Implants and depot injections for treating opioid dependence: Qualitative study of people who use or have used heroin

BACKGROUND

Long-acting opioid pharmacotherapy (OPT) is presumed to offer benefits over more conventional OPT formulations. This paper analyzes the views and experiences of people who use or have used heroin in order to explore two novel systems for delivering long-acting OPT: implants and depot injections. New materialism theorizing is used to interpret and frame the findings.

METHODS

Qualitative data were generated via seven focus groups conducted during 2017 in London, UK. Participants (n = 44; 28 men and 16 women; ages 33-66 years) had all received OPT. Focus group discussions covered real and potential OPT delivery systems. All participant data relating to implants and depot injections were coded using MAXQDA software and analysed inductively via Iterative Categorisation.

FINDINGS

Participants discussed implants and depot injections in terms of interacting physical, psychological and social factors: dose stability; OPT administration; stopping treatment; co-presence of an antagonist; breaking rituals and habits; reduced choice and control; feeling normal; information needs; getting on with everyday life; and social interaction. Participants identified both benefits and concerns, and variable needs and preferences, with respect to each delivery system.

CONCLUSIONS

Implants and depot injections are not 'fixed' medications that can be administered to people to achieve pre-determined treatment aims. Rather, they are complex 'assemblages' with uncertain outcomes. Furthermore, they are themselves part of wider interactive 'assemblages'. Drug developers and treatment providers need to understand this complexity in order to target long-acting OPT at people most likely to benefit from it, and to reduce any unintended negative consequences.

"With a PICC line, you never miss": The role of peripherally inserted central catheters in hospital care for people living with HIV/HCV who use drugs

BACKGROUND

People who use drugs (PWUD), and especially those who inject drugs, are at increased risk of acquiring bloodborne infections (e.g., HIV and HCV), experiencing drug-related harms (e.g., abscesses and overdose), and being hospitalized and requiring inpatient parenteral antibiotic therapy delivered through a peripherally inserted central catheter (PICC). The use of PICC lines with PWUD is understood to be a source of tension in hospital settings but has not been well researched. Drawing on theoretical and analytic insights from "new materialism," we consider the assemblage of sociomaterial elements that inform the use of PICCs.

METHODS

This paper draws on n = 50 interviews conducted across two related qualitative research projects within a program of research about the impact of substance use on hospital admissions from the perspective of healthcare providers (HCPs) and people living with HIV/HCV who use drugs. This paper focuses on data about PICC lines collected in both studies.

RESULTS

The decision to provide, maintain, or remove a PICC is based on a complex assemblage of factors (e.g., infections, bodies, drugs, memories, relations, spaces, temporalities, and contingencies) beyond whether parenteral intravenous antibiotic therapy is clinically indicated. HCPs expressed concerns about the risk posed by past, current, and future drug use, and contact with non-clinical spaces (e.g., patient's homes and the surrounding community), with some opting for second-line treatments and removing PICCs. The majority of PWUD described being subjected to threats of discharge and increased monitoring despite being too ill to use their PICC lines during past hospital admissions. A subset of PWUD reported using their PICC lines to inject drugs as a harm reduction strategy, and a subset of HCPs reported providing harm reduction-centred care.

CONCLUSION

Our analysis has implications for theorizing the role of PICC lines in the care of PWUD and identifies practical guidance for engaging them in productive and non-judgemental discussions about the risks of injecting into a PICC line, how to do it safely, and about medically supported alternatives.

Towards a relational paradigm in sustainability research, practice, and education

Relational thinking has recently gained increasing prominence across academic disciplines in an attempt to understand complex phenomena in terms of constitutive processes and relations. Interdisciplinary fields of study, such as science and technology studies (STS), the environmental humanities, and the posthumanities, for example, have started to reformulate academic understanding of nature-cultures based on relational thinking. Although the sustainability crisis serves as a contemporary backdrop and in fact calls for such innovative forms of interdisciplinary scholarship, the field of sustainability research has not yet tapped into the rich possibilities offered by relational thinking. Against this background, the purpose of this paper is to identify relational approaches to ontology, epistemology, and ethics which are relevant to sustainability research. More specifically, we analyze how relational approaches have been understood and conceptualized across a broad range of disciplines and contexts relevant to sustainability to identify and harness connections and contributions for future sustainability-related work. Our results highlight common themes and patterns across relational approaches, helping to identify and characterize a relational paradigm within sustainability research. On this basis, we conclude with a call to action for sustainability researchers to co-develop a research agenda for advancing this relational paradigm within sustainability research, practice, and education.

