Fallen Agents: Negotiations of Patient Agency in Norwegian Opioid Substitution Treatment
Keywords:
agency, addiction, noncompliance, opioid substitution treatment, patient involvment, NorwayAbstract
Based on an ethnographic fieldwork, this article explores how patients in a Norwegian heroin-addiction treatment program negotiate their agency, navigating between policies, medical guidelines, and their own lived experiences as they seek what they perceive as appropriate medication. Outlining these patients’ participation in treatment inside and outside the clinic, I illustrate that different types of agency are involved across these domains. I argue that patient agency is not something one has or does not have, but rather involves the institutional interpretations of these mobilised elements: What kind of agency is appropriate to exert in the Norwegian healthcare system? The analysis highlights the social constructions of the “addicted patient” and raises questions of the value of patient subjectivity and the politically tinged ascriptions of agency manifested in patient rights and guidelines for clinical decision-making.
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References
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A m u n d s e n E. J. and B r e t t e v i l l e - J e n s e n A. L. 2010. Hard drug use in Norway. Nordisk Alkohol- & Narkotikatidskrift 27 (1), 87–94.
A n d r e a s s e n T. A. 2004. Brukermedvirkning, politikk og velferdsstat. Oslo.
A n d r e a s s e n T. A. 2016. Professional Intervention from a Service User Perspective. In J. F. Gubrium, T. A. Andreassen and P. Solvang (eds.), Reimagining the human service relationship. New York, 35–56.
B a r n e s J. A. 1994. A pack of lies: towards a sociology of lying. Cambridge.
B a r r o w s H. S. and P i c k e l l G. C. 1991. Developing clinical problem-solving skills: a guide to more effective diagnosis and treatment. New York.
B a r t o s z k o A. 2018a. The lethal burden of survival: making new subjects at risk and the paradoxes of opioid substitution treatment in Norway. Contemporary Drug Problems 45 (3), 208–226.
B a r t o s z k o A. 2018b. The pharmaceutical other. Negotiating drugs, rights, and lives in substitution treatment of heroin addiction in Norway. Oslo.
B a r t o s z k o A. 2018c. From hope to §3–1: legal selves and imaginaries in the wake of substance treatment reform in Norway. Journal of Legal Anthropology 2 (1), 1–25.
B e s t J. 2008. Ambiguity, uncertainty, and risk: rethinking indeterminacy 1. International Political Sociology 2 (4), 355–374.
B o u r g o i s P. 2000. Disciplining addictions: The bio-politics of methadone and heroin in the United States. Culture, Medicine and Psychiatry 24 (2), 165–195.
B r e t t e v i l l e - J e n s e n A. and A m u n d s e n J. E. 2009. Forbruk av heroin i Norge. SIRUS Rapport. Oslo.
B r u n e r J. 2004. Life as narrative. Social Research 71 (3), 691–710.
C o n r a d P. 1985. The meaning of medications: another look at compliance. Social Science & Medicine 20 (1), 29–37.
C o u l t e r A., P a r s o n s S., A s k h a m J. 2008. Where are patients in decision-making about their own care? Copenhagen.
Da h l V. H. 2007. The methadone game: control strategies and responses. In J. Fountain and D. J. Korf (eds.), Drugs in society: European perspectives. Oxford, 102–115.
D u r h a m D. 2000. Youth and the social imagination in Africa: Introduction to parts 1 and 2. Anthropological Quarterly 73 (3), 113–120.
European Monitoring Centre for Drugs and Drug Addiction. 2017. Norway. Country drug report 2017, European drug report. Luxembourg.
F a i n z a n g S. 2014. Managing medicinal risks in self-medication. Drug Safety 37 (5), 333–342.
F i s c h e r E. 2014. Good life: aspiration, dignity, and the anthropology of wellbeing. Palo Alto.
F r i e d m a n J. and A l i c e a M. 2001. Surviving heroin: interviews with women in methadone clinics. Gainesville.
G i l l V. T. 2005. Patient “demand” for medical interventions: exerting pressure for an offer in a primary care clinic visit. Research on Language and Social Interaction 38 (4), 451–479.
