“Patients, Trauma Survivors, Sweethearts, or Troublemakers?”: A Discourse Analysis of General Practitioners’ and Pharmacists’ Accounts of Clients on Opioid Substitution Treatment

Despite the high level of scientific support for the effectiveness of opioid substitution treatments (OSTs), individuals who rely on this treatment are a highly stigmatized population within healthcare settings. Previous studies mainly focused on the experiences of OST clients, while the perspective of medical professionals regarding OST remains largely unexplored. This study aims to investigate the discourse of pharmacists and general practitioners about OST through the lens of positioning theory. To explore their stance toward OST, semi-structured interviews were conducted with 30 pharmacists and general practitioners working in pharmacies, community health centers, private medical practices, prisons, and drug treatment services in Flanders, Belgium. The participants of this study discursively constructed four storylines to position themselves and OST clients, namely, a biomedical, psychodynamic, biopsychosocial, and moralizing storyline. These storylines are based on historical explanatory addiction models, and their use varies according to the participant's work setting. While the moralizing storyline was characterized by othering, stereotyping, and labeling, participants who applied the biopsychosocial storyline approached clients in a destigmatizing manner. To conclude, participants used the identified storylines to define the position of clients in OST, along with their related rights and duties. The dominant storyline thus shapes the view on and treatment of OST clients in a medical setting.