Women, methadone, and the politics of supervised exclusion

This study examines women’s participation in methadone maintenance treatment (MMT) in British Columbia, Canada and concerns the intersections of addiction trajectories, clientization, and social exclusion. Drawing on life stories, physician interviews, and analysis of MMT (documentary) texts, the study explores how women experience MMT and other services in their efforts to improve life chances and social circumstances. Clientization in this case hinges on complex meanings of the body and care and can involve contestation of knowledge at various service sites. Five women’s life stories, told from the vantage point of their mid-adult years, confront the normative progress story that MMT involvement suggests and illustrate how participants actively navigated program demands and service relationships, as well as challenged moralizing and individualizing notions of the woman MMT client. Physician perspectives and MMT texts show narrow understandings of the woman methadone client and reveal the glaring need for broader supports for women experiencing drug use troubles. I develop the term “supervised exclusion” to show how medical subjectivity in this case minimally alleviates the participants’ experiences of social marginalization and complicates their economic and political marginalization. I argue that supervised exclusion is the intertwined process of “supervision” and “exclusion,” and MMT as a supervised treatment asserts a contradictory care and control element which additionally disempowers women who have few resources due to their long-term social, economic, and political exclusion. Women’s marginality persists in this context because although they actively challenge policies and discrimination at the level of MMT and broader service provision, they cannot dismantle such a complex problematizing of their lives without far more resources and political power.