G j e r s i n g L., Wa a l H., R ø i s l i e n J., G o s s o p M., C l a u s e n T. 2011. Variations in treatment organisation, practices and outcomes within the Norwegian opioid maintenance treatment programme. Norsk epidemiologi 21 (1), 113–118.
G u b r i um J. F., An d r e a s s e n T. A., S o l v a n g P. 2016. Reimagining the human service relationship. New York.
G u r m a n k i n A. D., B a r o n J., H e r s h e y J., U b e l P. A. 2002. The role of physicians’ recommendations in medical treatment decisions. Medical Decision Making 22 (3), 262–271.
H a c k i n g I. 1985. Making up people. In T. L. Heller, M. Sosna, D. E. Wellbery (eds.), Reconstructing individualism. Stanford, 161–171.
H a r r i s M. and R h o d e s T. 2013. Methadone diversion as a protective strategy: the harm reduction potential of ‘generous constraints’. International Journal of Drug Policy 24 (6), 43–50.
H a r r i s S. 2015. To be free and normal: addiction, governance, and the therapeutics of buprenorphine. Medical Anthropology Quarterly 29 (4), 512–530.
H e d r i c h D., A l v e s P., Fa r r e l l M., S t ö v e r H., Mø l l e r L., Ma y e t S. 2012. The effectiveness of opioid maintenance treatment in prison settings: a systematic review. Addiction 107 (3), 501–517.
Helsedirektoratet. 2010. Nasjonal retningslinje for legemiddelassistert rehabilitering ved opioidavhengighet. Oslo.
H e r z f e l d M. 1992. The social production of indifference: exploring the symbolic roots of Western bureaucracy. New York.
H o a g C. 2011. Assembling partial perspectives: thoughts on the anthropology of bureaucracy. Political and Legal Anthropology Review 34 (1), 81–94.
H o g g e t t P. 2001. Agency, rationality and social policy. Journal of Social Policy 30, 37–56.
H o n w a n a A. 2005. Innocent and guilty. Child-soldiers as interstitial and tactical agents. In A. Honwana and F. De Boeck (eds.), Makers and breakers: children and youth in postcolonial Africa. Oxford and Dakar, 31–52.
H y m a n S. E. 2005. Addiction: a disease of learning and memory. American Journal of Psychiatry 162 (8), 1414–1422.
Institute of Medicine. 2001. Crossing the quality chasm: A new health system for the 21st Century. Washington.
K a r n i e l i -Mi l l e r O. and E i s i k o v i t s Z. 2009. Physician as partner or salesman? Shared decision-making in real-time encounters. Social Science & Medicine 69 (1), 1–8.
K i rma y e r L. J. 1992. The body’s insistence on meaning: metaphor as presentation and representation in illness experience. Medical Anthropology Quarterly 6 (4), 323–346.
K l e i n m a n A. 1980. Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley.
K l o c k e r N. 2007. An example of ‘thin’ agency: child domestic workers in Tanzania. In R. Panelli, S. Punch, E. Robson (eds.), Global perspectives on rural childhood and youth: young rural lives. New York, 83–94.
K o e n i g C. J. 2011. Patient resistance as agency in treatment decisions. Social Science & Medicine 72 (7), 1105–1114.
L a v i e S., Na r a y a n K., R o s a l d o R. 1993. Creativity/anthropology. Ithaca.
L e a c h E. 1977. Custom, law, and terrorist violence. Edinburgh.
L u c a s S. D. 2016. The primacy of narrative agency: a feminist theory of the self. Sydney.
L u c a s S. D. 2017. The primacy of narrative agency: re-reading Seyla Benhabib on narrativity. Feminist Theory, First Published August 23, 2017.
M a h m o o d S. 2001. Feminist theory, embodiment, and the docile agent: some reflections on the Egyptian Islamic revival. Cultural Anthropology 16 (2), 202–236.
M a r c u s G. E. 2000. Introduction. In G. E. Marcus (ed.), Para-sites: a casebook against cynical reason. Chicago, 1–15.
