The becoming‐methadone‐body: on the onto‐politics of health intervention translations

Abstract

In this paper, we reflect on health intervention translations as matters of their implementation practices. Our case is methadone treatment, an intervention promoted globally for treating opioid dependence and preventing HIV among people who inject drugs. Tracing methadone's translations in high‐security prisons in the Kyrgyz Republic, we notice the multiple methadones made possible, what these afford, and the onto‐political effects they make. We work with the idea of the ‘becoming‐methadone‐body’ to trace the making‐up of methadone treatment and its effects as an intra‐action of human and nonhuman substances and bodies. Methadone's embodied effects flow beyond the mere psycho‐activity of substances incorporating individual bodies, to material highs and lows incorporating the governing practices of prisoner society. The methadone‐in‐practice of prisoner society is altogether different to that imagined as being in translation as an intervention of HIV prevention and opioid treatment, and has material agency as a practice of societal governance. Heroin also emerges as an actor in these relations. Our analysis troubles practices of ‘evidence‐based’ intervention and ‘implementation science’ in the health field, by arguing for a move towards ‘evidence‐making’ intervention approaches. Noticing the onto‐politics of health intervention translations invites speculation on how intervening might be done differently.

A qualitative study of diphenhydramine injection in Kyrgyz prisons and implications for harm reduction

“…Because, if he is discovered by the [informal leaders], he’ll really get it, and if he isn’t discovered, sooner or later everything comes to the surface. [Timur] In a prison setting where PWID are vulnerable to exploitation and informal and formal leadership systems compete for control, both MMT and Dimedrol acquire meaning that influence their use and distribution [ 22 ]. These explanations borrowed heavily from a shared sentiment that methadone was harmful and not to be trusted.…”

“…That’s how much they go hand in hand and are seen as something foreign. Dimedrol is not used on its own and methadone and Dimedrol are often conflated because of how they are used [ 22 ]. The harms of Dimedrol use were attributed to methadone and used as an argument for phasing out methadone: It actually has a lot to do with methadone because, without methadone, for example, why the hell would anyone need this shit?…”

“…The narrative that conflates MMT with Dimedrol injecting and its harmful effects [ 22 ] is especially damaging to public health efforts to implement MMT as an intervention for HIV prevention and harm reduction. Methadone has been a global mainstay of treatment for opioid use disorder for over 40 years.…”

“…The parent project was designed to longitudinally and qualitatively assess barriers to MMT uptake during and after incarceration and evaluate the ways in which the prison risk environment influenced perceptions and use of methadone. Findings on HIV risk [ 24 ] suggest that most PWID incarcerated in Kyrgyzstan continue to inject in prison [ 6 ], prisoners are organized into rigid hierarchies that perpetuate inequalities in access to HIV prevention resources [ 23 ], and social factors shape patient engagement with methadone [ 22 ], especially after prison release and during the transition to communities [ 25 ] and among women [ 26 ]. Here, we explore the harmful health effects of Dimedrol injecting in prisons and implications for harm reduction programs.…”

“…Dimedrol injecting is potentially detrimental to harm reduction and HIV prevention efforts, particularly in Kyrgyz prisons where HIV prevalence is high and methadone remains unpopular despite its availability for over a decade. We have previously described how the low uptake of methadone in Kyrgyz prisons is related to how other drugs are used in this context [ 22 ]. Despite its persistent global popularity, antihistamine injecting has never been specifically addressed in terms of HIV prevention, harm reduction, or public health.…”