In this country, you can die four times while waiting for detox: The pandemic, drug use and chronicity of crises in Poland

By Justyna Struzik

The CrimScapes project[i], in which I explore the experiences of opioid users in the context of drug possession criminalization in Poland, began at the peak of the restrictions imposed by the coronavirus pandemic (COVID-19). The regulations enacted in response to the COVID-19 pandemic not only shaped and constrained the context in which ethnographic research was conducted, but they also influenced the topics of my interviews with people who use drugs. Interviewees invariably referred to their experiences during the pandemic.

The pandemic, according to my interviewees, was not always unambiguously negative. Accustomed to the persistence of difficulties resulting from, among other things, the criminalization of drug use and perceiving themselves as a relatively “invisible” group to the Polish public discourse[ii], they did not anticipate the additional difficulties posed by the pandemic nor the specialized care provided in response to it. The chronicity of crises this group has experienced over the years has, in some ways, bolstered their resilience, or perhaps “indifference,” to the changes, crises, and difficulties that have occurred. Police violence, a lack of access to high-quality, non-stigmatizing health care, and the paucity of harm reduction programs, along with the dominance of abstinence-only programs, have shaped and continue to shape the social landscape of drug use in Poland.

 However, some of the narratives I have gathered emphasize the repercussions of the pandemic (and imposed restrictions) on drug users’ lives and experiences, particularly regarding access to health care, the availability of treatment, and social support. Following Jarrett Zigon (2018), who encourages us to deconstruct the ‘fantasy world’ of the drug war locally in order to demonstrate how specific components of this world translate into the lives of drug users, in this blog post, I want to look at the experiences of people who use opioids in Poland during a specific period – the pandemic. I do so, among other reasons, because there are so many voices in public debates about the adverse effects of the pandemic and its restrictions, but this group’s experiences remain primarily unrepresented. Notably, I do not consider this blog post to be exhaustive in its coverage of the complexity of drug users’ experiences during the pandemic. Rather, utilizing two narratives gathered during the course of my research, I wish to highlight specific inequalities in access to certain public services that were a part of my interviewees’ experiences. I want to exemplify how the individuals I interviewed navigate and frame these inequalities, either by emphasizing the catastrophic impact of the pandemic on their own lives or by highlighting the chronicity of crises and the continuity of the decades-long drug war.

Klara’s story

At the end of March 2022, I met 35-year-old Klara in Warsaw. Klara was in an intimate relationship with another heroin user at the start of the pandemic; they lived together. They both tried several times throughout their relationship to break the cycle of heroin use they had been in for a while and return to substitution treatment. Because of the risk of experiencing withdrawal symptoms a few hours after taking heroin, Klara mainly worked remotely from her home at the time. She also desired to devote more time to her ailing dog. Her partner worked for a transportation company and was frequently absent from the home.

“The main thing I remember from that period is that I felt quite alone. In the sense that I just spent a lot of time alone. Because also the social life died down a bit. And with my parents, we didn’t see each other […]. It was this sense of increasing isolation. And it was very [acute]. And it wasn’t conducive to handling our life, especially because we were already in the throes of using. “

To maintain financial stability, Klara kept a close eye on the amount of heroin they both were using. She describes her experiences during this time as “acutely repetitive.”

“It was kind of a black hole in general. In the sense that there was just nothing happening, especially nothing good for a long enough time. I wondered how the pandemic would affect the availability [of drugs], because there were actually some voices saying …’ and maybe there won’t be drugs available on the market…’. But the availability hasn’t changed a bit, at least in Warsaw.”