M a t t i n g l y C. 2009. Senses of ending: self, body, and narrative. In U. J. Jensen and C. Mattingly (eds.), Narrative, self and social practice. Århus, 245–269.
M j å l a n d K. 2015. The paradox of control: An ethnographic analysis of opiate maintenance treatment in a Norwegian prison. International Journal of Drug Policy 26 (8), 781–789.
M o o r e D. 2008. Erasing pleasure from public discourse on illicit drugs: on the creation and reproduction of an absence. The International Journal on Drug Policy 19 (5), 353–358.
P e t r y n a A. 2002. Life exposed: biological citizens after Chernobyl. Princeton.
R a p p o r t N. and O v e r i n g J. 2000. Social and cultural anthropology: the key concepts. London.
R i k s h e i m M., G o s s o p M., C l a u s e n T. 2014. From methadone to buprenorphine: Changes during a 10 year period within a national opioid maintenance treatment programme. Journal of Substance Abuse Treatment 46 (3), 291–294.
S k e i e I., B r e k k e M., G o s s o p M., L i n d b a e k M., R e i n e r t s e n E., T h o r e s e n M., W a a l H. 2011. Changes in somatic disease incidents during opioid maintenance treatment: results from a Norwegian cohort study. BMJ Open 1 (1), doi: 10.1136/bmjopen-2011–000130.
S t i v e r s T. 2005. Parent resistance to physicians’ treatment recommendations: one resource for initiating a negotiation of the treatment decision. Health Communication 18 (1), 41–74.
St r a u s s A. L., S c h a t z m a n L., E h r l i c h D., B u c h e r R., S a b s h i n M. 1963. The hospital and its negotiated order. In E. Freidson (ed.), The hospital in modern society. New York, 147–169.
T r o s t l e J. A. 1988. Medical compliance as an ideology. Social Science & Medicine 27 (12), 1299–1308.
W a a l H., B u s s e s u n d K., C l a u s e n T., L i l l e v o l d P. H., S k e i e I. 2018. LAR 20 år. Status, vurderinger og perspektiver. Statusrapport 2017. SERAF Rapport 3/2018. Oslo.
W e b s t e r A., Do u g l a s C., L e w i s G. 2009. Making sense of medicines: ‘lay pharmacology’ and narratives of safety and efficacy. Science as Culture 18 (2), 233–247.
World Health Organization. 1992. International statistical classification of diseases and related health problems. Geneva.
A m u n d s e n E. J. and B r e t t e v i l l e - J e n s e n A. L. 2010. Hard drug use in Norway. Nordisk Alkohol- & Narkotikatidskrift 27 (1), 87–94.
A n d r e a s s e n T. A. 2004. Brukermedvirkning, politikk og velferdsstat. Oslo.
A n d r e a s s e n T. A. 2016. Professional Intervention from a Service User Perspective. In J. F. Gubrium, T. A. Andreassen and P. Solvang (eds.), Reimagining the human service relationship. New York, 35–56.
B a r n e s J. A. 1994. A pack of lies: towards a sociology of lying. Cambridge.
B a r r o w s H. S. and P i c k e l l G. C. 1991. Developing clinical problem-solving skills: a guide to more effective diagnosis and treatment. New York.
B a r t o s z k o A. 2018a. The lethal burden of survival: making new subjects at risk and the paradoxes of opioid substitution treatment in Norway. Contemporary Drug Problems 45 (3), 208–226.
B a r t o s z k o A. 2018b. The pharmaceutical other. Negotiating drugs, rights, and lives in substitution treatment of heroin addiction in Norway. Oslo.
B a r t o s z k o A. 2018c. From hope to §3–1: legal selves and imaginaries in the wake of substance treatment reform in Norway. Journal of Legal Anthropology 2 (1), 1–25.
B e s t J. 2008. Ambiguity, uncertainty, and risk: rethinking indeterminacy 1. International Political Sociology 2 (4), 355–374.
B o u r g o i s P. 2000. Disciplining addictions: The bio-politics of methadone and heroin in the United States. Culture, Medicine and Psychiatry 24 (2), 165–195.
