The politics of providing opioid pharmacotherapy.

Abstract

People using opioid pharmacotherapy (OPT, methadone and uprenorphine medications used for maintenance purposes) have ecently provided accounts of the stigma that is often part of the reatment experience (Anstice, Strike, & Brands, 2009; Harris & cElrath, 2012; Strike, Millson, Hopkins, & Smith, 2013), as well s the restrictive and punitive practices (Chandler et al., 2013; rawford, 2013), and structural violence (Treloar & Valentine, 013), inherent within the treatment systems they encounter. The iews of treatment providers about their social and political locaion and agency within OPT systems have not, we believe, been dequately examined from a critical perspective. While Neale, n her editorial for this special issue (2013), refers to research n providers’ perspectives, such studies have tended to focus n specific clinical aspects of OPT rather than locating providers ore explicitly within the contexts of what many understand o be an inherently controversial and contested area of health are. Physicians have spoken out for some time about the recuring political anxiety linked to OPT, and the polarised and often deologically-driven discussions that commonly fail to engage eaningfully with either the new or old science on the effectiveess of this treatment, or with the practitioner ‘art’ of OPT in its any guises (see Ford, 2010, 2012; McNamara, 2012; Robertson Burrowes, 2010; Robertson, 2012; Wodak, 2002). However, the mpact has received little attention. We have therefore considered the papers in this special issue or the ways that they pay attention to the different political, social nd cultural contexts of OPT in the countries they are describing. e aim to discern the impact such heterogeneous contexts (China nd Nepal are featured as well as European, North American and ustralian examples) have on the development and ‘mainstreamng’ of OPT, access to treatment and treatment systems, regimes nd practices. We hope that this editorial goes some way towards ddressing the absence of explicit provider perspectives in this ompilation.

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