ID: HR19-1228

Presenting author: Tim Rhodes

Presenting author biography:

Tim Rhodes is Professor of Public Health Sociology at the London School of Hygiene and Tropical Medicine. He uses qualitative methods to study the evidencing of care practices, especially linked to hepatitis C, HIV and drug use. He is Editor of the International Journal of Drug Policy.

How does methadone treatment travel? On the ‘becoming-methadone-body’ of Kyrgyzstan prisons

Tim Rhodes, Lyuba Azbel, Kari Lancaster, Jaimie Meyer

Evidence-based approaches promote the translation of interventions from one setting to another assuming universal effect potential. One example is methadone treatment for opioid dependency, also evidenced as HIV prevention. Yet in Kyrgyzstan’s prisons, there is low uptake.

We draw on qualitative research in three Kyrgyz prisons in which internationally supported programmes of methadone treatment are yet to achieve anticipated uptake. Using interviews with prisoners and staff, we explore how methadone’s enactments perform methadone treatment as unwanted.

Rather than stable and singular, methadone treatment emerges as mutable and multiple, as a fluid intervention, with contingent effects. First, methadone is enacted as a ‘harm’, which ‘takes over’ the body. This is the ‘becoming-methadone-body’. Those who are ‘healthy’ avoid methadone. Second, methadone’s effects merge with those of Dimedrol (diphenhydramine). Available illicitly, these pills are injected to turn methadone into a high. Methadone and Dimedrol become one, with inseparable effects, creating a damaged body. The becoming-methadone-body shifts, in time, to a less-than-human body. The methadone-Dimedrol subject is variously Othered as a “zombie” and “monster,” and as beyond knowability. Accordingly, methadone treatment is constituted as a loss of agency, a slow death, and for some, a sure death. Third, methadone does not afford the drug-inducing effects and capacities that heroin is enacted to have. While Dimedrol is used locally to make methadone into a ‘drug’ with a ‘high’, this is a drug which falls short of heroin’s euphoric potential. Lastly, the becoming of methadone in prison is at once the making of prisoner society. The ways in which methadone is ‘made-to-matter’ is an element of local governing practices, including of Kyrgyz prisons in relation to the State.

Exploring methadone treatment as a matter of its implementations rather than as a stable intervention in translation helps understand the ‘multiple methadones’ made possible.