Becoming enwinded: A new materialist take on smoking pleasure

What might new materialist perspectives bring to our understanding of smoking pleasure? In this paper, I draw on this thinking to sketch out an alternative, non-unitary smoker who is at the mercy of the whims of the breeze - a yielding I will argue is key to smoking pleasure. With these intentions in mind, rather than thinking of what the biotechnology of cigarettes accomplishes in terms of the chemical delivery of pleasure, or adding to the multiply of social and cultural reasons anthropologists have tendered to account for it, I approach smoking pleasure in and through the medium of the smoky air. This approach permits examination of how nonhuman and human agents, like cigarettes, lungs, hands and other things form momentary and contingent relation in the air, as well as the role of the air itself in 'enwinding' the smoker. When smoking pleasure is explored from such a perspective, the smoker can be recast as part of a complex of relations that she does not fully control, rather than the agentic centre or principal arrayer of the nonhuman world. The pleasures of smoking, and the smoker herself, I argue, are emergent and come into being precisely in these relations: 'the smoker' originates, terminates, and is defined in and with elements, rather than being surely and certainly attached to a particular smoker subjectivity. Chief among the complex of things and elements that make the smoker and her pleasure is the air itself - and it is the air itself that is my primary informant in this paper.

Understanding addiction: The shift from epistemology to ontology

This essay contrasts a late modernist epistemological paradigm with an ontology-oriented Anthropocene-conscious Approach (ACA) as frameworks for understanding the coming into being and the making of addiction. Operationalizable theories and concepts of addiction have been crucial in an era with a great demand for compartmentalizing and systemically defining psychological struggles and social problems. In the modernistic progress story, the addiction phenomenon materializes through the conceptual division between capacity and non-capacity, with those capable of mastering their urges on one side and those incapable of doing so on the other. The ACA strives actively to move beyond artificial divides between agency/structure, culture/nature, mind/matter and instead explore phenomena ecologically across these continuums. This entails a conscious re-focus away from authoritative human-made assumptions towards new types of knowledge and knowing. In the ACA assemblage-like ontology, different elements are brought together in their capacities to affect each other into entities. Due to its claims of practical uses, I predict that the ACA will become as influential as Foucauldian genealogy in the field of addiction studies.

Coronavirus, capitalism and a 'thousand tiny dis/advantages': a more-than-human analysis

This paper establishes a relational, post-anthropocentric and materialist approach to the Covid-19 coronavirus pandemic. Analysis of the 'pandemic assemblage' reveals that the virus has subverted the social and economic relations of capitalism, enabling its global spread. This insight establishes a materialist framework for exploring socio-economic disparities in Covid-19 incidence and death rates, via a more-than-human and monist analysis of capitalist production and markets. Disparities derive from the 'thousand tiny dis/advantages' produced by people's daily interactions with human and non-human matter, making sense of the unequal occupational patterning of coronavirus incidence. This more-than-human approach supplies a critical alternative to the mainstream public health and scientific perspectives on the pandemic, with important implications for current and future policy to counter future microbiological outbreaks.

Can robots lie? A posthumanist approach to robotic animals and deceptive practices in dementia care

Robotic animals are designed to resemble real, living animals, but at the same time, dementia care guidelines and policies often emphasize the value of transparency in relation to robots-people should not be led to believe that robots have capacities that they in fact lack. However, it is not obvious how to separate truth from lies in everyday care practice. Based on participant observations and interviews with certified assistant nurses and nursing assistants in Swedish nursing homes for people with dementia, this article studies how robotic animals become "real" in care practice. The article takes a posthumanist approach to the co-constitution of aging, care, and technology-a perspective that recognizes that not only care staff and nursing home residents, but also robots and other material things, can take an active part in shaping care practice. The analysis results in four typical situations out of which robotic animals emerge as real, living animals: the cuddle, with its simple but dynamic embodied actions; the comfort, where the robot is used as a resource for distraction and emotional support; the conversation, by which robotic animals' agency is both established and challenged; and the adoption, through which narratives and props are used to establish the robot as a pet. Robots cannot lie, at least not by themselves; instead, robots' deceptive potential is enabled by a network of actors, which is why it is often difficult to draw a clear line between lying and care workers' empathic following.

