Pharmaceutical leakage, diverted uses and the reconfiguration of a pharmaceutical for opiate substitution
Through the mechanism of pharmaceutical leakage from the medical sphere to drug markets, the ambivalent nature of molecules contributes to the multiple uses of medicines. This article examines diverted uses of Subutex® (high dose buprenorphine – HBD) – currently the most frequently used substitution treatment for opiate dependency in France – by injection drug users (IDUs) in Marseille. Following findings about the necessity of taking into account individual and contextual factors to understand drug trafficking and risky drug consumption, this study began with the working hypotheses that (1) diverted uses of HDB are integrated into pre-existing drug worlds; (2) geographic characteristics are implicated in the reconfiguration of these uses. Data collected through questionnaires on 62 UDI clients of automats for syringe exchange-recuperation in Marseille, a group little known to drug treatment programs, were explored in a series of multiple components analyses, resulting in two paradoxical effects. Diverted HDB appears to be integrated in a configuration of intensive drug use with risky practices characteristic of the very opiate (heroin) it is meant to replace. In a poor, de-industrialized area of Marseille, such uses are associated with the stabilisation of some IDUs, not through social reintegration in accordance with French health drug policy, but through marginal integration, by holding in abeyance a population of older users. Pharmaceutical leakage thus furnishes a heuristic tool for looking beyond the medical gaze and should be useful for better understanding medicines in general.