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The Demedicalization of Methadone Maintenance

1995; Taylor & Francis; Volume: 27; Issue: 2 Linguagem: Inglês

10.1080/02791072.1995.10471683

2159-9777

Marsha Rosenbaum,

Crime, Illicit Activities, and Governance

Abstract Abstract The institution of methad one maintenance as a treatment modality for heroin addiction in the mid-1960s was part of the growing medicalization of social problems in the United States. The definition of deviance as "sickness" rather than "badness" set the stage for America's first harm-reduction strategy. By the 1970s methadone maintenance was seen as a way to reduce drug-related crime, and federally funded programs prolife rated. Accompanying methadone's phenomenal expansion was increased regulation, bureaucratization, and criticism. The early 1980s brought the Reagan era, fiscal austerity, the new "just say no" abstinence morality, and demediculization of methadone maintenance. By the time needle-sharing was recognized as a major contributing factor ill the spread of HIV, methadone had been transformed into a largely fee-for-service, short-term, begrudgingly tolerated treatment modality. Ironically, while other countries were able to use methadone to curh the spread of AIDS, the United States refused to facilitate its expansion, and in fact impeded it. To the frustration of proponents and consumers, this original harm-reduction tool, with the potenual to impact the epidemic, was demedicalized and remains marginalized. Keywords: AIDSdemedicalizationharm reductionmethadonesubstance abuse