‘We’re Gonna Be Addressing Your Pepsi Use’

Abstract

Methadone Maintenance Treatment (MMT) in the United States has recently adopted an approach based on the principles of the Recovery movement -a view of treatment informed by addiction-as-disease models but also incorporating social, psychological, and spiritual components. Although organizations that administer drug treatment services claim that the shift represents a more client-centered, individualistic approach, it may not meet the needs of the many individuals who use MMT to reduce the harms of drug use, like overdose, rather than as a way to become abstinent. In this article, I use interview data from treatment providers to argue against institutional claims of Recovery as an individualistic model. My research demonstrates how -despite the wide variety of treatment goals among people on MMT -the Recovery discourse positions and organizes treatment strictly as abstinence-based, self-help. Moreover, I show how the Recovery model serves as the justification for an expansion of clinics' ability to surveil and intervene in aspects of people's lives which had previously been seen as outside of MMT's purview, including nutrition, public service, and spirituality. In conclusion, I argue that Recovery restricts MMT's ability to reduce harms, like overdose, in the lives of people who use drugs, and recommend that MMT adopt a more open-ended, low-threshold approach to treatment.

“It’s like ‘liquid handcuffs”: The effects of take-home dosing policies on Methadone Maintenance Treatment (MMT) patients’ lives

“…Similarly, while the Substance Abuse and Mental Health Services Administration (SAMHSA) provides treatment providers with recommendations on how to determine patient eligibility for take-home doses, clinics have wide latitude to determine which patients meet that standard. For example, some clinics will not provide any take-home doses to patients who use cannabis or drink alcohol [ 15 ]. Thus, there is substantial diversity among individual clinics in regard to how many take-home doses are allowed and under what circumstances they are provided [ 11 , 16 ].…”

“I'm pretty sure it's either food poisoning or Covid-19”: Lived experience versus medical knowledge in diagnosing substance use problems

“…For those in substance use treatment programs such as methadone maintenance treatment, like myself, the situation can be even more fraught. Arguing against a treatment provider, where the power differential between doctor and patient is even more one-sided, could potentially put one's treatment in jeopardy ( Frank, 2019 ; Strike et al, 2013 ; Caplehorn et al, 1996 ).…”

A chance to do it better: Methadone maintenance treatment in the age of Covid-19

“…Methadone maintenance treatment (MMT) in the United States (U.S.), and particularly the clinic system of distribution, is often criticized as punitive, over-regulated, and misaligned to the needs of many patients ( Frank, 2018 , Frank, 2019 ; McElrath, 2018 ; Novick et al, 2015 ). However, as someone who both studies, and has been on MMT for approximately 15 years, I am hopeful that changes to the regulations that COVID-19 initially caused may have given us a chance to do it better.…”

“…Such organizations, who argue that take-home regulations are far too restrictive, point out that previous research has linked MMT's low rates of use and retention to its time-consuming, intrusive nature ( Frank, 2018 ; Nolan et al, 2015 ; Open Society Foundation, 2010 ; Strike et al, 2013 ). Moreover, qualitative studies have demonstrated the tremendous difficulty of maintaining a job, school, or stable life while forced into a system of endless daily attendance—often early in the morning and for many hours at a time ( Frank, 2019 ; Gerra et al, 2011 ). When the threat of COVID-19 is reduced most participants who have been enjoying the benefits of expanded take-homes will not want to revert to pre-COVID-19 regulations, and forcing them to do so would almost certainly lead to increased drop-outs.…”

“…People who study medication for opioid use disorder, myself included, have also argued that now is the ideal moment to begin offering methadone maintenance in an office-based setting, similar to the way that buprenorphine is managed ( Filter Magazine, 2020 ; Frank, 2020 ). Scholars and advocates have pointed out that in addition to problems specific to COVID-19, the clinic system itself is both stigmatizing and poorly suited to address the diversity of patients' needs ( Bonuck et al, 2003 ; Filter Magazine, 2020 ; Frank, 2020 )—particularly the many who utilize MMT as a way of reducing the harms of active substance use rather than to become abstinent ( Frank, 2018 , Frank, 2019 ).…”