Highlighting heroin users’ perspectives

Philip Lalander, professor of social work at Malmö University, is in Helsinki to take part in a seminar organised by the Matilda Wrede Institute. There he has given lectures about unaccompanied minors and their experiences with social workers. At present, it is unaccompanied minors who are in focus in Lalander’s research; something which is to become a book.

He has written many books over the years, including a trilogy about heroin users in Norrköping. The three books are based on an extensive ethnographic work. The last book in the trilogy; Människor behöver människor – att lyssna till de misstänkliggjorda [People need each other – listening to those regarded with suspicion], came out two years ago, in which Lalander returns to Norrköping and follows up on how life has been for the heroin users that he started following in 2000.

Over the years, he has travelled to Norrköping, spent time with heavy drug users, interviewed them about their lives and made new friends among them. He started interviewing and following 25 people in 2000, but at the time he had no idea where the project would lead him.

“It was quite intensive fieldwork in the beginning, but I was just so driven by my commitment and affected by the young people that I met who were in their twenties at the time. Perhaps I also had a fascination with outsiders.”

Two have died

A lot has happened since then, and Lalander himself has changed in his role as researcher.

“Sometimes I feel that I have become stronger in my conviction about ethnographic work; how important it is. I have gained a more nuanced understanding, and I am sometimes quite critical of traditional research which in some way simply aims to describe the situation and which holds the belief that conducting one interview of a person in an institution surrounded by power structures can yield so much. I have learned to truly question prejudices and stereotypes.”

He has also seen the consequences of heavy drug use; two of those he has been following have died.

With less social inequality and better social work, it wouldn’t have needed to happen. Having said that, relatively few of those included in the study have died, which people sometimes think is strange.

Lalander has also become more attentive to language and now uses words such as “heroinerfaren” [person with experience of heroin use] instead of “heroinist” [heroin addict], as many of those he interviews no longer use heroin.

The long research process has led to Lalander building close relationships with those he has interviewed. He still spends time with them, has travelled to Chile several times with one of the interviewees, has been invited to weddings and still meets several of them when he is in Norrköping.

“I changed during this period; by getting to know them, it was easier to see some people’s suffering. It meant I could lend money, and I often gave it away. I could give someone enough money for a Subutex tablet; otherwise they would have bought something cheaper – bad stuff that they would have used instead. I approached it with a kind of harm-reduction mindset. But they have helped me so much by telling me about their lives, so I find it difficult to be tough with them and tell them I won’t help.”

It is difficult to say where the line should be drawn when it comes to what a researcher can and cannot do.

“I think it’s important to reflect on what the Central Ethical Review Board asks for in its forms, but in ethnographic research there are moments which are highly unpredictable. You have to make decisions on how to act within a few seconds. On principle, I think that if people are at risk of losing their life, I feel that I have a responsibility to attempt to help these people, and I have done this several times.”

Things have gone well

Those interviewed are not part of a homogenous group, but Lalander sees a sort of class dimension among those he started to follow. Most come from the working class; the majority are young boys, and many had problems in school and did not feel at home in the established manner they were expected to act in.

“They were young in the time when local drug lords created a local market, and they moved in networks where there was heroin. They knew that heroin was something they should avoid, but there were no living examples in Norrköping at the time to serve as a warning. For some, it was also something of an adventure. We have a media world which emphasises the idea of “creating your own adventure” and of money being important. This is also another reason to begin helping the drug lord and to start selling; to be confirmed as a person by being given a task.”

Fifteen years later, almost all of them have stopped using heroin, but many have become addicted to buprenorphine, a drug used to block heroin cravings.

“There are some who have turned their lives around completely; who are living completely normal lives. There is a group experiencing ups and downs, such as Lorenzo from the book, who can stay away and have his own projects for a while; only to get drawn back into his old life. Around half of the interviewees went through the LARO programme: medication-assisted rehabilitation for opioid dependence. Some have been ejected and then allowed back in again, waited in a queue, gone through urine tests and so on. Some have stopped with the medical side of things, but this isn’t so easy because medication is the big solution. On the whole, I think we can say that things have gone well, if by well we mean being able to live a harmonious life.”

The social perspective

Lalander is in many ways critical of how the medication-assisted rehabilitation is run.

“Most people tell me that I was very hard on LARO. But it was the interviewees that saw it this way, which means that that’s how it was. I mostly focused on LARO during the first qualification period; the first half-year when you need to give urine samples often; it’s a very rigorous testing process. But I feel it was a scandal really, especially back then when there was a two-year queue for the programme; people suffered. It contributed to the creation of the black market, and as the town had had such a large heroin problem, people were exposed to great risks.”

Lalander is not the only one who is critical of the programme.

“A few people working at LARO called me afterwards and said that they felt it was really good that I highlighted these aspects. They said that they thought it was really horrible having to treat the client as an object; though there was some chit-chat, the main thing was to make sure the tablet is taken. Then the client may be asked to show their gums and provide a urine sample.”

Nevertheless, closing LARO clinics is not the answer.

“It is important to bring in the social perspective, modify the clinics, listen to people and also have more user cooperation, more active participation and more power to act. Allow people to change. Urine tests could be switched for another type of test, such as saliva, as has been done in some departments. Some think that substance dependency treatment should be exclusively a hospital affair, but I feel it’s very important from the social work side of things to get involved and work together with people to open up opportunities for change.”

In the foreword to the book Människor behöver människor, Lalander writes that he does not know if the research work with heroin users is finished yet. The answer to this very question on this cold January afternoon in Helsinki goes like this:

“Probably not.”