“That Doesn’t Sound Like a Good Treatment”: Objections to Medications for Opioid Use Disorder (MOUD) and Moral Capital in Rural Indiana

Abstract

Stigma associated with the use of the medications for opioid use disorder (MOUD), methadone and buprenorphine, is widespread and pervasive. I examine local perspectives toward MOUD in a rural Indiana county through 29 qualitative interviews with people with and without opioid use experience. Objections to Methadone Maintenance Treatment (MMT) voiced by interviewees centered on the perceived length of treatment, the continuation of an addict habitus or disposition, and the profit motives of the local MMT clinic. Local understandings of the temporal rationalities associated with methadone and buprenorphine treatment were used by interviewees in determinations of treatment legitimacy, as well as its moral acceptability. In rural contexts, the loss of moral capital known to accompany any association with illicit substance use can threaten economic survival for the poor. MOUD providers may want to carefully consider the meaning and experience of time with regard to treatment duration, as well as the moral landscapes of rural contexts, while creating treatment plans and communicating them to patients.