Ethical problems related to needle-exchange and methadone-provision programs
Workers who work with drug addicts in needle-exchange and methadone-provision programs encounter ethical challenges every day. This article presents the results of a qualitative analysis of the ethical problems encountered by 26 Montreal workers in their daily practice. The data was analysed using an ethical framework inspired by Paul Ricoeur’s ethical approach. Problems were classified in two categories. First, those linked to the political, legal, or organizational context, notably, the prosecution of drug addicts, the discrepancy between technocratic management and ground-level realities, and inconsistencies in practices and services. Second, the problems mentioned involve the relationships that develop during these programs related to access for certain people (e.g. minors, pregnant women, violent individuals) to services, outreach workers’ relationships with the people being helped, confidentiality, power relationships, and moralizing. This study shows the complexities inherent in these problems and the necessity of analysing them in an ethical system that integrates all dimensions of harm reduction intervention.