Systemic neglect hidden behind tolerance: the reproduction of vulnerability among aging heroin users within the community-based rehabilitation.

Abstract

Background and objectives: Contemporary Chinese drug governance is shifting its focus toward the rehabilitation of people who use drugs, prioritizing restorative over punitive measures. Moving beyond previous research that has primarily focused on the importance of community-based rehabilitation mechanisms in facilitating social reintegration, this study aimed to understand aging heroin users' experiences within broader systems of power, citizenship, and social exclusion in China.

Research design and methods: We conducted fieldwork in a city in the eastern region in China in 2020-2021 and interviewed 12 heroin users aged 65-75 years. We employed Atkinson's life story interview as an approach to collect data and Abbott's group life course to examine how aging heroin users, both as individuals and as a cohort with distinct drug experiences and aging traits, narrate their interactions within the national rehabilitation programs.

Results: Our findings contend that older heroin users, even after testing positive, receive lenient institutional treatment, often exempting them from compulsory rehabilitation due to age-related health issues and care burdens. To mitigate the risk of overdose, drug enforcement authorities utilize social welfare programs as a means of promoting self-management among aging users. However, this approach neglects the general well-being needs of the older population. Moreover, drug social workers often overlook aging users as clients for their casework because of performance and tangling professional ethics. The systematic neglect thus formed, and it provokes reflection on the position of aging users and how they seek to be citizens but are excluded by the "violence of citizenship."

Discussion and implications: We found the systematic neglect experienced by aging heroin users through the judicial process, welfare programs, and service practices. This structural disadvantage, more important than their needs, underscores the urgent value of addressing the social issues surrounding their marginalized position in society.