‘It's not just a matter of taking the drug. It's about changing the way you function in your society too’: Narratives of power and resistance in the lived experiences of opioid agonist therapy consumers in regional Victoria, Australia

Abstract

Opioid Agonist Therapy (OAT) has initiated extensive discussion regarding its efficacy, cost-effectiveness and best practice delivery. Although this discussion has been dominated by pharmacologists, clinicians, pharmacists and public policy-makers, there is increasing interest in examining OAT consumer experience and voice, particularly regarding consumers’ navigation and experience of the social field of their treatment. Concerned with the expression and circulation of power and resistance, Michel Foucault's work offers rich resources for examining OAT consumers’ experience and navigation of the social field of their treatment, including the administration of OAT as a harm reduction and social welfare intervention and consumers’ efforts to shape their relationships with medical and allied health professionals and other stakeholders. In the case of this study, Foucault's conceptions of power provide a productive means to critically interrogate the experience of 16 OAT consumers participating in pharmacotherapy treatments within a community pharmacy model in regional Victoria, Australia. Through the application of Foucauldian analyses of subjects and power to OAT participant accounts, precisely what the participant responses in our study have shown is that the relationship between OAT practitioners and consumers is neither always oppositional nor binary. Findings suggest that practitioners must pay attention to the everyday interactions they have with consumers (and others)—to how they communicate, listen, understand, present and provide solutions. Interactions with consumers should be treated as sites that produce complex power relations with moral and ethical implications for subjects, including consumers, practitioners and other stakeholders. Both practitioner and consumers need to remember that they are both productive subjects locked in a complex assemblage of practices and social discourses that circumscribe the social field of opioid treatments.