To examine what happens to patients who have been involuntarily discharged from medication-assisted treatment (MAT) with methadone or buprenorphine in Malmö, Sweden.
Material And Method
A total of 35 people, with a long history of heroin addiction, were interviewed, including ten women. Most interviewees were recruited among visitors with discharge experiences at the local needle exchange programme. The article focuses on these informants’ experiences and interpretations of being discharged.
Results
Discharge had little legitimacy and was perceived as unfair. Several of the interviewees went back to heroin abuse while others tried to create their own maintenance programmes by buying methadone or buprenorphine on the black market. Many resorted to crime or prostitution to make ends meet.
Conclusions
According to National Board of Health and Welfare regulations, discharge and a three-month exclusion from all MAT is an appropriate response to violation of rules. Exclusion nevertheless led to harsh consequences. The interviewees’ living conditions were consistently impaired, as were their physical and mental health and contacts with family members, since they soon returned to a lifestyle and drug abuse similar to that before treatment.
AmatoL., & DavoliM., & PerucciaC., & FerriM., & FaggianF., & MattickR. (2005): An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research.Journal of Substance Abuse Treatment28: 321–329
2.
BerglundM., & JohanssonB.A. (2003): The SBU report on treatment of alcohol and drug problems. In: WaalH., & HagaE. (ed.): Maintenance treatment of heroin addiction.Oslo: Cappelen Akademisk Forlag
3.
BoothR.E., & KwiatkowskiC., & IguchiM.Y., & PintoF., & JohnD. (1998): Facilitating treatment entry among out-of-treatment injection drug users.Public Health Reports113: 116–128
4.
BourgoisP. (2000): Disciplining addictions: the bio-politics of methadone and heroin in the United States.Culture, Medicine and Psychiatry24: 165–195
5.
BråbäckM. (2011): Personal interview
6.
Bretteville-JensenA.L. (2002): Understanding the demand for illicit drugs.Bergen: Department of Economics, University of Bergen
7.
CaplehornJ.R.M., & McNeilD.R., & KleinbaumD.G. (1993): Clinic policy and retention in methadone maintenance.International Journal of Addiction28: 73–89
8.
CaplehornJ.R.M., & DaltonM.S., & CluffM.C., & PetrenasA.M. (1994): Retention in methadone maintenance and heroin addicts’ risk of death.Addiction89: 203–209
9.
CaplehornJ.R.M., & LumleyT.S., & IrwigL. (1998): Staff attitudes and retention of patients in methadone maintenance programs.Drug and Alcohol Dependence52: 57–61
10.
ClausenT., & AnchersenK., & WaalH. (2008): Mortality prior to, during and after opioid maintenance treatment (OMT): a national prospective cross-registry study.Drug and Alcohol Dependence94(1-3): 151–157
11.
CovielloD.M., & ZanisD.A., & WesnoskiS.A., & AltermanA.I. (2006); The effectiveness of outreach case management in re-enrolling discharged methadone patients.Drug and Alcohol Dependence85: 56–65
12.
DavstadI. (2010): Drug use, mortality and outcomes among drug users in the general population and in methadone maintenance treatment.Stockholm: Karolinska institutet
13.
DeBeckK., & ShannonK., & WoodE., & LiK., & MontanerJ., & KerrT. (2007): Income generating activities of people who inject drugs.Drug and Alcohol Dependence91(1): 50–56
14.
ECNN (2010): Situationen på narkotikaområdet i Europa. Lissabon: ECNN Årsrapport (The state of the drugs problem in Europe.Lissabon: ECNN Annual Report)
15.
EMCDDA (2008): Towards a better under-standing of drug-related public expenditure in Europe.Luxembourg: Office for Official Publications on the European Union
ErikssonA., & PalmJ., & StorbjörkJ. (2003): Kvinnor och män i svensk missbruksbehandling (Women and men in Swedish addiction treatment).Stockholm: SoRAD Forskningsrapport 15
19.
