Destruction, fascination and illness: risk perceptions and uses of heroin and opiate maintenance treatment drugs

Abstract

In this article, we examine the symbolic meaning, perceived risks and cultural framing of heroin and opiate maintenance treatment drugs among legal and illegal drug users in Norway. We use data from three groups of drug users, binge-drinkers in the night-time economy, cannabis users and heavy-end illegal drug users. We interviewed 207 drug users of who 123 talked about heroin and/or opiate maintenance treatment, and 25 had used such substances. We found that these users framed heroin in two interlinked ways: one frame emphasised the risk, destruction and illness associated with heroin use and in the other heroin was associated with pleasures and fascinating transgressions. We found that most participants in our studies described how heroin users needed medical help and held favourable opinions of the opiate maintenance treatment system. However, heavy-end drug users were more sceptical, claiming that these drugs were also used for intoxication purposes and associated with risk of overdose, dependence and stigma. The framing of heroin emphasising intense pleasures and transgressions did not have an equivalent in descriptions of opiate maintenance treatment drugs. Among heavy-end users opiate maintenance treatment drugs were often described with contempt, and these drugs were situated at the bottom of the hierarchy of drugs. Such cultural framings can lead some heroin users to avoid this treatment system. We suggest that policy makers and those involved in treatment pay close attention to the continuous framing of drug risks in drug-using populations.