We are what we smell: the smell of dis-ease during lockdown

How does the COVID-19 pandemic shape subjectivity? This paper is concerned with contributing to theorising subjectivity at an ontological level. It draws on a feminist new materialist understanding of subjectivity as an intra-active becoming of human-non-human matter that includes smell. Smellwalks are mobilised to apprehend how subjectivity is altered via restrictions around movement and social connection during lockdown. This sensory method recognises knowing is not simply a cognitive practice and that odour actively shapes understandings of ourselves and the world. The varying presence and absence of odours in and out of lockdown eventuate a re-arrangement of subjectivity which draws on Vannini's (2020) notion of atmospheric dis-ease. Lockdown produces a subjectivity of dis-ease which generates changes in perception of self and others, as sources of potential viral contagion. Lockdown's material conditions engender a 'socially flattened' and 'suspended subjectivity' as our 'normal' selves are experienced as being put on hold until the global crisis abates.

The Matter of Disability

By ruling out questions of impairment from the social critique of disability, Disability Studies (DS) analyses establish a limit point in the field. Of course the setting of "limits" enables possibilities in multiple directions as well as fortifies boundaries of refusal. For instance, impairment (the biological conditions of an organism's inefficient attachment to the world) becomes in DS simultaneously a productive refusal to interpret disabled bodies as inferior to non-disabled bodies (i.e. pathologized) and a bar to thinking through more active engagements with disability as materiality. Disability materiality such as conditions produced by ecological toxicities serve as active switch-points for creative corporeal navigations of the interaction between bodies and environments.In fact in this paper we want to propose a more "lively" definition of disability materiality to existing definitions of impairment as limiting expressions of non-normative bodies. We have no useful ways of explaining disability as adaptation and it's time we begin the process of theorizing more active ideas of materiality that extend existing ideas of disability beyond simplistic conceptions of socially rejected biologies made available by social constructivist thought.

Waiting for inpatient detoxification: A qualitative analysis of patient experiences

BACKGROUND

There is limited provision of inpatient detoxification relative to other treatments for alcohol and other drug (AOD) use. This means people often need to wait prior to detoxifying. However, waiting for healthcare is generally perceived as negative and stressful. This paper aims to understand patients' experiences of waiting for inpatient AOD detoxification to ascertain whether and how service-level policies and practices might be improved.

METHODS

Semi-structured telephone interviews were conducted with 32 people (20 males, 12 females; aged 25-67 years) who were waiting for inpatient detoxification. Data collection was part of a wider evaluation of a policy initiative started in 2021 to increase detoxification service capacity in England, UK. Interviews were professionally transcribed and data on waiting experiences were coded using qualitative software. Analyses were informed by new materialist thinking and undertaken via Iterative Categorisation.

RESULTS

We found that waiting was constituted through five dimensions: i. duration; ii. support; iii. information; iv. preparations; and v. emotions. These five dimensions were multi-faceted and operated in and through wider interacting social, material, and affective forces (e.g., professional judgements, formal and informal relationships, the availability of beds and funding, bureaucratic procedures, the utility and relevance of information, and participants' diverse feelings, including desperation for treatment). Not all accounts of waiting were negative. The experience was complex, non-uniform and variable over time. Moreover, it affected how people felt and how they behaved.

CONCLUSIONS

Changes to service-level policies and practices can potentially minimise the stress of waiting for inpatient AOD detoxification. The negative impact of waiting may be reduced if professionals more consistently engage patients in a wider range of constructive pre-treatment activities, offer regular 'check-ins' to mitigate any anxiety, explain changes in wait duration to help with planning and demonstrate fairness, and facilitate contact between those waiting to lessen feelings of isolation.

Forms of life: a literary formalist view on biological individuality

This article argues for a formalist approach to biological individuality, bridging formalist ways of reading in cultural and literary studies with contemporary debates in the philosophy of biology. Central to this discussion is the idea that the question of what constitutes an individual, spanning across domains such as biology, politics, law, and literature, is essentially a question of form: the conditions by which we individualise enforce a specific pattern through which we interpret the world, whether it is the natural world, the social world, or the fictional world of a literary text. Taking this as a starting point, the article adopts a strategic formalist method as articulated by Caroline Levine, employing a close-reading method that asks how forms of individuality, whether they are phenomenal, theoretical, or cultural, operate as they move beyond their designated system of discourse; what they afford when they travel across dissimilar materials; and what occurs when they intersect with other forms, be they sociopolitical, poetic, or aesthetic. Considering literary and sociopolitical forms on the same plane of existence as theoretical forms of individuality enables a needed conversation on the affordances of forms in both the production of knowledge and in the cultural imagination.

