Comparing the role of takeaways in methadone maintenance treatment in New South Wales and Victoria
Dr Suzanne Fraser, Dr Carla Treloar, Professor Susan Kippax, Dr Alex Wodak
Methadone maintenance treatment (MMT) is currently the primary treatment for opioid addiction in Australia. Takeaway doses (methadone doses consumed at home rather than on clinic or pharmacy premises) are highly valued by MMT clients because they allow clients to develop or resume a lifestyle that does not revolve around delivery of medication. However, concerns about the potential negative effects of takeaway dosing, including the diversion of methadone to street sale (which has in turn been linked to accidental fatal overdose) remain unresolved.
In NSW and Victoria, MMT is also subject to a range of other issues which impact on how (and whether) takeaways are provided. These include community resistance to methadone provision; lack of clear political support for MMT; the relative costliness of takeaway dosing compared to over-the-counter dispensing; concerns about security around dispensing; and distortions of service provision due to undersupply or oversupply of services.
This three-year project looks at clients’, service providers’ and policymakers’ views on and experiences of MMT in general and takeaways in particular, focusing on issues of power, agency and normalisation in treatment. Funded by the NHMRC, the project asks what role notions of addiction play in the development and delivery of MMT, how ideas of gender shape community attitudes towards drugs and drug treatment, and how clients and service providers operate within these broad social and cultural parameters in participating in MMT.
UPDATE: The final report published from the project can be accessed at:
http://nchsr.arts.unsw.edu.au/publications/
Since its publication it has been downloaded over 4000 times.
The method of research is qualitative in-depth interviews with methadone clients, service providers and MMT policy makers.
Outcomes:
- Understanding of the role of social and cultural norms in the formation, delivery and client experiences of MMT in Australia
- Understanding of how takeaways function practically and symbolically in MMT for both clients and healthcare workers
- Understanding of the differing political constraints and contexts in which MMT policy making takes place in NSW and Victoria
- Understanding of the effects produced by the differing takeaway policies in NSW and Victoria
- Understanding of the different roles takeaways play in urban and rural settings
- Understanding of why people divert methadone in both urban and rural settings
The project is a collaboration between the Centre for Women’s Studies and Gender Research, Monash, the National Centre in HIV Social Research at the University of New South Wales, and St Vincent’s Hospital, Sydney.
Research outputs to emerge from the study to date
Publications
Fraser, S. & Valentine, k. (2008). Substance and substitution: Methadone subjects in liberal societies, Basingstoke: Palgrave.
Fraser, S., Valentine, k., Treloar, C. & Macmillan, K. (2007). Methadone maintenance treatment in NSW and Victoria: Takeaways, diversion and other key issues. Monograph. Sydney: National Centre in HIV Social Research.
Fraser, S. (forthcoming). Repetition and rupture: The gender of agency in methadone maintenance treatment. In C. Patton and H. Loshny (Eds), Rebirthing the clinic: The multiple spaces and temporalities of clinical practice. Minnesota University Press.
Fraser, S. (2006). Speaking addictions: Substitution, metaphor and authenticity in newspaper representations of methadone treatment. Contemporary Drug Problems, 33, 669-698.
Valentine, k. (2007). Methadone maintenance treatment and making up people. Sociology 41, 497-514.
Treloar, C., Fraser, S., & Valentine, k. (2007). Valuing methadone take-away doses: The contribution of service user perspectives to policy and practice. Drugs: Education, Prevention & Policy, 14, 61-74.
Fraser, S. (2006). The chronotope of the queue: Methadone maintenance treatment and the production of time, space and subjects. International Journal of Drug Policy, 17, 192-202.
Fraser, S. & Valentine, k. (2005). Gendered ethnographies: Researching drugs, violence and gender in New York. Australian Feminist Studies, 20(46), 121-124.
Winstock, A. R., Banks, S., Fraser, S., Crawford, R., Leahy, D., Klein, G., Webster, I. W., & Hepatitis C Council of NSW. (2006). Premier's methadone in malls plan. Hep C Review, 54, 24-27.
Kippax, S., Treloar, C., Valentine, k., Bryant, J., Holt, M., Hopwood, M. & Fraser, S. (2007). Parliamentary submission into the impact of illicit drugs on families. Canberra: House Standing Committee on Family and Human Services, Australian Parliament of Australia.
. http://www.aph.gov.au/house/committee/fhs/illicitdrugs/subs/sub061.pdf
Conference presentations
The study has yielded approximately 20 conference presentations, including invited keynote presentations and dedicated conference sessions. Conferences include:
- International Harm Reduction Conference, Warsaw 2007
- European Association for the Study of Science and Technology, Lausanne 2006
- Australian Professional Society of Alcohol and Other Drugs Conference, various locations 2005, 2006, 2007
- Rural Victorian Drug and Alcohol Conference, Warrnambool, 2006
- Comet-VELIM Conference, Sydney 2005
- Dangerous Consumptions, Canberra 2006