The repetitiveness mentioned by Klara was also, in her opinion, something that kept them from quitting heroin and returning to substitution. Moreover, their relationship was becoming increasingly difficult, and violence began to emerge. During a holiday they spent together in the summer of the first year of the pandemic, they decided that they would both go to addiction treatment centers. Her partner decided to go into detox. He returned to Warsaw intending to seek further treatment for his addiction. However, new admissions were halted at the time due to the pandemic; the center’s staff advised him to wait and call every week to see if anything had changed. As a result, they were both in limbo for a while. Klara, on the other hand, was supposed to go to another center, but the number of beds available for women who use drugs was reduced due to the pandemic. The facility gave her the option of arriving the next day or waiting three months for a spot to become available. Due to the need for detoxification, the first option was not feasible. Klara, therefore, waited for the center for a few more months, which was especially challenging as it involved obtaining a new referral for treatment at the center from a doctor. During this time, her partner chose another center where new patients were being admitted. He first went to detox at a place that, ironically, she described as ‘not cool’ when she recalled the conditions there. When he returned, his admission date was again postponed by a few days. Eventually, Klara managed to drive him to the treatment center before going for treatment herself.

“I waited for detox for 3 weeks+. This is one of the wonderful features of the Polish healthcare system. In this country, you can die four times waiting for detox. The only opioid detox in Warsaw at the moment is the Nowowiejski center, where there were plenty of empty beds when I was there, but it doesn’t pay them [financially – author’s note] to have patients. In any case, when I finally got there, of course not without adventures, I was surprised that I got there at all, that it worked out after all, and I had this brief feeling that something had worked out and that [my boyfriend] was in the center and that I had survived. I was in a very bad physical state. And also, mentally, it was bad, but also physically. I had 45 abscesses, and in general, I was all swollen, at least on my legs. Throughout the detox, no one managed to take my blood, unfortunately. “

Her partner left the center where he was staying after a few days. Then, while waiting for the next one, he overdosed and died in Warsaw while Klara was still in the center. She was unable to attend the funeral due to pandemic restrictions.

“We were both aware that it would end up that way eventually, that it would be like one of us would eventually go down, and the fact that it happened to be him, I think it’s more of a coincidence; it probably didn’t have to be that way.”

Klara’s narrative is grounded on the category of waiting and her constant navigation of Poland’s complex treatment system. Their struggle to get into the center, to survive, was dependent not only on their own agency (e.g., trying to get into detox, planning a leave of absence from work for treatment, saving money for a more difficult time) but also on a volatile and unpredictable system in which the rules for accepting new patients were frequently changed.

The social landscape depicted in the interview demonstrates how drug users, specifically opioid users, are positioned as “less-than-human Others” (Zigon 2018, 59) – as someone who is constructed as an “incomplete subject,” as an addict who deserves less assistance and support than full citizens. This conception of drug users is sharpened to some extent by the pandemic, which makes some lives worth saving while condemning others to death (Agamben 2017[1], Caduff 2020).

Ryszard’s story

I met Ryszard in June 2022 in Warsaw. He’s 42 years old and has been undergoing substitution therapy since 2006. During his first ten years on the program, he used a variety of other psychoactive substances (amphetamine, clonazepam, and mephedrone). Currently, he only consumes alcohol, which he tries to limit as much as possible. Due to the fact that he faced incarceration for drug possession, he decided to enroll in a substitution program. As he had already had a negative experience with abstinence-only programs, he started taking methadone to avoid prison. He has had non-healing wounds on his leg for the past sixteen years. Due to his Hepatitis C and HIV co-infection, he is automatically referred to a hospital for infectious diseases, where no effective treatment to heal these wounds has been undertaken to date.

“As I have had these wounds for 16 years, I have not been to any other hospital for 16 years. They [infectious disease hospital’s staff – author’s note] treat poorly other than your main infectious disease issues. In other hospitals they didn’t want to treat me at all. For example, these wounds they didn’t want to treat at all. […] In the Prague hospital I was with this leg and fuck, and they told me to fuck off to this infectious hospital. I lay there for two days, I went on Friday afternoon, and on Monday a head doctor came and [says to me]: ‘fuck off to the infectious hospital’.”