B r e t t e v i l l e - J e n s e n A. and A m u n d s e n J. E. 2009. Forbruk av heroin i Norge. SIRUS Rapport. Oslo.
B r u n e r J. 2004. Life as narrative. Social Research 71 (3), 691–710.
C o n r a d P. 1985. The meaning of medications: another look at compliance. Social Science & Medicine 20 (1), 29–37.
C o u l t e r A., P a r s o n s S., A s k h a m J. 2008. Where are patients in decision-making about their own care? Copenhagen.
Da h l V. H. 2007. The methadone game: control strategies and responses. In J. Fountain and D. J. Korf (eds.), Drugs in society: European perspectives. Oxford, 102–115.
D u r h a m D. 2000. Youth and the social imagination in Africa: Introduction to parts 1 and 2. Anthropological Quarterly 73 (3), 113–120.
European Monitoring Centre for Drugs and Drug Addiction. 2017. Norway. Country drug report 2017, European drug report. Luxembourg.
F a i n z a n g S. 2014. Managing medicinal risks in self-medication. Drug Safety 37 (5), 333–342.
F i s c h e r E. 2014. Good life: aspiration, dignity, and the anthropology of wellbeing. Palo Alto.
F r i e d m a n J. and A l i c e a M. 2001. Surviving heroin: interviews with women in methadone clinics. Gainesville.
G i l l V. T. 2005. Patient “demand” for medical interventions: exerting pressure for an offer in a primary care clinic visit. Research on Language and Social Interaction 38 (4), 451–479.
G j e r s i n g L., Wa a l H., R ø i s l i e n J., G o s s o p M., C l a u s e n T. 2011. Variations in treatment organisation, practices and outcomes within the Norwegian opioid maintenance treatment programme. Norsk epidemiologi 21 (1), 113–118.
G u b r i um J. F., An d r e a s s e n T. A., S o l v a n g P. 2016. Reimagining the human service relationship. New York.
G u r m a n k i n A. D., B a r o n J., H e r s h e y J., U b e l P. A. 2002. The role of physicians’ recommendations in medical treatment decisions. Medical Decision Making 22 (3), 262–271.
H a c k i n g I. 1985. Making up people. In T. L. Heller, M. Sosna, D. E. Wellbery (eds.), Reconstructing individualism. Stanford, 161–171.
H a r r i s M. and R h o d e s T. 2013. Methadone diversion as a protective strategy: the harm reduction potential of ‘generous constraints’. International Journal of Drug Policy 24 (6), 43–50.
H a r r i s S. 2015. To be free and normal: addiction, governance, and the therapeutics of buprenorphine. Medical Anthropology Quarterly 29 (4), 512–530.
H e d r i c h D., A l v e s P., Fa r r e l l M., S t ö v e r H., Mø l l e r L., Ma y e t S. 2012. The effectiveness of opioid maintenance treatment in prison settings: a systematic review. Addiction 107 (3), 501–517.
Helsedirektoratet. 2010. Nasjonal retningslinje for legemiddelassistert rehabilitering ved opioidavhengighet. Oslo.
H e r z f e l d M. 1992. The social production of indifference: exploring the symbolic roots of Western bureaucracy. New York.
H o a g C. 2011. Assembling partial perspectives: thoughts on the anthropology of bureaucracy. Political and Legal Anthropology Review 34 (1), 81–94.
H o g g e t t P. 2001. Agency, rationality and social policy. Journal of Social Policy 30, 37–56.
H o n w a n a A. 2005. Innocent and guilty. Child-soldiers as interstitial and tactical agents. In A. Honwana and F. De Boeck (eds.), Makers and breakers: children and youth in postcolonial Africa. Oxford and Dakar, 31–52.
H y m a n S. E. 2005. Addiction: a disease of learning and memory. American Journal of Psychiatry 162 (8), 1414–1422.
Institute of Medicine. 2001. Crossing the quality chasm: A new health system for the 21st Century. Washington.
K a r n i e l i -Mi l l e r O. and E i s i k o v i t s Z. 2009. Physician as partner or salesman? Shared decision-making in real-time encounters. Social Science & Medicine 69 (1), 1–8.
