Riikka Perälä

Behind the Scenes: The Justifications for Opioid Maintenance Treatment in Finland

Opioid maintenance treatment (OMT) has been developed within drug dependency treatment in Finland over the last 20 years. This study, based on interviews with 15 stakeholders and content analysis of 174 newspaper texts, draws on Boltanski and Thévenots theory of justification to explore ways in which OMT has been justified and identifies the main actors contributing to its development. Multiple factors, involving different actors, have influenced the development process, reflecting the ethos of contemporary Finnish welfare and health policy. Currently, the main justifications for choosing OMT treatment seem to emerge from a neoliberal frame of understanding.

Opioid substitution treatment in Finland and other Nordic countries: Established treatment, varying practices

The authors would like to express their thanks to Helge Waal (Norway), Kirsten Frederik-sen (Denmark), Ulf Malmstrom (Sweden) and Valgerður Runarsdottir (Iceland) for searching data on Nordic countries, and to Anssi Vartiainen, Aila Ronkanen, Tarja Koskinen, Mia-Veera Koivisto, Martti Marila, Pasi Lehti, Paivi Martikainen, Tuomo Seppanen, Maiju Hakala-Kallio and Jukka Makinen for collecting the data concerning Finland.

Remains of care: opioid substitution treatment in the post-welfare state

This article examines how the amplified role of pharmaceutical substances in addiction treatment affects the everyday realisation of care, particularly the relationship between workers and patients, in so called austere environments. Theoretically the article draws firstly on the literature that links pharmaceuticalisation to the neoliberal undoing of central public structures and institutions of care, and secondly on Anne-Marie Mols concept of the logic of care. Based on an ethnographic analysis of the everyday life at a Finnish opioid substitution treatment clinic we show the mechanisms through which the realisation of pharmacotherapy can, in the current political climate, result in a very narrow understanding of drug problems and minimal human contact between patients and professionals. Our analysis manifests an important shift in the logic of addiction treatment and health-care policy more broadly; namely, a growing tendency to emphasise the need for patients to care for themselves and make good choices with limited help from formal care institutions and professionals. We call this new ethos the logic of austerity.

What drives treatment

The general aims of the health and welfare services are the social wellbeing of the population as well as the maintenance and promotion of health and security. The realization of these goals is to a growing degree managed by society, along with families and other local communities (...) The central objective of the social services is the promotion of social justice and equality. Substance misuse is to be regarded as a pervasive societal question. In addition to treatment and maintenance, attention has to be paid to preventing and correcting the kinds of societal circumstances that increase social and health problems as well as related substance use. (HE 246, 1984)