"Tethered to this ball and chain": Women's perspectives on bodily agency within opioid treatment programs

Methadone Maintenance Treatment (MMT) reduces the risks associated with opioid use disorder (OUD), including overdose mortality and HIV/HCV transmission, and promotes patient well-being. Nonetheless, MMT is highly underutilized in the United States, with less than 10 % of those with OUD receiving MMT. This study examines how women's feelings of bodily agency while receiving MMT through Opioid Treatment Programs (OTPs) can impact treatment retention.

In-depth interviews were conducted with 20 women in Pennsylvania with a lifetime history of criminal legal involvement and use of medications for opioid use disorder (MOUD), and 12 substance use disorder (SUD) treatment professionals who work with criminal-legal involved women using MOUD. A thematic analysis was conducted using iterative rounds of inductive coding.

While women attested to the profound benefits which methadone treatment can provide, they also described how both formal and informal policies in the OTP system can taper these benefits by diminishing their feelings of bodily agency. Women reported a lost sense of bodily agency due to being unable to provide input in the dosing process, navigating strict requirements that tied medication receipt to compliance, and facing mistreatment or threats of punishment when committing perceived transgressions. Women responded through actions that reclaimed bodily agency, by either leaving treatment or using illicit drugs while in treatment; both of these actions can end women's engagement with treatment. Finally, evidence suggests that these feelings of lost agency may be particularly prevalent among female patients due to gendered judgments about women's histories and capabilities.

Findings suggest the need for MMT programs to shift toward patient-centered, trauma-informed care informed by harm-reductionist principles. Concrete policy recommendations include reducing measures of surveillance, prohibiting administrative discharge due to the use of other substances, and expanding access to methadone beyond OTPs.