Marsha Rosenbaum

Treatment as harm reduction, defunding as harm maximization: The case of methadone maintenance

Despite numerous research studies demonstrating the efficacy of methadone maintenance treatment (MMT) in general and the value of retention in particular, the increasing defunding of this modality has compromised its potential. From 1990 to 1995 the lead author conducted a longitudinal research project to determine the impact of the cost of treatment on 233 San Francisco Bay Area study participants seeking, enrolled in, or defunded from MMT. This paper reports on selected findings from that study. Using variables of drug use, crime, gender and HIV risk, qualitative and quantitative results comparing those seeking treatment with those enrolled in treatment indicated that MMT functioned as a harm-reduction tool. When clients were defunded, however, drug use, crime and HIV risk increased and harm was maximized.

Women Who Use Cocaine Too Much: Smoking Crack vs. Snorting Cocaine

Monique (an African-American 19-year-old) and Becky (a white 21-year-old) were interviewed as part of a NIDA-funded study of women and cocaine. Although they were not necessarily typical, they do illustrate some of the differences among women who use cocaine. Despite the fact that they were close in age and both used cocaine, their scenarios and outcomes were very different, as one was a white middle-class woman and the other was an underclass woman of Color. The argument presented in this article is that it is not simply substance use that frames the experiences of women who use cocaine too much, but the social class mediated by gender and race. Through these life histories, the lives of these women are examined prior to cocaine use. Then the differential processes of initiation into and continuation of cocaine are described and analyzed, followed by a discussion of their lives after cocaine use.

Reflections on the Meaning of Drug Epidemics

Fluctuations in the use of many drugs at one time or another have been characterized as drug epidemics. The depiction of drug use as an epidemic, as in the recent cases of methamphetamine and crack use, is a proven mechanism for communicating that a problem exists, but such depictions are not without risk. When the public characterization of drug use as an epidemic represents more than its epidemiological meaning of “unusually elevated occurrence,” panic is often substituted for reasoned action. Such declarations are likely to truncate objective investigation, generate fear rather than understanding, and stimulate reactive measures that exacerbate drug misuse. This article discusses the epidemiological origin and meaning of epidemic, documents how media headlines have sensationally depicted methamphetamine use, and recommends that alternative strategies for describing an increase in the incidence and prevalence of use may be more successful in directing researchers and policy makers toward effective strategies for reducing misuse.

Staying Off Methadone Maintenance

Methadone maintenance is again receiving attention as an intervention for needle use/sharing among intravenous drug users. A major criticism is that methadone has its own addictive properties; consequently, the client is unable to detoxify and stay off opioids permanently. Study respondents had been off methadone for several years and offered their strategies for success. Motivating forces included the freedom and rewards, such as pride and respect. The following helped individuals to get off and stay off methadone: avoidance of opioids; treatment affiliation to supply ideology and to structure and fill free time; employment; social supports, specifically family and role models; modest plans to avoid disappointment; effective coping skills to avoid depression; and aging and burning out. In addition, those individuals who had immersed themselves in the conventional world, especially those having a higher social class status, had a less difficult time staying off methadone.

Defunding the Poor: The Impact of Lost access to Subsidized Methadone Maintenance Treatment on Women Injection Drug Users:

Qualitative data from women defunded from a subsidized methadone maintenance treatment (MMT) program were analyzed to determine the impact of defunding on the women and their dependents. Women attested to the efficacy of MMT in creating a stable environment in which their illicit drug use was eliminated or controlled; they were able to decrease their participation in illicit activities and pursue further employment and educational goals. When defunding occurred women employed a variety of strategies including family borrowing, welfare funds, and illicit activities to remain on private MMT programs. The result of these payment strategies was often a premature detoxification from MMT due to unpaid clinic bills. Many women returned to heroin use to alleviate withdrawal symptoms from methadone detoxification. This return to heroin use was also accompanied by increased illicit activities. Defunded women reported severe emotional and financial destabilization as a result of lost access to subsidized methadone maintenance treatment.

Always a Junkie?: The Ardous Task of Getting off Methadone Maintenance

Getting off maintenance is problematic for methadone clients. This paper, based on data from qualitative/ethnographic data from 100 depth interviews with women on methadone, attempts to document and analyze this problem. We begin with a discussion of womens conceptions of readiness to detoxify from methadone, the components of this state and the illusions which are operative. Next is a discussion of obstacles to detachment from methadone: models of failure so visible in the clinic setting; being a success in the eyes of clinic staff and clients; and ever-present and intensive fears of clients about this process. We examine the actual detoxification process: the clinics role, methadone withdrawal, and aids and accessories in this endeavor. Finally we look at the failure to complete a detoxification or remain abstinent upon getting off methadone, the meaning this has for the addict, and its implications.

Involuntary versus voluntary detoxification from methadone maintenance treatment: The importance of choice

The authors report on a subset of data from a three-year qualitative and quantitative study of 233 injection drug users (IDUs) in and out of methadone maintenance treatment (MMT) programs in the San Francisco Bay Area. We analyzed data from ten study participants detoxified from their MMT programs voluntarily and thirty involuntarily detoxified due to the defunding of their subsidized MMT slots. All of the study participants reported benefits from MMT program participation including decreased drug use or abstinence; decreased illicit activity; increased ability to maintain or initiate conventional employment; and increased ability to respond to parenting and family obligations. Those who were involuntarily detoxified from MMT programs experienced severe destabilization. Many were financially unstable and dependent on subsidized drug treatment prior to defunding. Several defunded participants were detoxified because they could not afford private fees (

The rhetoric of reproduction: pregnancy and drug use

225-300/month); others reverted to illicit activities ...

Pursuit of Ecstasy: The Mdma Experience

Sheigla Murphy is a senior resarch associate at the Institute for Scientific Analysis (2595 Mission St.• Suite 300. San Francisco. CA 94110). She has two books forthcoming in 1996. Women on Crack (Temple University Press) and Pregnancy and Drug Use (with Marsha Rosenbaum) (Rutgers University Press). Marsha Rosenbaum is the director of the Center for Drug Studies at ISA. She is also the co-author ofPursuit of Ecstasy: The MDMA Experience (Suny. 1994) and author ofanother forthcoming book. Women on Methadone. for Sage Publications.