Involuntary discharge from medication-assisted treatment for people with heroin addiction - patients' experiences and interpretations

AIMS - To examine what happens to patients who have been involuntarily discharged from medication-assisted treatment (MAT) with methadone or buprenorphine in Malmo, Sweden. MATERIAL AND METHOD - A total of 35 people, with a long history of heroin addiction, were interviewed, including ten women. Most interviewees were recruited among visitors with discharge experiences at the local needle exchange programme. The article focuses on these informants' experiences and interpretations of being discharged. RESULTS - Discharge had little legitimacy and was perceived as unfair. Several of the interviewees went back to heroin abuse while others tried to create their own maintenance programmes by buying methadone or buprenorphine on the black market. Many resorted to crime or prostitution to make ends meet. CONCLUSIONS - According to National Board of Health and Welfare regulations, discharge and a three-month exclusion from all MAT is an appropriate response to violation of rules. Exclusion nevertheless led to harsh consequences. The interviewees' living conditions were consistently impaired, as were their physical and mental health and contacts with family members, since they soon returned to a lifestyle and drug abuse similar to that before treatment.