Rosenbaum M
Institute for Scientific Analysis, San Francisco, California 94123, USA.
J Psychoactive Drugs. 1995 Apr-Jun;27(2):145-9. doi: 10.1080/02791072.1995.10471683.
The institution of methadone maintenance as a treatment modality for heroin addiction in the mid-1960s was part of the growing medicalization of social problems in the United States. The definition of deviance as "sickness" rather than "badness" set the stage for America's first harm-reduction strategy. By the 1970s methadone maintenance was seen as a way to reduce drug-related crime, and federally funded programs proliferated. Accompanying methadone's phenomenal expansion was increased regulation, bureaucratization, and criticism. The early 1980s brought the Reagan era, fiscal austerity, the new "just say no" abstinence morality, and demedicalization of methadone maintenance. By the time needle-sharing was recognized as a major contributing factor in the spread of HIV, methadone had been transformed into a largely fee-for-service, short-term, begrudgingly tolerated treatment modality. Ironically, while other countries were able to use methadone to curb the spread of AIDS, the United States refused to facilitate its expansion, and in fact impeded it. To the frustration of proponents and consumers, this original harm-reduction tool, with the potential to impact the epidemic, was demedicalized and remains marginalized.
20世纪60年代中期，美沙酮维持疗法作为海洛因成瘾的一种治疗方式得以确立，这是美国社会问题日益医学化的一部分。将越轨行为定义为“疾病”而非“恶行”，为美国首个减少伤害策略奠定了基础。到20世纪70年代，美沙酮维持疗法被视为减少与毒品相关犯罪的一种方式，由联邦政府资助的项目激增。随着美沙酮惊人的扩张，监管、官僚化和批评也随之增加。20世纪80年代初迎来了里根时代、财政紧缩、新的“只要说不”的禁欲道德观念以及美沙酮维持疗法的非医学化。到共用针头被确认为艾滋病毒传播的一个主要促成因素时，美沙酮已基本上转变为一种主要按服务收费、短期且勉强被容忍的治疗方式。具有讽刺意味的是，当其他国家能够利用美沙酮来遏制艾滋病的传播时，美国却拒绝推动其扩大使用，实际上还加以阻碍。令支持者和使用者沮丧的是，这种原本有可能对疫情产生影响的减少伤害工具被非医学化了，并且仍然处于边缘地位。
