Ambiguous indifference: fatal overdoses following treatment for drug use

Abstract

BACKGROUND – In the European context, Norway has one of the highest overdose mortality rates. Research shows that the risk of overdose mortality among marginalized drug users is particularly high during the weeks immediately following in-patient treatment for drug use. AIM – It is therefore interesting to investigate whether there might be a connection between marginalization and treatment culture in order to understand the overdose mortality following discharge from in-patient treatment. DESIGN & METHODS – The case study is based on a previous field study combined with a registry link. The study focuses on a single individual, Sam, and his treatment process. Data is analysed in the light of a culture-analytical perspective. RESULTS – The results show how the treatment system can represent a social arena for institutional exclusion and marginalization, which can aggravate the person’s self-esteem and life situation. One central aspect of the treatment process was that it generated indifference. Sam’s treatment motivation developed into treatment indifference. In the last part of the article, the author discusses indifference as a risk aspect of overdose mortality after discharge from treatment. It is not possible to conclude whether Sam’s fatal overdose was an accident or suicide. However, in the light of action theory, the case can show that indifference can be a central aspect of both unintentional and intentional fatal overdoses. Sam’s death can be understood in the light of the concept ambiguous indifference. CONCLUSION – The case shows that there may be a relationship between marginality, treatment culture and overdose mortality. Cultural and structural aspects of the treatment system put Sam in a risky situation and left him in a void, which probably contributed to his death. A comparison of risk situations between this case history and recent research on the treatment system shows several worrying similarities in relation to overdose mortality after discharge from in-patient treatment.