Long-term methadone users feel 'stigma, fear, and shame'

People on long-term methadone programmes are concealing their attendance at clinics because of stigma, fear, and shame.

The finding is from research into the experiences of 25 long-term clients of methadone treatment, 16 of whom had first accessed the support more than 20 years ago.

Entitled 'I'm always hiding and ducking and diving': the stigma of growing older on methadone,  the study found that for many of those interviewed, they experienced "public and private shame", with some feeling socially isolated as a result.

The research, conducted by Paula Mayock and Shane Butler, both of the School of Social Work and Social Policy at Trinity College Dublin, looked at the lived experiences of the long-term clients of methadone treatment, two-thirds of whom were aged over 40, and all of whom were living in south Dublin. 

At the time of interview, 22 people from the sample were taking a daily dose of prescribed methadone and just three were not currently on a programme. Just three were in full-time employment.

Treated differently

According to the study, one interviewee, Christine "felt she was treated differently — not like a ‘normal person’ — by people who knew she attended a methadone clinic. 

Her response was to ‘hide’, ‘duck’ and ‘dive’ in an effort to disguise clinic attendance, which she equated with a public admission of her status as a methadone patient".

Christine herself told the authors: "I’m always hiding and ducking and diving and waiting on all the cars to pass, you know?"

"I’ve often missed the clinic from hiding down the road."

Another woman, now no longer on a methadone programme, recalled "grovelling" to doctors and in pharmacies.

The study suggested that stigma was prevalent, with one man, Alvin, stating: "You’d say, “Look doctor” [and the doctor would reply], “There you go, there’s a script”. And you’re spoken to like you’re dirt so you just toe the line and you live with it. Like you don’t know how to deal with your emotions, I suppose, when you’re young ... But it’s hard to unravel all that as you get older."

Many felt the stigma associated with methadone use increased as they got older. 

"That one word straightaway gives them your whole history: methadone," one interviewee said. "It lets them know that there’s a threat."

Public shaming

Some described public shaming during pharmacy visits and the pressures and anxieties associated with negotiating the routine demands of methadone treatment.

According to the study: "Perspectives on employer attitudes were revealing in that participants firmly rejected the notion or suggestion of disclosing their status as a methadone patient: ‘No I wouldn’t tell an employer. Sure that’s like telling them I could be found dead in the toilet or something’."

One woman felt that she would not be accepted as a romantic partner because she was a methadone patient and said: "They’d run a mile, they wouldn’t want to bring you home to mammy and daddy. So I’m cutting myself off from that side of society."

Among the recommendations is that Irish health policymakers and service providers look critically at current arrangements for methadone treatment "with a view to bringing about change and improvement" and that addiction services "could clearly benefit from being drawn back into a mainstream area of health service delivery".