Anthea Martin | Middlesex University (original) (raw)

Papers by Anthea Martin

$Research paper thumbnail of Treatment expectations and satisfaction of treatment-refractory opioid-dependent patients in RIOTT, the Randomised Injectable Opiate Treatment Trial, the UK's first supervised injectable maintenance clinics$

Introduction and Aims. The study investigates patients' pre-treatment expectations of, and post-t... more Introduction and Aims. The study investigates patients' pre-treatment expectations of, and post-treatment satisfaction with, supervised injectable opiate treatment delivered within UK's first such clinics within the Randomised Injectable Opiate Treatment Trial (RIOTT) (ISRCTN0133807). Design and Methods. Data were collected from 127 chronic heroin addicts recruited to RIOTT and randomised to receive supervised injectable (heroin or methadone) treatment or optimised oral maintenance treatment at supervised injectable maintenance clinics in London, Darlington and Brighton. Results. Of 127 RIOTT patients, 113 (89%) provided responses to structured enquiry about treatment expectations, and 94 (74%) subsequent responses about treatment satisfaction (at six months). Patients were hoping that injectable heroin treatment would: reduce substance misuse ; help achieve normality, routine and structure (16%); and increase education and work prospects (15%).At six months, an area of treatment satisfaction most commonly reported by all three trial groups was reduced substance misuse (supervised injectable heroin 59%, supervised injectable methadone 56%, optimised oral methadone 54%). Most found supervision acceptable, but some desired modifications were also identified. Discussion and Conclusions. Patients previously considered non-responsive to treatment appear to have similar treatment expectations and aspirations as other drug users in treatment. Supervised injectable opioid treatment patients consistently reported treatment satisfaction but also that more could be done to optimise aspects of current arrangement. This raised the challenging issue of the extent to which opinions of patients need to be taken into consideration in shaping future treatment provision. Future research may need to examine the extent of expectations 'fit' and the relationship between treatment sought and received. [Groshkova T, Metrebian N, Hallam C, Charles V, Martin A, Forzisi L, Lintzeris N, Strang J. Treatment expectations and satisfaction of treatmentrefractory opioid dependent patients in Randomised Injectable Opiate Treatment Trial, the UK's first supervised injectable maintenance clinics. Drug Alcohol Rev 2013;32:566-573]

International journal of drug policy, Jan 1, 2004

This paper considers the use of qualitative research in the drugs field. Proponents have traditio... more This paper considers the use of qualitative research in the drugs field. Proponents have traditionally claimed that by capturing participants' lived experience through language, qualitative approaches are either the 'antidote' or the necessary complement to quantitative methods. The present paper troubles this over-simplistic dichotomy between quantitative and qualitative: both approaches often share the same ontological assumptions, rely on the same representational logic and are, in the context of 'applied' research, subject to a 'will to truth' born of a specific relation to policy. Poststructuralist ideas about the production of knowledge and the relationship between discourse and power are presented. Drugs research as both praxis and knowledge base may be seen as part of the machinery of advanced liberal government, which seeks to govern at a distance through the inscription of subjectivity. The drug user is produced and re-produced as a subject within research, always already positioned in relation to certain 'truths'. We need to conceive of qualitative research and what our participants tell us differently, such that the constructive and constructed nature of knowledge and talk becomes the focus of inquiry. Discourse analysis -with its focus on construction and function within discourse -is presented as compatible with poststructuralist ideas. To illustrate the use of this approach, three interview accounts of how participants first came to use heroin are analysed. The discourses and subject positions underpinning the 'peer pressure', the 'response to distress' and the 'risk appraisal' account are described, and we consider how these accounts might function as 'harm warrants' for intervention. Criticisms of a poststructuralist approach and its implications for qualitative research within the broader field of drugs research and policy are addressed.

