT programs discontinue care before this time, limiting its effects. To better understand this process, we undertook an exploratory descriptive qualitative study and interviewed 12 men and women who were using MMT. Using the theoretical work of Foucault and Hardt and Negri, the interview data highlighted that MMT continues to be strongly stigmatized, and that it is a system of care that involves rewards and penalties, based on if patients behave according to prescribed norms. These results suggest that MMT is a disciplinary mechanism, albeit one that impedes its own access. We consequently recommend that healthcare providers work to facilitate access to MMT, which means altering care delivery.

Healthcare Seeking Among Swedish Patients in Opioid Substitution Treatment – a Mixed Methods Study on Barriers and Facilitators

“…Similar responses were found in a study on methadone maintenance treatment as social control, where Australian patients reported avoiding healthcare seeking due to own, or others, experiences of stigma and of their health problems not being taken seriously. This study also pointed to how micro-level internalized stigma was depicted by the participants, referring to themselves as "junkies", or "the plague of society", internalizing and perpetuating the structural stigma in society [44], also described among our interviewees. The shame of having caused this situation themselves made them reluctant to seek healthcare.…”

Factors influencing recovery in opioid substitution treatment: a systematic review and thematic synthesis

“…The keyworker role may provide unique challenges for both service users and staff, with staff having to perform multiple roles including 'gatekeeper' of medications and 'monitor' of treatment adherence (42). This may result in service users feeling the need to withhold information in order to secure their medications (21,25,28,34,(42)(43)(44)(45)(46). The 'monitoring' aspect of the role (for instance, performing drug testing) appeared to be a particular barrier to building trust in client-staff relationships (42):…”

“…Recovering service users often live in the same communities as they did before they entered treatment and are surrounded by constant social and environmental triggers to use drugs (26,29). Even treatment settings can be a place of danger, with others around them still using, or dealers unscrupulously targeting such locations (23,31,33,41,45): Due to this disconnection from community, it is often suggested that service users try to engage in recovery communities such as AA and NA. However, there are barriers to participating in such communities, particularly the aversion to religious aspects of such communities described above.…”

“…Stigma is a cross-cutting concept that permeated all levels of the SEM and was referred to either directly or indirectly in 22 of the 37 included studies. The studies showed that service users are vulnerable to experiencing stigma from a wide range of sources including from pharmacy staff and other customers when collecting OST medications (44,(47)(48)(49)(50); the GP surgery and other healthcare settings (21,43,45,50,51); from their family and friends (25); from the wider community (25,27,29,41,43,45) and from the government (27,50).…”

Trade-offs in Substitution Treatment: A Qualitative Study of an Opioid Substitution Therapy Clinic as an Enabling and a Risk-Environment

“…This makes OST a treatment regime that often involves a large measure of surveillance and control. OST has therefore also been presented as a system of social control that seeks to pacify and subjugate a particular segment of the population through a combination of disciplinary power and biopower (Bourgois, 2000;Dahl, 2006;Friedman & Alicea, 2001;Harris & McElrath, 2012;O'Byrne & Jeske Pearson, 2019). Many studies have shown how OST can create experiences of disempowerment, humiliation, anger, hopelessness, and stigmatization among clients and how it can have adverse consequences for them (Bourgois, 2000;Fraser & Valentine, 2008;Ja ¨rvinen & Miller, 2010).…”