K i rma y e r L. J. 1992. The body’s insistence on meaning: metaphor as presentation and representation in illness experience. Medical Anthropology Quarterly 6 (4), 323–346.
K l e i n m a n A. 1980. Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley.
K l o c k e r N. 2007. An example of ‘thin’ agency: child domestic workers in Tanzania. In R. Panelli, S. Punch, E. Robson (eds.), Global perspectives on rural childhood and youth: young rural lives. New York, 83–94.
K o e n i g C. J. 2011. Patient resistance as agency in treatment decisions. Social Science & Medicine 72 (7), 1105–1114.
L a v i e S., Na r a y a n K., R o s a l d o R. 1993. Creativity/anthropology. Ithaca.
L e a c h E. 1977. Custom, law, and terrorist violence. Edinburgh.
L u c a s S. D. 2016. The primacy of narrative agency: a feminist theory of the self. Sydney.
L u c a s S. D. 2017. The primacy of narrative agency: re-reading Seyla Benhabib on narrativity. Feminist Theory, First Published August 23, 2017.
M a h m o o d S. 2001. Feminist theory, embodiment, and the docile agent: some reflections on the Egyptian Islamic revival. Cultural Anthropology 16 (2), 202–236.
M a r c u s G. E. 2000. Introduction. In G. E. Marcus (ed.), Para-sites: a casebook against cynical reason. Chicago, 1–15.
M a t t i n g l y C. 2009. Senses of ending: self, body, and narrative. In U. J. Jensen and C. Mattingly (eds.), Narrative, self and social practice. Århus, 245–269.
M j å l a n d K. 2015. The paradox of control: An ethnographic analysis of opiate maintenance treatment in a Norwegian prison. International Journal of Drug Policy 26 (8), 781–789.
M o o r e D. 2008. Erasing pleasure from public discourse on illicit drugs: on the creation and reproduction of an absence. The International Journal on Drug Policy 19 (5), 353–358.
P e t r y n a A. 2002. Life exposed: biological citizens after Chernobyl. Princeton.
R a p p o r t N. and O v e r i n g J. 2000. Social and cultural anthropology: the key concepts. London.
R i k s h e i m M., G o s s o p M., C l a u s e n T. 2014. From methadone to buprenorphine: Changes during a 10 year period within a national opioid maintenance treatment programme. Journal of Substance Abuse Treatment 46 (3), 291–294.
S k e i e I., B r e k k e M., G o s s o p M., L i n d b a e k M., R e i n e r t s e n E., T h o r e s e n M., W a a l H. 2011. Changes in somatic disease incidents during opioid maintenance treatment: results from a Norwegian cohort study. BMJ Open 1 (1), doi: 10.1136/bmjopen-2011–000130.
S t i v e r s T. 2005. Parent resistance to physicians’ treatment recommendations: one resource for initiating a negotiation of the treatment decision. Health Communication 18 (1), 41–74.
St r a u s s A. L., S c h a t z m a n L., E h r l i c h D., B u c h e r R., S a b s h i n M. 1963. The hospital and its negotiated order. In E. Freidson (ed.), The hospital in modern society. New York, 147–169.
T r o s t l e J. A. 1988. Medical compliance as an ideology. Social Science & Medicine 27 (12), 1299–1308.
W a a l H., B u s s e s u n d K., C l a u s e n T., L i l l e v o l d P. H., S k e i e I. 2018. LAR 20 år. Status, vurderinger og perspektiver. Statusrapport 2017. SERAF Rapport 3/2018. Oslo.
W e b s t e r A., Do u g l a s C., L e w i s G. 2009. Making sense of medicines: ‘lay pharmacology’ and narratives of safety and efficacy. Science as Culture 18 (2), 233–247.
World Health Organization. 1992. International statistical classification of diseases and related health problems. Geneva.
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Published
2019-12-15
How to Cite
Bartoszko, A. (2019). Fallen Agents: Negotiations of Patient Agency in Norwegian Opioid Substitution Treatment. Ethnologia Polona, 40, 125–145. Retrieved from https://journals.iaepan.pl/ethp/article/view/28
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