Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H9SH, United Kingdom.
Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H9SH, United Kingdom.
Int J Drug Policy. 2013 Nov;24(6):e43-50. doi: 10.1016/j.drugpo.2012.10.003. Epub 2012 Nov 28.
Methadone maintenance treatment is evidenced as a successful harm reduction initiative in regard to the prevention of blood borne viruses and other injecting related harms. This is attributable to reductions in heroin use and injecting equipment sharing incidents, yet the means by which these are achieved are rarely elaborated. Methadone diversion is predominantly presented in a negative light; associated with overdose and other harms. In our qualitative London-based study with 37 people who inject drugs, 35 on substitution therapies, we found that methadone self regulation and diversion played a prominent role in helping participants to manage their drug use, prevent withdrawal, cement social relationships, and inadvertently protect against hepatitis C transmission. The ability of participants to enact these 'indigenous harm reduction strategies' was constrained to various degrees by their treatment dosing protocols. In this article we explore the strategies participants enacted with methadone, the role of 'generous constraints' in this enactment and the associated production and reduction of risk. In order to reengage people who inject drugs with harm reduction interventions, it is necessary for initiatives to take stock of the indigenous strategies that individuals are already utilising and - in the case of methadone self regulation - support them by the implementation of more generous constraints.
美沙酮维持治疗被证明是一种成功的减少伤害举措，可预防血源性病毒和其他与注射相关的危害。这归因于海洛因使用和注射设备共享事件的减少，但实现这些目标的手段很少被详细阐述。美沙酮转移主要以负面的方式呈现；与过量用药和其他危害有关。在我们对伦敦的 37 名吸毒者进行的定性研究中，其中 35 名正在接受替代疗法，我们发现美沙酮自我调节和转移在帮助参与者管理他们的药物使用、预防戒断、巩固社会关系以及无意中防止丙型肝炎传播方面发挥了重要作用。参与者实施这些“本土减少伤害策略”的能力受到其治疗剂量方案的不同程度的限制。在本文中，我们探讨了参与者实施的美沙酮策略，以及“慷慨限制”在这种实施中的作用，以及相关的风险产生和减少。为了让吸毒者重新参与减少伤害干预措施，有必要让各举措了解个人已经在利用的本土策略，并在美沙酮自我调节的情况下，通过实施更慷慨的限制来支持他们。
