“Street drug” or “medication”? A qualitative study of the social representation of heroin within an outpatient hospital unit prescribing pharmaceutical heroin

This study examines the social representations (SRs) of heroin within a university treatment center that provides diacetylmorphine-assisted therapy (DAT) in French-speaking Switzerland. Thirteen professionals participated in individual interviews, and a subgroup also participated in a focus group. Three main findings emerged. Firstly, the SR of heroin is dual. It refers to two distinct types of heroin: street heroin (SH) and pharmaceutical heroin (PH). Secondly, the SRs of SH and PH are dependent on one another and are dynamically interconnected around a central core. Thirdly, the SR of heroin is polyphasic: While its SH component is perceived as a “hard drug,” characterized as a particularly dangerous non-medical substance, its PH component oscillates between being seen as a “medication” and a “drug,” thereby eluding a singular treatment status. These findings provide a better understanding of the resistance among clinical teams toward DAT, despite scientific evidence supporting its therapeutic efficacy.