Theorising mother-baby-assemblages: The vital emergence of maternal health

First-time motherhood is a well-studied yet poorly understood determinant of health. Giving birth has significant physical, mental and social health impacts across the life course. Maternal transition research has attempted to understand first-time mothers' psychological and social needs to improve overall health. However, much of this research struggles to capture the fluid and fluctuating nature of affects, senses and bodies across human and non-human spheres, and has reached conceptual saturation. In this paper, I develop mother-baby-assemblages as a way forward in theorising first-time motherhood to better understand how maternal health is produced intra-actively through the relationality between human and non-human actants. I achieve this by plugging into feminist psychoanalytic and new materialist theory, diffractively reading across published qualitative maternal transition literature spanning five decades and enriching affectively through my own mothering encounters. I engage with topics at the forefront of maternal health research, including bodies, babies, vibrant matter, physical and online spaces and paid employment demands. I theorise trans-subjective and more-than-human emergent mother-baby-assemblages that invite relationality and difference over identity and linearity in the becoming-mother to replace human agency with the capacity to affect and be affected through human and non-human forces. I weave together theory, published data and personal encounters to move beyond understanding becoming-mother as a linear process, and instead think of this becoming-through-each-other as mother-baby-assemblages. Maternal health therewith becomes a product of distributed, emerging, fluctuating, and affecting agencies across human and non-human spheres. Such an approach can steer towards health initiatives for first-time mothers that are socio-materially grounded, consider reciprocity of needs, diversify responsibilities for child-rearing, and encourage future scholarship of the human and non-human emergence of maternal health.

Carving and making space through dance - Older people using dance to experience their ageing body and challenge ageist discourse

Drawing on qualitative data from a study of older adults' participation in a contemporary dance group, this paper asks what can be gained from new materialist concepts of the older body, and how they can expand cultural gerontological thinking about embodiment. This paper examines the connections between the older body, movement, thoughts, words and spaces, arguing that dance demonstrates that there is a spatial dimension to embodiment. In drawing from models of materiality emerging in gerontology, this paper provides insights about the experience of age, questioning fundamental categorizations promoted in Western culture, and re-thinks agency in relation to the body and space. Emphasising the importance of the material world in the production of the social has important implications in terms of understanding the experience of ageing within an ageist society.

The dynamics of more-than-human care in depot buprenorphine treatment: A new materialist analysis of Australian patients' experiences

BACKGROUND

Long-acting injectable depot buprenorphine has become an important treatment option for the management of opioid dependence. However, little is known about patients' experiences of depot buprenorphine and its embodied effects. This qualitative study aims to explore patients' experiences of depot buprenorphine treatment, including how it feels within the body, experiences of dosing cycles across time, and how this form of treatment relies on wider ecologies of care beyond the clinical encounter.

METHODS

Participants were recruited from sites in Sydney, regional New South Wales, and Melbourne, Victoria, Australia. Thirty participants (16 men, 14 women) participated in semi-structured interviews. Participants had histories of both heroin and prescription opioid consumption, and opioid agonist therapy including daily dosing of buprenorphine and methadone.

RESULTS

Our analysis illuminates: (1) how patients' expectations and concerns about treatment are linked to past embodied experiences of withdrawal and uncertainty about the effectiveness of depot buprenorphine; (2) the diverse meanings patients attribute to the depot buprenorphine substrate 'under the skin'; and, (3) how depot buprenorphine is embedded within wider ecologies of care, such as counselling and social supports.

CONCLUSION

Our analysis destabilises commonplace assumptions about a linear, causal relationship between the pharmacological action of depot buprenorphine and experiences of treatment. Instead, it highlights patients' variable experiences of depot buprenorphine, tracing the everyday practices, embodied feelings, expectations and wider networks of care that shape patient experiences. We conclude with some reflections on the implications of our analysis for alcohol and other drug treatment, specifically how they might inform the design of client education materials and care.

Working in a 'community-engaged' university during an era of reconciliation

This duoethnography, informed by the new materialist turn, explores how educational work is materially reconfigured within university-community collaborations. Through our co-facilitation of two community-based Master of Education programs we, as White settlers, endeavoured to journey with Indigenous colleagues, community members, and students to respond to calls for transformative reconciliation. It is within these complex relational fields that we explore the shifting nature of our work as educators within a Canadian university. When educational work resides within community, it becomes a living relationship among people and place, requiring a new type of faculty expertise that disrupts the usual boundaries between disciplinary knowledge and the academic triad, and exceeds professional responsibilities. Through our MEd programs, we are coming to understand our work as educators as always a collaborative act in the making, and as a form of scholarly activism.