Ryszard currently resides with his partner, who is also enrolled in a methadone substitution program and awaiting surgery for a fractured spine. According to Ryszard, the impact of the pandemic on their lives has been minimal. He temporarily stopped taking antiretroviral treatment for HIV, but he does not directly attribute this to the pandemic. Rather, he attributes it to a sense of alienation and stigma in the infectious disease clinic and the medical staff’s lack of concern for people who inject drugs.

“But they [the doctors – author’s note] do, they really approach us like…I tell the doctor that here I am starting to have some pain with these legs. And he says: ‘Ah, these legs, well yes. ‘ And he prescribes me cream as standard; I even already know I’m not going to heal it that way. I tell him I have vein problems because I do, and they’re huge. The nurses couldn’t take my blood, but I found a deep vein in my hand and took blood myself. I’m like, ‘doctor, we did it!’ And he says to me, with such a snarky tone, ‘how can you still get your blood drawn, what kind of drug addict are you?’. And as I’m thinking: ‘retard, I told you, I haven’t been taking that many years’. Fucked up, right?”

From Ryszard’s perspective, the substitution program has not changed significantly during the pandemic. He relied on taxis for the majority of his and his girlfriend’s two-week advance methadone dosage due to his leg wounds. His narrative, similar to Klara’s, demonstrates the ways in which people who use opioids are systemically constructed as disposable subjects (Wang, 2018) – as a group that the system, including the health care system, willingly pushes beyond what it is intended to address. Patients living with HIV and other infectious diseases or opioid users become invisible, unnecessary, and unprotected by the system, particularly in a criminalized context or during a ‘state of exception’ (Agamben 2005). Looking at the experiences of drug users, on the other hand, gives the impression that the pandemic is merely another crisis – part of a complex, multi-layered social world in which the criminalization of drug use and the emphasis on abstinence-only approaches translate not only into continued stigma, but also into poor housing and the threat of homelessness, difficulties in finding work, a lack of access to health and social care, and social isolation. When viewed through the lens of these experiences, the pandemic appears to be less of a unique process bringing social chaos and fear and more of a component of chronic crises, felt most by vulnerable groups.

Agamben Giorgio. (2005). State of Exception. Chicago: University of Chicago Press.

Agamben Giorgio. (2017). The Omnibus Homo Sacer. Stanford California: Stanford University Press.

Caduff, Carlo. (2020). What Went Wrong: Corona and the World after the Full Stop. Medical Anthropology Quarterly, 34(4), pp. 467-487.

Wang, Jackie. (2018). Carceral Capitalism. South Pasadena (CA): Semiotext(e).

Zigon, Jarrett. (2018). A War on People: Drug User Politics and a New Ethics of Community. Oakland: University of California Press.

[i] I would like to warmly thank all the people who agreed to talk to me and share their stories. I would like to thank Kasia Urbaniak for discussing a possible theoretical framework for the stories described in the post and Bardh Lipa for helping me express myself better in English.

[ii] For more on the invisibility of opioid users in the Polish context, see the interview with Magdalena Bartnik, ‘Niewidoczne populacje [Invisible populations]’ in the book ‘HIVstorie. Żywe polityki HIV/AIDS w Polsce [HIV-stories. Living HIV/AIDS Politics in Poland]’, edited by Justyna Struzik and Agata Dziuban, published by the NOMOS publishing house in 2022.

Vulnerabilising criminalised subjects. On the Entanglements of Care and Punishment

Friederike Faust, Agata Chełstowska, Agata Dziuban, Justyna Struzik

Researching criminalisation and the punitive turn, we are familiar with the scholarly work on the construction of particular social groups or behaviours as risks to social order and security. The politics of criminalisation, crime control and policing necessitate rely upon and maintain figurations of dangerousness, monstrosity and threat. However, during discussion we had among our research team, we noticed that the subjects we encounter in our new research sites seem to be more complex, revealing dimensions of vulnerability and victimisation, although criminalised and sometimes even convicted. They seem to resist a categorisation as either threatening or vulnerable, as either innocent or guilty, as either perpetrator or victim. These subjects – transgressing one-dimensional and simplistic categorisations – have aroused our interest. Within regimes of crime control, policing and punishment they are not only governed through coercion, prosecution and confinement, but also through care and protection. Figures such as the female offender-as-victim that emerged within feminist criminology and entered into prison policy and practice seem to blur the lines between care and punishment, innocence and guilt, and victim and threat.