EU (2005): EU:s narkotikastrategi (2005–2012) (EU Drugs strategy (2005–2012)).Bryssel: Generalsekretariatet
FugelstadA., & StenbackaM., & LeifmanA., & NylanderM., & ThiblinI. (2007): Methadone maintenance treatment: the balance between life-saving treatment and fatal poisonings.Addiction102: 406–412
22.
FugelstadA., & JohanssonL.A., & ThiblinI. (2010): Allt fer dör av metadon (More and more people die from methadone).Läkartidningen 4 maj 2010
23.
GjersingL., & WaalH., & CaplehornJ.R.M., & GossopM., & ClausenT. (2010): Staff attitudes and the associations with treatment organisation, clinical practices and outcomes in opioid maintenance treatment.BMC Health Services Research10: 194
24.
GoldsteinM.F., & DerenS., & KangS.Y., & Des JarlaisD.C., & MaguraS. (2002): Evaluation of an alternative program for MMTP drop-outs: impact on treatment re-entry.Drug and Alcohol Dependence66: 181–187
25.
GrönbladhL., & ÖhlundL.S., & GunneL.M. (1990): Mortality in heroin addiction: impact of methadone treatment.Acta Psychiatrica Scandinavica82: 223–227
26.
GrönbladhL. (2004): A national Swedish methadone program 1966–1989. Doctoral dissertation.Uppsala: Acta Universitatis Upsaliensis
27.
HallW., & LynskeyM., & DegenhardtL. (1999): Heroin use in Australia: its impact on public health and public order.Sydney: NDARC Monograph Number 42
28.
HedinU.K., & MånssonS.A. (1998): Vägen ut. Om kvinnors uppbrott från prostitutionen (The way out. On women's breakaway from prostitution).Stockholm: Carlssons
29.
HeiligM. (2003): Dum dogmatism dödar (Foolish dogmatism kills). In: ThamH. (ed.): Forskare om narkotikapolitiken.Stockholm: Kriminologiska institutionen
30.
HirschmanA.O. (1970): Exit, voice, and loyalty: responses to decline in firms, organizations, and states.Cambridge, MA: Harvard University Press
31.
HserY.I., & AnglinM.D., & PowersK. (1993): A 24-year follow-up of California narcotics addicts.Archives of General Psychiatry50: 577–584
32.
HserY.I., & MaglioneM., & PolinskyM.L., & AnglinM.D. (1998): Predicting drug treatment entry among treatment-seeking individuals.Journal of Substance Abuse Treatment15: 213–220
33.
HserY.I., & HoffmanV., & GrellaC.E. (2001): A 33-year follow-up of narcotics addicts.Archives of General Psychiatry58: 503–508
34.
JohnsonB. (2005): Metadon på liv och död: en bok om narkomanvård och narkotikapolitik i Sverige (Methadone, a matter of life and death: a book about addiction treatment and drug policy in Sweden).Lund: Studentlitteratur
35.
JohnsonB. (2011): Utvärdering av sam-verkan mellan socialtjänsten och bero-endesjukvården kring läkemedelsassisterad rehabilitering av opiatberoende (LARO) i Jönköping (Evalutation of co-operation between social services and drug dependency health care in relation to medication-assisted rehabilitation of opioid dependency).Malmö: Malmö högskola
36.
JosephH., & StancliffS., & LangrodJ. (2000): Methadone maintenance treatment (MMT): a review of historical and clinical issues.Mount Sinai Journal Medicine67: 347–364
37.
KellyS.M., & O'GradyK.E., & MitchellS.G., & BrownB.S., & SchwartzR.P. (2011): Predictors of methadone treatment retention from a multi-site study: a survival analysis.Drug and Alcohol Dependence117(2-3): 170–175
38.
KnightK.R., & RosenbaumM., & IrwinJ., & KelleyM., & WengerL., & WashburnA. (1996): Involuntary versus voluntary detoxification from methadone maintenance treatment: the importance of choice.Addiction Research & Theory3(4): 351–362
39.
KvaleS. (1997): Den kvalitativa forskningsintervjun (An introduction to qualitative research interviewing).Lund: Studentlitteratur
40.
