Skip Page Header

Home > Stigma of growing older on methadone maintenance treatment.

McGrath, Emma (2021) Stigma of growing older on methadone maintenance treatment. Drugnet Ireland, Issue 78, Summer 2021, pp. 16-17.

[img]
Preview
PDF (Drugnet Ireland 78)
1MB

Background

Following the opiate epidemic of the 1980s and 1990s, the United States (US) and many countries across Europe have seen a significant increase in the proportion of older individuals with a drug dependency and those receiving drug treatment. In 2017, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) reported that clients over the age of 40 receiving methadone maintenance treatment (MMT) had increased from 20% to 40% between 2006 and 2015.1 These trends are also reflected in Irish data, with a growing number of clients over the age of 35 receiving treatment for opiate use since 2009.2

The connection between drug use and the experience of stigma and discrimination in society is well known. However, there is also a growing recognition of stigmatisation against opioid agonist therapies, such as MMT, despite vast evidence of the public health benefits these interventions provide.3,4 In addition, increasing age is associated with stigma becoming further pronounced; however, with only limited research to date, the experiences of those interacting with drug treatment services over a prolonged timeframe are not well understood.

Stigma, classically defined as an ‘attribute that is deeply discrediting’ by Erving Goffman in 1963,5 has since been conceptualised on three interacting levels: institutional stigma, social stigma, and self-stigma. The complex and overlapping nature of stigma presents a significant barrier to individuals in which negative stereotyping at all levels serves to reinforce the structural inequalities in place.

In line with similar studies published in the US and the United Kingdom (UK) identifying age-related embarrassment and shame in older methadone patients, a 2021 research paper by Mayock and Butler, published in the journal Drugs: Education, Prevention and Policy, examined the intersecting levels of stigma experienced by service users who are growing older on long-term MMT in Ireland.6

Methods

In-depth qualitative interviews were recorded with 25 long-term clients who had been enrolled in MMT at least 10 years prior to participating in the study. Recruitment was guided by a purposive sampling strategy within a geographical area of South Dublin and focused primarily on clients of specialist addiction clinics. An interview schedule of topics and questions was prepared in advance but maintained flexibility to ensure collected data accurately reflected the respondents’ personal perspectives. Analysis did not separate the sources of stigma in order to reflect the interwoven nature of these experiences by study participants.

Results

In total, 16 male and nine female clients participated in the study, all of whom identified as Irish and were of white ethnicity. Greater than two-thirds of participants were over the age of 40 at the time of the research taking place and 16 of the 25 recruited had accessed MMT more than 20 years previously.

Methadone treatment system

While study participants had encountered kindness and empathy among some healthcare professionals, accounts overall summarised the methadone treatment regime to be ‘demoralising’ and unlike other healthcare services. For many, stigma was experienced and conveyed through an absence of trust from treatment providers and a sense of control exerted over the client. Privileges such as takeaway doses could be easily withdrawn and the requirement to provide urine samples under supervision was described by interviewees as ‘mortifying’ and ‘degrading’. The lack of agency and palpable divide felt by clients with their treatment professionals served to reinforce feelings of inferiority and the perception of clients as deviant and a ‘junkie’.

Secrecy and concealment

For many participants, fear of public scrutiny and negative responses from family, friends, and the community dictated their behaviour towards clinic or pharmacy attendance. The pressure to manage public perceptions was reported by women, in particular, with one respondent explaining how she would ‘go down at a certain time knowing that’s the time there won’t be many there and I’m in and out in a flash’. Many clients felt they were treated differently and had experienced public shaming in these settings. One interviewee described how she was ‘outed’ by a pharmacist due to lack of discretion in the presence of a neighbour and felt that ‘the ground couldn’t open up fast enough, I just wanted to die’.

Participants also believed that revealing their status as a methadone patient could jeopardise their employment opportunities, and opinions expressed in the workplace served to strengthen the need for secrecy. As one interviewee explained of her colleagues: ‘I’d be afraid for them to know. The things they say about drug addicts … It wouldn’t go down good.’

Private burden

For study participants, the stigmatising attitudes and experiences in their external environment had  perpetuated a deep sense of self-stigma interwoven with their self-identity. This was highlighted by one interviewee who described their personal perspective on addiction as ‘that’s what you do as a drug addict – you let people down, you’re unreliable, you’re of fucking no use to nobody’.

Internalised shame also impacted participants’ ability to have close relationships or form new ones for fear for rejection, with one participant describing herself as a ‘junkie in disguise’. Such feelings of social isolation and loneliness were reinforced further with age, with participants already having experienced long periods of marginality. Many had resigned themselves to being cut off from wider society and felt they were now condemned to ostracisation: ‘That sort of loneliness is physically painful, as well as emotionally, but I just can’t see that ever changing.’

Conclusions

This study describes how long-term methadone treatment was punctuated by stigma intersecting at macro, meso, and micro levels in clients’ lives. Methadone use in older patients implicitly revealed their histories as drug users and carried negative connotations that marked them as different to other health service users. The authors acknowledge the small sample size and selection of participants primarily from specialist addiction clinics to be limitations of this work. They recommend that future studies engage with larger groups and wider treatment contexts. Nevertheless, these findings reveal that current practices and public perceptions severely hinder an improved quality of life for long-term clients of MMT.

1   European Monitoring Centre for Drugs and Drug Addiction (2017) Health and social responses to drug problems: a European guide. Luxembourg: Publications Office of the European Union.
https://www.drugsandalcohol.ie/28040/

2   Health Research Board National Drugs Library (2017) Treatment data tables. Dublin: Health Research Board.
http://www.drugsandalcohol.ie/treatment-data/

3   Lloyd C (2013) The stigmatization of problem drug users: a narrative literature review. Drugs Educ Prev Pol, 20(2): 85–95.

4   Carlsen SEL, Gaulen Z, Alpers SE and Fjaereide M (2019) Beyond medication: life situation of older patients in opioid maintenance treatment. Addict Res Theory, 27(4): 305–313.

5   Goffman E (1963) Stigma: notes on the management of spoiled identity. Englewood-Cliffs, NJ: Prentice-Hall.

6   Mayock P and Butler S (2021) ‘I’m always hiding and ducking and diving’: the stigma of growing older on methadone. Drugs Educ Prev Pol, Early online. https://www.drugsandalcohol.ie/33894/

Repository Staff Only: item control page