Drawing on qualitative interview accounts with people who have injected drugs, we deploy ideas of... more Drawing on qualitative interview accounts with people who have injected drugs, we deploy ideas of biological and therapeutic citizenship to explore how the negotiation of access to hepatitis C treatment enacts patient citizenship potential. We find that the patient citizenship made through hepatitis C treatment divides those who are deserving from those who are not, largely in relation to their presentations of self-control, responsibility and recovery regarding drug use. Accessing treatment requires that patients negotiate their entitlement by reflexively producing the patient citizen role expected of them. In this context of rationed treatment expectation, access to treatment is constructed in relation to gratitude rather than entitlement. Rationed treatment expectation also interplays with a utilitarian approach to hepatitis C expertise. Accounts of the bio-effects of hepatitis C and its treatment as uncertain further weaken the potential for shared illness identity and biosocial membership as well as contributing to treatment delay. We conclude that the construction of hepatitis C treatment as a negotiation of 'recovery towards normality' positions people who continue to use or inject drugs as beyond patient citizenship. Our findings underscore the situated limits of therapeutic and biological citizenship, emphasising that these processes are unavoidably forces of governance.

a b s t r a c t HCV (hepatitis C) treatment uptake among the population most affected e people wh... more a b s t r a c t HCV (hepatitis C) treatment uptake among the population most affected e people who inject drugs e is suboptimal. Hospital based treatment provision is one evidenced barrier to HCV treatment uptake. In response, HCV treatment is increasingly located in treatment settings seen as more amenable to people who inject drugs, such as drug and alcohol services. We explored the accessibility of HCV treatment provision at two such partnerships. Data collection comprised qualitative interviews collected in 2011 and 2012 with 35 service users and 14 service providers of HCV treatment in London, United Kingdom. We draw here primarily on thematic analyses of service provider accounts, yet narratives relating to trust and environment emerged unsolicited in both user and provider accounts of negotiated HCV treatment access. A key theme in service provider accounts were strategies they deployed to 'tame' the treatment system so as to create an 'enabling environment' of care, in which trust was a critical feature. This 'taming' of the system was enacted through practices of 'negotiated flexibility', including in relation to appointments, eligibility, and phlebotomy. Service user accounts accentuated familiar environments and known health providers as those most trusted, and the potentially stigmatising effects of negotiating treatment in unfamiliar territory, especially hospital settings. Whilst noting the effects of provider strategies to negotiate flexibility on behalf of would-be patients seeking treatment, we conclude by noting the limits of trust relations in settings of constrained choice.

The Lancet, Jan 1, 2010

Background Some heroin addicts persistently fail to benefit from conventional treatments. We aime... more Background Some heroin addicts persistently fail to benefit from conventional treatments. We aimed to compare the effectiveness of supervised injectable treatment with medicinal heroin (diamorphine or diacetylmorphine) or supervised injectable methadone versus optimised oral methadone for chronic heroin addiction.

Mental Health and …, Jan 1, 2010

Social Science & …, Jan 1, 2007

Drug injecting in public places is associated with elevated health harm among injecting drug user... more Drug injecting in public places is associated with elevated health harm among injecting drug users (IDUs). Yet there is little research exploring the lived experience of injecting in public places, and specifically, a need to explore the interplay of public injecting environments, risk practices and social marginalisation. We undertook 49 qualitative interviews with IDUs in South Wales, UK, in six locations. Analyses focused on injectors' narratives of injecting in public places and risk identity. Findings show how the lived experience of public injecting feeds a pervasive sense of risk and 'otherness' among street injectors, in which public injecting environments act as contextual amplifiers of social marginalisation. Injecting in public places was characterised by urgency associated with a fear of interruption, a need to maintain privacy to prevent public exposure, and an awareness or sense of shame. We argue that daily interactions involving public exposure of injecting status, combined with the negative social meanings ascribed to public places used for injection, are experienced as potentially degrading to one's sense of self. We conclude that the public injecting environment is experienced in the context of other forms of public shaming in the lives of street injectors, and is thus productive of symbolic violence. This highlights tensions between strategies seeking to create safer communities and environmental interventions seeking to reduce drugrelated health harm, including recent innovations such as the 'drug consumption room' (DCR). r

