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.

中文翻译：

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“我总是躲起来躲避潜水”：美沙酮变老的耻辱

摘要

背景

正在形成共识，即老年阿片类药物治疗患者有特定的健康和社会护理需求，并且有证据表明与阿片类药物维持治疗相关的特定污名。然而，对于长期与美沙酮治疗服务互动的个人所经历的污名化知之甚少。

目的和方法

本文在爱尔兰进行，并利用对 25 名美沙酮治疗的长期客户的定性研究的数据，研究了作为 MMT 患者年龄增长的患者的耻辱叙述。超过三分之二的人年龄在 40 岁以上，16 岁的人在参与研究前 20 多年第一次接受美沙酮治疗。

发现

调查结果揭示了参与者生活中无处不在的耻辱感，这在机构和公共层面都经历过，导致许多人试图隐瞒就诊情况。治疗相关的污名与使用美沙酮变老的过程密切相关；这种老化效应在参与者对公共和私人耻辱的描述中尤为明显。多重交叉污名的致残效应可能在参与者关于内化污名的叙述中最为明显，这些叙述揭示了以孤立和隐居为特征的私人世界。

结论

所呈现的研究结果反映了在爱尔兰更广泛的医疗保健系统中成瘾治疗的边缘地位以及美沙酮治疗未能正常化。