Frank David
New York University, Behavioral Science Training in Drug Abuse Research program, United States.
Int J Drug Policy. 2020 Sep;83:102844. doi: 10.1016/j.drugpo.2020.102844. Epub 2020 Jul 9.
The claim that methadone maintenance treatment (MMT) is 'just swapping one drug for another' has typically been used to de-legitimize the treatment and attack those who use it. However, this commentary re-positions that argument as a way of bringing analytic focus to the role of structural forces, like criminalization and the war on drugs, in the treatment decisions of people who use illegal drugs. Specifically, I use my experience as a qualitative sociologist who studies MMT as well as my own experience on MMT to demonstrate how criminalization functions as source of harm in the lives of people who use illegal drugs, that drives them towards the legal, and thus comparatively safer, style of substance use made available by MMT. Moreover, I argue that the dominance of individually-focused theories based on addiction and recovery to understand MMT is related to its punitive organizational structure and lack of popularity among people who use illegal opioids. Ultimately, I argue for a paradigm shift, both in policy and scholarship, that acknowledges the pragmatic value of MMT within the structural context of criminalization.
美沙酮维持治疗（MMT）“只是用一种药物替代另一种药物”这一说法，通常被用来使该治疗失去合法性，并攻击接受该治疗的人。然而，这篇评论文章将这一论点重新定位，作为一种将分析重点放在诸如刑事定罪和禁毒战争等结构性力量在使用非法药物者治疗决策中所起作用的方式。具体而言，我作为一名研究MMT的定性社会学家，利用自己的经验以及我接受MMT的亲身经历，来证明刑事定罪如何成为使用非法药物者生活中的伤害源，驱使他们转向合法且相对更安全的药物使用方式，即MMT所提供的方式。此外，我认为基于成瘾和康复的以个体为重点的理论在理解MMT方面占据主导地位，与MMT惩罚性的组织结构以及在使用非法阿片类药物者中不受欢迎有关。最终，我主张在政策和学术研究方面都进行范式转变，承认在刑事定罪的结构背景下MMT的实用价值。
