Polluting pharmaceutical atmospheres: Compulsion, resistance, and symbolism of buprenorphine in Norway

Bartoszko, Aleksandra

doi:10.1177/1455072518814313

Cited by 7 publications

(8 citation statements)

References 47 publications

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“…This created mistrust between patients and staff, which produced negative behaviors, as indicated by informants reporting that the only way to switch to sublingual medication was through having a “severe relapse”. These findings were in line with the “polluted therapeutic atmosphere”, described by Bartoszko [ 27 ] regarding an inadequate introduction of buprenorphine-naloxone. According to the author, forced transfers “fostered a sense of disrespect, failure, and mistrust in patients” (p. 282).…”

Section: Discussionsupporting

confidence: 87%

“…Switching medications can create a great deal of frustration and worry among OAT patients, particularly if the patients experience the change as being forced upon them or as not having a choice in the matter. The introduction of buprenorphine-naloxone (Suboxone) as a replacement for mono-buprenorphine led, for example, to conflict, opposition, and the spread of rumors, particularly in contexts where patients were forced to switch medications [ 27 , 32 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…Among other things there were rumors about serious side effects that the staff were said to have suppressed. The introduction of the depot formulation at this clinic had led to what Bartoszko [ 27 ] has referred to as a pollution of the pharmaceutical atmosphere. The trust that several patients had previously felt in relation to staff had been replaced by distrust.…”

Section: Resultsmentioning

confidence: 99%

“…Previous research indicates that the local contexts, or “pharmaceutical atmosphere” as described by medical anthropologist Aleksandra Bartoszko, may influence perceptions of a certain medication [ 27 ]. This pharmaceutical atmosphere, emerging in the tension between clinical practice, the regulatory framework, scientific narratives, and the patients’ emotions, history, and experience, may in turn influence the perception of efficacy and side effects.…”

Section: Introductionmentioning

confidence: 99%

“…This pharmaceutical atmosphere, emerging in the tension between clinical practice, the regulatory framework, scientific narratives, and the patients’ emotions, history, and experience, may in turn influence the perception of efficacy and side effects. Analyzing the introduction of buprenorphine-naloxone combination tablets in Norway, when patients were forced to transfer from buprenorphine to combination treatment, Bartoszko described how an inadequate introduction “polluted the therapeutic atmosphere” of OAT [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

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Patient perspectives on depot buprenorphine treatment for opioid addiction – a qualitative interview study

Johnson

Flensburg

Capusan

2022

Subst Abuse Treat Prev Policy

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Background Recently developed buprenorphine depot injections have the potential to reduce risk for diversion and misuse, and to increase adherence with fewer visits for supervised intake. However, it is unclear how patients perceive this new form of medication. The purpose of this study was to explore patients’ experiences of depot injections and their reasons for continuing, discontinuing, or declining depot injection treatment. Methods We conducted semi-structured qualitative interviews with 32 people, 14 of whom had ongoing depot injection treatment, 11 who had discontinued depot-injections and switched to other medication and seven who had declined treatment with depot formulations. Interviews were transcribed, coded, and analysed using NVivo, based on this overall stratification into three participant groups. Results The main categories relate to the effects and side effects of the depot formulation, social and practical factors, psychological benefits and disadvantages, and interactions with treatment staff. Social and practical factors were of importance for choosing depot formulations, such as increased freedom and their making it easier to combine treatment with work and family life, as well as psychological advantages including “feeling normal”. Initial withdrawal symptoms that resolved themselves after a number of injections were reported by most participants. Reliable information and patient-staff relationships characterized by trust helped patients to cope with these initial problems. Those who discontinued treatment often did so near the beginning of the treatment, reporting withdrawal symptoms and insufficient effects as the main reasons. Coercion and insufficient information contributed to a negative pharmaceutical atmosphere at one of the clinics, which may have adversely influenced perceptions of depot formulations and decreased willingness to accept and continue treatment. Conclusions Buprenorphine depot injections may have social, practical, and psychological benefits compared to other formulations. However, depot injections are not perceived as an attractive option by all patients. Trust, consistent and adequate information, and awareness of the implications of the pharmaceutical atmosphere should be considered when introducing new medications.

