Governing parental opioid use: a relational ethnography

SUMMARY: Policy and practice, which governs parental drug use within the family, is of global importance - economically, socially and politically. It is also highly contested. Crucially, it lacks a substantive evidence base and critical theorising on its complexity, construction, processes and effects. Whilst researching parental drug use is extremely challenging, the extreme marginalisation and stigmatisation of parents and stark inequalities in outcomes for children and families, provides a compelling argument for innovative ways of exploring and examining the governing of parental substance use, including novel ways of representing and responding to ‘the problem’.

STUDY AIM: Our study aims to critically examine, and advance theoretical understanding of, how parents who use drugs are governed within the context of health and social care, in order to build capacity and capability for transformational change within this field of policy and practice.

STUDY DESIGN: We propose a 36 month mixed methods comparative study, involving the integration of three innovative methodologies: relational ethnography, post-structural policy analysis, and learning alliance methodology. The study will comprise three phases and four interconnected workstreams, across two contrasting sites in Scotland and England. The inclusion of two distinct ‘fields of policy and practice’ is designed to enable a comparative analysis of wider relational, contextual and structural influences on the way families are governed and how these diverge (or not) in terms of processes and outcomes for families.

SETTING: NHS Lothian Region in Scotland (City of Edinburgh, West Lothian, Midlothian and East Lothian) and NHS London South London and the Maudsley in England (Lambeth, Greenwich, Southwark). These field sites were chosen because they both have large populations of drug users and parents who use opioids, yet they differ significantly in terms of their policy and legal context, service delivery models, and population.

STUDY OBJECTIVES: 1.To engage and collaborate with multiple stakeholders who have experience of parental drug use in order to involve them in the project aims and objectives and to harness their experience and support for co-producing study outputs that lead to systems change and improvements in the treatment and care of parents who are opioid-dependent and their families. 2.To conduct a relational ethnography across two contrasting ‘fields of policy and practice’ related to the treatment and care of parents who are opioid-dependent and their families, in order to systematically observe, analyse and theorise on the governing of parental drug use within health and social care. 3.To identify national and local policies, which are instrumental in the governing of parental drug use and employed in everyday practice, to critically evaluate representations of, and responses to, parental drug use, including an assessment of their impact. 4.To analyse, synthesise and compare the data from each study site (and workstream) to contextualise and theorise on the governing of parental drug use within the family. Ethnographic findings across and within each field of policy and practice (Scotland and England) will be ‘nested’ in the policy analysis and within wider political, economic and social frameworks. 5.To identify alternative representations, and innovative responses to, parental drug use within the family that could inform future developments in policy and practice in the UK and internationally, with a focus on the translation of evidence and lessons learned from this project.