Responsibility and Resistance at the Clinic – How is Opioid Use Now Understood and Managed?

Post-industrialisation, opioid use has been problematised to serve various socio-political interests. This thesis explores how medical institutions now manage what is increasingly described as an international opioid ‘crisis’. Through an institutional ethnography of an opioid substitution treatment service, the present construction and management of opioid dependence is explicated. In critical literature, treatment services are argued to create self-managing subjects who consume substances in a way which does not impede their ability to be productive. To investigate these claims, the day-to-day work at a treatment service was assessed, to see how it was informed by the values of staff, service users, and policy makers. Across a 12-month period, nine informants were interviewed from these groups, and their work at the service was observed. Findings were organised into a map of the treatment institution; informants’ work was connected by the guidelines and procedural documents that coordinated it. This map was analysed according to a Foucauldian framing to describe the ideologies that permeated these texts, and how they affected informants’ work and informed the construction of opioid dependence. Confirming previous claims, there was a persistent ideology that translated from institutional texts to the talk of the research informants, of successful recovery requiring individuals to become self-responsible. Service users were described by staff as being ‘chaotic’ before presenting to the service, and recovery was described, by staff and in texts, as requiring individuals to maintain employment and to manage their treatment. Accordingly, service users were expected to collect their opioid doses within a narrow time window and were made accountable for their own recovery. However, though dominant (responsibilising) modes of constructing opioid dependence and recovery were identified, these manifested in myriad complex and conflicting ways. How service users described themselves and their opioid use was equally varied, but was also a product of opportunistic utilisation by this group. It is thus argued that there was evidence of a complex performativity of dependence amongst the informants. Service users constructed themselves and their dependence in relation to the expectations of the service, but also in resistance to these, despite the seeming intent of the treatment institution.

Name thesis:degree_name

PhD

Level thesis:degree_level

Doctoral

Discipline thesis:degree_discipline

Social and Community Health

Grantor dc:publisher

ResearchSpace@Auckland

Year dc:date.issued

2024

Author dc:creator

• Birch, Oliver Jules

Advisors dc:contributor.advisor

• Adams, Peter
• Cohen, Bruce
• Newcombe, David

Statement dc:rights

• Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Licence dc:rights.uri

• https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm

Handle dc:identifier.uri

https://hdl.handle.net/2292/70092

OAI identifier oai:identifier

oai:researchspace.auckland.ac.nz:2292/70092