飲鴆止渴的病人：徘徊於正規醫療與自助醫療的毒品使用者

Illegal Drug Users are Caught between the Formal and Self-help Medical Systems

毒品使用者除了需要戒癮治療外，因使用毒品衍生的意外、精神疾病、傳染病與慢性病等，亦需正規醫療提供適當的治療服務；有研究提出正規醫療受到毒癮再犯預防的影響，容易不自覺忽略這群人毒癮以外的治療需求。因此，本研究想從毒品使用者的經驗出發，以瞭解他們求助正規醫療及尋找替代醫療策略的狀況。本研究採用質性取向的研究方法，深度訪談七位毒品使用者的就醫經驗，並到他們求助醫療的場域進行參與觀察。研究發現，受訪者求助正規醫療時，經常因前科與毒癮身分被反覆強調，形成令人難以招架的污名枷鎖，使他們對此體系產生適應不良並主動遠離；遠離後採取的自助醫療行動，如同儕提供藥品、藥物混搭術、民俗療法或偏方等飲鴆止渴策略，反而增加毒品誤用、復發、過量致死的風險。最後提出三點建議：一、正規醫療應降低法規建構「毒品污名」所衍生的不利就醫處境；二、提供正規醫療臨床助人者以科學實證為基礎的毒品教育訓練；三、正規醫療應善用毒品使用者的社區復元資本。

Besides drug treatment, drug addicts may require medical treatment as a result of their suffering accidental injuries, mental health problems, infectious diseases, chronic diseases, etc. However, few studies indicate that they do not actively seek help from the formal medical system for treating their physical and mental problems. The reason for not seeking help from the formal medical system is generally either personal preference or the stigmatization associated with social exclusion resulting from the identity of drug users being revealed as a result of their seeking help from the formal medical system. This study intends to explore the subjective experiences of drug users when seeking help from the formal medical system, as well as determining what kind of alternative medical systems they sought help from. Using a qualitative approach tocollect data, this study employed in-depth interviews with seven drug users regarding their help-seeking experiences in the formal medical system. This study also conducted participatory observation when five interviewees sought help at different kinds of medical systems. The results indicated that the interviewees experienced recurrent stigmatization due to the judgmental identification of these addicts not only as patients, also as criminals. The unfriendly social treatment they experienced precluded them from subsequently accessing formal medical systems. Subsequently, the drug users sought help from other alternative self-help sources, such as drugs provided by their peers, drug stores or clinics in the community, mixing drugs and medicine, folk therapy, etc., which sometime resulting in lethal harm from drug misuse and overdosing. Three suggestions for ameliorating the situation delineated above are included in the conclusion section.