Why People Who Inject Drugs Voluntarily Transition Off Methadone in Ukraine

• Published in: Qualitative health research Vol. 27; no. 13; pp. 2057 - 2070
• Main Authors: Rozanova, Julia, Marcus, Ruthanne, Taxman, Faye S., Bojko, Martha J., Madden, Lynn, Farnum, Scott O., Mazhnaya, Alyona, Dvoriak, Sergii, Altice, Frederick L.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.11.2017; SAGE PUBLICATIONS, INC
• Subjects: Addictions; Adult; Drug addiction; Drug Users - psychology; Drugs; Female; Focus Groups; Harassment; Health psychology; Health technology assessment; HIV; Human immunodeficiency virus; Humans; Identity; Illnesses; Male; Methadone; Methadone - administration & dosage; Methadone - therapeutic use; Opiate Substitution Treatment - psychology; Opioid-Related Disorders - drug therapy; Opioids; Patient Acceptance of Health Care - psychology; Power; Prevention; Prevention programs; Preventive medicine; Professional-Patient Relations; Qualitative research; Recovery; Recovery (Medical); Resistance; Self image; Self-Management; Selfmanagement; Social capital; Social control; Stigma; Substance abuse treatment; Substance Abuse, Intravenous - drug therapy; Substance Abuse, Intravenous - psychology; Ukraine; Ukraine; thematic analysis; Eastern Europe; adherence; Ukraine; social construction; recovery; HIV prevention; illness and disease; inequality; social issues; people who inject drugs; focus groups; methadone maintenance therapy
• ISSN: 1049-7323; 1552-7557
• DOI: 10.1177/1049732317732307

Methadone maintenance therapy (MMT) treats opioid use disorder among people who inject drugs (PWID). To understand why PWID may voluntarily discontinue MMT, we analyzed data from 25 focus groups conducted in five Ukrainian cities from February to April 2013 with 199 participants who were currently, previously, or never on MMT. Using constant comparison method, we uncovered three themes explaining why PWID transition off MMT: (a) purposeful resistance to rigid social control associated with how MMT is delivered and to power asymmetries in provider–patient relationships, (b) self-management of a PWID’s “wounded identity” that is common in socially stigmatized and physically sick persons—MMT serves as a reminder of their illness, and (c) the quest for a “normal life” uninterrupted by daily MMT site visits, harassment, and time inefficiencies, resources, and social capital. Focusing on holistic principles of recovery would improve addiction treatment and HIV prevention in Ukraine and globally.