LaanemetsL. (2007): Navet. Om kvinnor, prostitution, metadon- och Subutexbehandling (Navet. About women, prostitution, methadone and Subutex treatment).Stockholm: Mobilisering mot narkotika
41.
LalanderP. (2003): Hooked on heroin.Oxford: Berg
42.
MaguraS., & NwakezeP.C., & KangS.Y., & DemskyS. (1999): Program quality effects on patient outcomes during methadone maintenance: a study of 17 clinics.Substance Use and Misuse34(9): 1299–1324
43.
McIntoshJ., & McKeganeyN. (2002): Beating the dragon.Harlow: Prentice Hall
44.
NIH (National Institutes of Health) (1997): Effective medical treatment of opiate addiction.JAMA280: 1936–1943
45.
MilesM.B., & HubermanA.M. (1994): Qualitative data analysis.London: SAGE Publications
46.
Regeringen (2010): En samlad strategi för alkohol-, narkotika-, dopnings- och tobakspolitiken (An integrated approach to alcohol, drugs, doping and tobacco policy).Regeringens proposition 2010/11: 47
SandM., & RomelsjöA. (2005): Opiatmissbrukare med och utan behandling i Stockholms län (Opiate addicts with and without treatment in Stockholm County).Stockholm: SoRAD Forskningsrapport 30/2005
49.
SBU (2001): Behandling av alkohol- och narkotikaproblem: en evidensbaserad kunskapssammanställning (Treatment of alcohol and drug problems: an evidence-based knowledge overview). Vol. 1.Stockholm: Statens beredning för medicinsk utvärdering
50.
SBU (2009): Behandling av opioidmissbruk med metadon och buprenorfin (Treatment of opioid addiction with methadone and buprenorphine).Statens beredning för medicinsk utvärdering
51.
SjölanderJ., & JohnsonB. (2009): Tillgängligheten till läkemedelsassisterad behandling i Sverige – en uppföljning (The availability of medication-assisted treatment in Sweden: a follow-up).Malmö: Malmö högskola
52.
Socialstyrelsen (1997): Metadonbehandlingen i Sverige. Beskrivning och utvärdering (Methadone treatment in Sweden. Description and evaluation).Stockholm: SoS-rapport1997: 22
53.
Socialstyrelsen (2004): Underhållsbehandling vid opiatberoende. Handbok med kommentarer till Socialstyrelsens föreskrifter och allmänna råd (SOSFS 2004:8) om läkemedelsassisterad behandling vid opiatberoende (Maintenance treatment for opioid dependence.Manual with comments to the National Board of Health and Welfare's regulations and guidelines (SOSFS 2004: 8) on medication-assisted treatment for opiate dependence).Stockholm: Socialstyrelsen
54.
Socialstyrelsen (2006): Metadonregistret. Registerbokslut – sammanställning av vissa uppgifter (Methadone Registry. Register Closing: summary of certain information).Stockholm: Socialstyrelsen. Statistik
55.
Socialstyrelsen (2009): Läkemedelsassisterad behandling vid opiatberoende. Föreskrifter och allmänna råd (Medication-assisted treatment for opiate dependence. Regulations and regular guidelines).Stockholm: SOSSF2009: 27
StrainE.C., & BigelowG.E., & LiebsonI.A., & StitzerM.L. (1999): Moderate- vs high-dose methadone in the treatment of opioid dependence. A randomized trial.JAMA282(11): 1000–1005
59.
StrikeC.J., & GnamW., & UrbanoskiK., & FischerB., & MarshD., & MillsonM. (2008): Retention in methadone maintenance treatment: a preliminary analysis of the role of transfers between methadone prescribing physicians.The Open Addiction Journal1: 10–13
60.
StålenkrantzB. (2010): Personal interview on 4 November
VigilantL.G. (2008): I am still suffering: the dilemma of multiple recoveries in the lives of methadone maintenance patients.Sociological Spectrum28(3): 278–298
63.
ZanisD.A., & WoodyG.E. (1998): One-year mortality rates following methadone treatment discharge.Drug and Alcohol Dependence52: 257–60.