International Journal of …, Jan 1, 2006

Drawing on data from recent surveys and pilot qualitative interviews among injecting drug users (... more Drawing on data from recent surveys and pilot qualitative interviews among injecting drug users (IDUs) in England, we highlight the potential 'normalisation' of the use of the femoral vein (groin) as a site of injection. We estimate that 45% (428/952) of IDUs in English cities report groin injecting in the last 4 weeks, rising to over 50% in some areas. We also note transitions towards the injection of crack cocaine among poly drug injectors in some UK locations. We estimate that 40% (381/952) of IDUs in English cities report crack injection in the last 4 weeks, rising to over 70% in some cities. Findings from pilot qualitative interviews among homeless injectors in London are suggestive of groin injecting being situated as an 'acceptable risk'. We emphasise the need for research to explore the potential interplay between unstable housing, groin injecting and crack injecting. We call for renewed emphasis within harm reduction interventions advising injectors how to maximise the health and longevity of arm and other peripheral veins, and for greater preparedness to advise known groin injectors how to minimise health risks associated with groin injecting.

Social Science & Medicine, Jan 1, 2004

There is little published research about how people who inject drugs are responding to the hepati... more There is little published research about how people who inject drugs are responding to the hepatitis C epidemic. This study seeks to address the prevention of hepatitis C using qualitative interviews with people who inject drugs in London. We explored narratives about risk reduction and hepatitis C in the social and historical context of other risks such as HIV, vein damage and overdose. Themes of the narratives included: the importance of autonomy in the acquisition of safer injecting skills; that safer injection was regarded as 'common sense', normalised and predicated on the risk of HIV; that hepatitis C risk was relativised with HIV risk and thereby seen as less important; and that hepatitis C infection was also seen as unavoidable. These narrative forms represent significant challenges for the management of the hepatitis C epidemic, both in terms of the existing risk reduction efforts designed for HIV and in terms of the articulation of risk reduction for injectors with general public health policy. r

Reports by Anthea Martin

Home Office Research, …, Jan 1, 2003

Vulnerability and involvement in drug use and sex work Foreword This re p o rt is one of five re ... more Vulnerability and involvement in drug use and sex work Foreword This re p o rt is one of five re s e a rch re p o rts published as part of the Vulnerable Gro u p s R e s e a rch Programme. The central focus of the programme was to investigate patterns of d rug use among groups of vulnerable young people and their access to services. Each p roject focuses on a diff e rent group of vulnerable young people, who tend not to be included in general population surveys. The project reported on here concentrates on young people involved in sex work. The four other projects examine: young people leaving care including runaways; homeless young people; young drug users who are in contact with juvenile drug services; and young people in contact with youth offending teams. Many of the young people across these projects are likely to have had similar backgrounds and vulnerabilities. A number of the studies explore this area and the degree to which the young people are in fact the same population caught at diff e rent points in their lives and via different services.

No.: ISBN 1 84473 031 …, Jan 1, 2003

The substance misuse t reatment needs of minority prisoner gro u p s : women, young off e n d e r... more The substance misuse t reatment needs of minority prisoner gro u p s : women, young off e n d e r s and ethnic minorities Home Office Development and Practice Report The substance misuse treatment needs of minority prisoner groups: women, young offenders and ethnic minorities Home Office Development and Practice Reports draw out from re s e a rch the messages for practice development, implementation and operation. They are intended as guidance for practitioners in specific fields. The re c o m m e n d a t i o n s explain how and why changes could be made, based on the findings from re s e a rch, which would lead to better practice.

The conclusions and recommendations at the end of this report reflect the findings from both quan... more The conclusions and recommendations at the end of this report reflect the findings from both quantitative survey and qualitative investigations.

Conference Presentations by Anthea Martin