“I Was Not Sick and I Didn't Need to Recover”: Methadone Maintenance Treatment (MMT) as a Refuge from Criminalization

ABSTRACT

Background: Methadone Maintenance Treatment (MMT) in the United States (U.S.) has been undergoing a shift towards conceptualizing the program as recovery-based treatment. Although recovery is seen by some as a means to restore MMT to its rightful position as a medically-based treatment for addiction, it may not represent the experiences, or meet the needs of people who use drugs (PWUD), many of whom who use the program as a pragmatic means of reducing harms associated with criminalization. Objectives: To examine alternative constructions of MMT in order to produce a richer, more contextualized picture of the program and the reasons PWUD employ its services. Methods: This paper uses semi-structured interviews with 23 people on MMT (either currently or within the previous two years). Results: Most participants linked their use of MMT to the structural-legal context of prohibition/criminalization rather than through the narrative of the recovery model. Responses suggested the recovery model functions in part to obscure the role of criminalization in the harms PWUD experience in favor of a model based on individual pathology.

Conclusions/Importance: In contrast to the recovery model, MMT cannot be understood outside of the structural context of criminalization and the War on Drugs which shape illegal drug use as a difficult and dangerous activity, and consequently position MMT as a way to moderate or escape from those harms.

KEYWORDS:

• Methadone Maintenance Treatment (MMT)
• recovery
• harm reduction
• abstinence
• disease model
• criminalization
• medicalization

Acknowledgments

The author was supported as a predoctoral fellow in the Behavioral Sciences Training in Drug Abuse Research program sponsored by Public Health Solutions and National Development and Research Institutes with funding from the National Institute on Drug Abuse (5T32 DA007233). Points of view, opinions, and conclusions in this paper do not necessarily represent the official position of the U.S. Government, Public Health Solutions or National Development and Research Institutes.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Notes

1 It is beyond the scope of this paper to discuss the definitional and taxonomic problems associated with culturally determined and highly unstable categories like “drug” or “abstinence” (see for example Keane, 2002), however, it should be noted that these same difficulties problematize their use in recovery settings too.

2 There has been more critique of recovery-based policies in the UK and Australian contexts. For example, see (AIVL, 2012)