Excusing exclusion: Accounting for rule-breaking and sanctions in a Swedish methadone clinic

Petersson, Frida

doi:10.1016/j.drugpo.2013.10.001

Cited by 19 publications

(29 citation statements)

References 24 publications

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“…Some of the patients who had been involuntarily discharged described the access to illicit medication as lifesaving. In two previous Swedish studies [ 34 , 55 ], the practice of involuntary discharges has been characterized as dubious and inhumane since it nearly always increases health risks and bring about other negative consequences for anyone who is discharged. Among other things, discharges have been linked to a significantly increased mortality [ 56 , 57 ], and the substances used in the treatment may cause strong withdrawal symptoms if treatment is discontinued.…”

Section: Discussionmentioning

confidence: 99%

“…Among other things, discharges have been linked to a significantly increased mortality [ 56 , 57 ], and the substances used in the treatment may cause strong withdrawal symptoms if treatment is discontinued. Criticism has been leveled at both the national regulations, which cite a number of circumstances when discharges should take place and the not infrequently arbitrary nature of discharge decisions by staff [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

“…There are, as already noted, two principal approaches. From a normalization perspective, with its strong focus on rehabilitation and abstinence, discharges can be legitimized on other grounds than the purely medical; for instance, if the patient is not fulfilling his/her commitments or is breaking the program rules [ 55 ]. From a harm-reduction perspective, where the focus is on reducing drug use and its negative consequences for the individual, discharges are harder to justify since they nearly always put the patient at greater risk than if he/she were to remain in treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In Sweden, it is typically not possible to switch programs g , and speaking up and voicing criticism is, according to many patients, fraught with perils [ 34 ]. This means that patients find themselves at a considerable disadvantage in relation to staff [ 50 , 55 ]. The dependency on medication and the suspension rule exacerbate this disadvantage.…”

Section: Discussionmentioning

confidence: 99%

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Long-term self-treatment with methadone or buprenorphine as a response to barriers to opioid substitution treatment: the case of Sweden

Richert

Johnson

2015

Harm Reduct J

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BackgroundIt is well known that illicit use of methadone and buprenorphine is common among people with an opioid dependence. Less notice has been taken of the fact that these substances are also used for extended periods of self-treatment, as a way of handling barriers to OST. In this study, motives for self-treatment are investigated, as well as attitudes and perceived barriers to OST among drug users with an opioid dependence in Sweden.MethodThe study is based on qualitative research interviews with 27 opioid users who have treated themselves with methadone or buprenorphine for a period of at least three months.ResultsThe duration of self-treatment among the interviewees varied from 5 months to 7 years. Self-treatment often began as a result of a wish to change their life situation or to cut back on heroin, in conjunction with perceived barriers to OST. These barriers consisted of (1) difficulties in gaining access to OST due to strict inclusion criteria, limited access to treatment or a bureaucratic and arduous assessment process, (2) difficulties remaining in treatment, and (3) ambivalence toward or reluctance to seek OST, primarily due to a fear of stigmatization or disciplinary action. Self-treatment was described as an attractive alternative to OST, as a stepping stone to OST, and as a way of handling waiting lists, or as a saving resource in case of involuntary discharge.ConclusionIllicit use of methadone and buprenorphine involve risks but may also have important roles to play for users who are unwilling or not given the opportunity to enter OST. A restrictive and strict rehabilitation-oriented treatment model may force many to manage their own treatment. More generous inclusion criteria, a less complex admission process, fewer involuntary discharges, and less paternalistic treatment may lead to increasing numbers seeking OST. Control measures are necessary to prevent diversion and harmful drug use but must be designed in such a way that they impose as few restrictions as possible on the daily life of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long-term self-treatment with methadone or buprenorphine as a response to barriers to opioid substitution treatment: the case of Sweden

Richert

Johnson

2015

Harm Reduct J

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“…As it was not possible to tape-record the conversations, field notes were taken during the meetings. This led to some complications, however, as it was not possible to retain all the grammatical details, word order and semantics of the original discussion (Nikander 2003;Petersson 2013). A choice, therefore, had to be made about what to focus on and what to leave out, and the conversations were prioritized.…”

Section: Data Collection and Analysesmentioning

confidence: 99%

The clinical gaze – ascribed gender(ed) identities in a mental health service context

Olin

2016

Scandinavian Journal of Disability Research

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This article focuses on gender(ed) ascribed identities of service users in a mental health service context in Sweden. The empirical data were collected through observations of weekly team conferences. The examples can be described as 'frozen images' or ideal types in the sense that they illustrate the different ways service providers describe the service users' problems at a certain time in a certain context. This article illustrates that the 'the gaze' of the service providers was value-laden, making moral judgements tied to the notion of responsibility. However, the same kind of behaviour or diagnoses can be accounted for in different ways and hence lead to different outcomes for the service user, which illustrates 'severe mental illness' as a stretchable phenomenon. The team discussions also mirror the service users' strategies to handle professional and institutional power, that is, challenge the power position of professionals, with regard to the construction of service users as passive recipients or marked as 'the other'. The predominant accounts and constructions of identities as victimized can be seen as part of a feminization process, closely related to weakness and dependence.

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Reductions in convictions for violent crime during opioid maintenance treatment: A longitudinal national cohort study

Havnes¹,

Bukten²,

Gossop³

et al. 2012

Drug and Alcohol Dependence

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Excusing exclusion: Accounting for rule-breaking and sanctions in a Swedish methadone clinic

Cited by 19 publications

References 24 publications

Long-term self-treatment with methadone or buprenorphine as a response to barriers to opioid substitution treatment: the case of Sweden

Long-term self-treatment with methadone or buprenorphine as a response to barriers to opioid substitution treatment: the case of Sweden

The clinical gaze – ascribed gender(ed) identities in a mental health service context

Reductions in convictions for violent crime during opioid maintenance treatment: A longitudinal national cohort study

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