“I’m always hiding and ducking and diving”: the stigma of growing older on methadone

Abstract

Background

There is emerging consensus that older opiate treatment patients have specific health and social care needs and also evidence of a particular stigma associated with opiate maintenance treatment. Yet, very little is known about the stigma experienced by individuals who have been interacting with methadone treatment services over a prolonged period.

Aim and Method

Conducted in Ireland and drawing on data from a qualitative study of 25 long-term clients of methadone treatment, this paper examines the stigma narratives of patients who are growing older as MMT patients. More than two-thirds were over the age of 40 and 16 had first accessed methadone treatment more than 20 years prior to taking part in the research.

Findings

The findings reveal the omnipresence of stigma in participants’ lives, which was experienced at institutional and public levels, leading many to attempt to conceal clinic attendance. Treatment-related stigma intersected strongly with the process of growing older on methadone; an ageing effect that was particularly apparent in participants’ accounts of public and private shame. The disabling effects of multiple intersecting stigmas were perhaps most apparent in participants’ narratives of internalized stigma, which uncovered private worlds characterized by isolation and seclusion.

Conclusions

The findings presented reflect the marginal position of addiction treatment within the wider healthcare system in Ireland and a failure to normalize methadone treatment.

Keywords:

• Methadone maintenance treatment
• stigma
• older patients
• ageing
• qualitative research

Ethical approval

Ethical approval for the conduct of the research was obtained from the Research Ethics Committee, School of Social Work and Social Policy, Trinity College Dublin.

Acknowledgements

The authors wish to extend special thanks to all of the individuals who agreed to participate in this research and to the large number of service professionals who facilitated participant recruitment. We also want to thank Daniel Hoey and Kathyan Kelly, who assisted with data collection and analysis.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 There is currently no agreed or standard definition of an ‘older’ drug user (Carew & Comiskey, 2018), possibly reflecting the fact that research is only beginning to examine the complexities of being an older person who has been using drugs and/or accessing drug treatment for a prolonged period. Older drug users have been defined by some as persons ‘35 years old or older’ (Boeri et al., 2008; Atkinson, 2016) while other research has classifed ‘older’ as aged 50 and over (Beyon et al., 2009; Doukas, 2017) or 45 years or more (Carlsen et al., 2019). The stated cut-off point for older drug users is defined as 40 years by the EMCDDA (2010).

2 One of these participants had been in methadone treatment for a total of 17 years and the second for a period of 16 years.

3 This participant stated that he planned to re-engage with MMT and, at the time of interview, was accessing a community-based addiction service where he was receiving counselling and support.

Additional information

Funding

This research was funded by the Dun Laoghaire Rathdown Drug and Alcohol Taskforce, supported by Southside Partnership and the Dun Laoghaire Rathdown Community Addiction Team.