Learning To Live Without It: Women, Biography and Methadone
This paper addresses some issues relating to Methadone-maintenance as a treatment for heroin addiction. From the position of a sociologist in Melbourne, I am aware that New South Wales has had a vigorous debate about Methadone, mainly presented as a battle between the religious, dogmatic right and pragmatic health professionals and public health scientists.(1) There has been no such debate in Victoria. Methadone-maintenance has been presented as the best treatment for heroin addicts, with little or no comment being made as to its shortcomings and problems. This has been the case even though the Victorian Coroner had a major inquest into deaths related to Methadone in the 1990s.(2) I do not wish to be aligned with the religious right but, as a feminist and sociologist, I have misgivings about the widespread use of Methadone as a treatment and about the ideology of harm reduction as the only policy response to the issue of heroin addiction. Many of my misgivings become evident through the stories of women who have had experience of Methadone maintenance treatment. I have written of my general reservations about harm reduction policies in a previous article.(3)
Women's relationship to all forms of drug use is quite different to men's. With the exception of prescription tranquillisers, women use less of all drugs (and alcohol). This lesser use (and abuse) has been an excuse in the past to ignore the problems that drug abuse may have for women. However, since the 1980s, feminists have drawn attention to the gender implications in the way that drugs are used and abused. There has, nevertheless, been little critical discussion of the gender implications of recent drug policies such as harm reduction. The assumption seems to be that harm reduction is less punitive than abstinence based models, which therefore cannot be good for women. We need to unpack this assumption to develop policies which will be effective for certain groups of women.
This article is about a group of women who have been active heroin addicts in the past and who had experience of Methadone-maintenance treatment (MMT) before becoming totally drug-free. My intention is to try to understand public health policy through the individual lives of women who are experiencing the pointy end of modern drug addiction policy and thereby question the meanings we give to the term `harm reduction.' The goal of harm reduction is the minimisation of the social, psychological, and personal damage of drugs and, while this is a laudable goal, it can take on the flavour of a platitude with little understanding by the layperson of what its effects are on those who live with it. In the world of public policy and treatment, harm reduction and abstinence are placed in opposition to each other. The choice of abstinence is considered a failure on the part of the woman since she clearly has not developed the necessary qualities of a `rational liberal' citizen. This paper tells a story of the clash between a state policy (backed by an army of health professionals, researchers and bureaucrats) and some women who have experienced a central part of this policy.
For me the question is always: harm reduction for whom? If it is for the addict, then we must ask the addicts for their shared meanings of the term. If it is for the relatives and friends of the addicts, then they should be asked. If we are talking about harm reduction for other parts of the community, then it is up to the policy makers to clarify who they mean when they use the term. These are complex issues and cannot adequately be covered in one short article, so I will limit myself to the group of women that I interviewed and portions of those stories that I will tell. I present their meanings as told to me.
Biography, autobiography and science
Biographies are strange things; they presume to tell the truth but never the whole truth. …