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Section: Discussionsupporting

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Patient perspectives on depot buprenorphine treatment for opioid addiction – a qualitative interview study

Johnson

Flensburg

Capusan

2022

Subst Abuse Treat Prev Policy

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The Spaces Between Fault/Lines: Collaborative Politics of Addiction in Japan

Atici

2022

Contemporary Drug Problems

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In the last decade, the Japanese welfare system has dramatically expanded health-care services and introduced new therapeutic programs for people diagnosed with addiction problems. Staff and members of volunteer-led non-profit rehabilitation centers (known as DARCs) together with medical professionals, developed pilot clinical therapies and critical studies of current clinical models. By encouraging encounters between professionals and DARC volunteers, these programs serve as a basis for new social and economic welfare policies. They incorporate critical assessments of causality and responsibility in the context of social marginalization and the lack of medical care. Scholars of Japanese welfare and a wider scholarship of governmentality and drug policies have analyzed deinvestment in marginalized populations by focusing on medicalization and criminalization. However, the Japanese therapeutic expansion produced alternative experiential, moral, and medical understandings of drug use, as it enabled grassroots participation through new forms of citizenship, peer studies, and alliances across medical, penal, and welfare fields. This article therefore focuses on how grassroots activists engage with medical professionals and welfare officials through self-studies and research about these collectives. Drawing on the anthropology of addiction literature and critical drug studies, and 6 months of anthropological fieldwork in Japan, I interrogate the emerging collaborative politics of addiction in Japan, focusing on alliances between various actors and institutions, the organization of care in a time of economic abandonment of marginalized social classes, and the making of grassroots solidarity. Finally, I reflect on the politics of fault and practices of space-making that characterize these pragmatic alliances. I consider these alliances as interventions into the hegemonic understandings of fault and responsibility in the context of social assistance and addiction-specific welfare policies.

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Long-acting injectable depot buprenorphine from a harm reduction perspective in patients with ongoing substance use and multiple psychiatric comorbidities: a qualitative interview study

Johnson,

Monwell,

Capusan

2024

Harm Reduct J

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Background Long-acting injectable depot buprenorphine may increase access to opioid agonist treatment (OAT) for patients with opioid use disorder in different treatment phases. The aim of this study was to explore the experiences of depot buprenorphine among Swedish patients with ongoing substance use and multiple psychiatric comorbidities. Method Semi-structured qualitative interviews were conducted with OAT patients with experience of depot buprenorphine. Recruitment took place at two OAT clinics with a harm reduction focus, specializing in the treatment of patients with ongoing substance use and multiple comorbidities. Nineteen participants were included, 12 men and seven women, with a mean age of 41 years (range 24–56 years), and a mean of 21 years (5–35 years) of experience with illicit substance use. All participants had ongoing substance use and psychiatric comorbidities such as ADHD, anxiety, mood, psychotic and eating disorders. Interviews were transcribed verbatim. Thematic content analysis was conducted both manually and using qualitative data analysis software. Results Participants reported social benefits and positive changes in self-perception and identity. In particular, depot buprenorphine contributed to a realization that it was possible to make life changes and engage in activities not related to substance use. Another positive aspect that emerged from the interviews was a noticeable relief from perceived pressure to divert OAT medication, while some expressed the lack of income from diverted oral/sublingual OAT medication as a negative, but still acceptable, consequence of the depot buprenorphine. Many participants considered that the information provided prior to starting depot buprenorphine was insufficient. Also, not all patients found depot buprenorphine suitable, and those who experienced coercion exhibited particularly negative attitudes towards the medication. Conclusions OAT patients with ongoing substance use and multiple psychiatric comorbidities reported clear benefits of depot buprenorphine, including changes in self-perception which has been theorized to play an important role in recovery. Clinicians should consider the specific information needs of this population and the extensive diversion of traditional OAT medications in this population to improve the treatment experience and outcomes. Overall, depot buprenorphine is a valuable treatment option for a population in need of harm reduction and may also contribute to psychological changes that may facilitate recovery in those with the greatest need.

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Polluting pharmaceutical atmospheres: Compulsion, resistance, and symbolism of buprenorphine in Norway

Cited by 7 publications

References 47 publications

Patient perspectives on depot buprenorphine treatment for opioid addiction – a qualitative interview study

Patient perspectives on depot buprenorphine treatment for opioid addiction – a qualitative interview study

The Spaces Between Fault/Lines: Collaborative Politics of Addiction in Japan

Long-acting injectable depot buprenorphine from a harm reduction perspective in patients with ongoing substance use and multiple psychiatric comorbidities: a qualitative interview study

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