As anthropologists and sociologists studying contemporary politics of criminalisation we are concerned with the social lives of criminal law and crime control policies. As outlined by the anthropology of policy (Shore/Wright 1997), policies and laws work on people, they produce, and react to, figures of crime. To analytically engage with subject construction or figurations, we find Michel Foucault’s distinction between the subject of the offender and the delinquent particularly helpful that he introduces in his famous study on discipline and punishment (1977). The offender, according to Foucault, is constituted through the isolated act of rule violations. Thus, he is the subject known and constituted by criminal law. The delinquent, however, is called into being within the processes of punishment and judicial procedures. Subjected to police, judges, attorneys, prison administration and so on, the delinquent is not only constituted through the act of rule violation.

Following the criminal justice rationality of correction and just sentencing, the delinquent is constituted through their biography, personality and social conditions. It`s within the subjection of the delinquent, where according to Foucault, psychiatric and judicial discourses meet and merge. It is here, where psychiatric knowledge confuses the judicial attribution of responsibility. In our research we engage with different subjects constructed as “delinquent”: with women who undergo abortion, with sex workers, with people who use drugs and with female prisoners.  

To illuminate subject constructions at the intersection of criminalisation and vulnerabilisation, a  gender theoretical perspective is particularly promising. Foucault writes that the intertwining of the judicial and psychiatric discourses allowed for the figure of the dangerous individual to emerge. And several other scholars have pointed to the construction of criminals as monsters or risks. The subjects we are concerned with are, however, not so dangerous, and not so monstrous. Instead, engaging with certain gendered and infantilised notions of victimhood, vulnerability and innocence allows us to craft out the nuances, complexities and contradictions within what is considered dangerous to the normative and moral social order. Therefore, a gender perspective promises to interrogate, and to add nuances to theorisations of criminalisation and punishment.

Carceral-care, as defined by Ghazah Abbasi (Abbasi 2020) is a situation whereby “disciplinary tactics intertwine state repression with state care”. Carceral-care programs:

  • „are designed to promote material and psychological well-being of carceral populations”
  • are characterized by a “paradoxical nature”
  • „are neither purely coercive nor purely consensual, but contain elements of both coercion and consent, care and incarceration”
  • individualize a problem, obscuring the systemic root of suffering

Other social sciences scholars have theorized about systems which provide both care and criminalisation as “jailcare” (Sufrin 2017), “carceral protection” (Musto 2019) “penal welfare system” (Gruber, Cohen, und Mogulescu 2016). The concept of carceral care helps us understand the complexities of criminalisation policies. The motivation for these policies contain both concerns about the danger of the criminalised activity (e.g. drug use, sex work) and concerns for the criminalised subjects (e.g. people who use drugs, sex workers). This concern, however, does not increase the groups’ agency, as they are being infatilised, victimised, portrayed as unable to make fully responsible decisions.

This blog post is a summary of the introduction to the workshop “Vulnerabilising criminalised subjects: Entanglements of Gender and Crime“ facilitated by Friederike Faust and Agata Chełstowska. The Workshop was held on Friday, June 11th 2021 via Zoom platform, as a part of CrimScapes’ first Thematic Seminar. During the workshop four project researchers presented insights from their research on sex-work (dr Agata Dziuban), drug use (dr Justyna Struzik), abortion (dr Agata Chełstowska) and women’s prisons (dr Friedrike Faust).

Abbasi, Ghazah. 2020. „Discipline and Commoditize: How U-Visas Exploit the Pain of Gender-Based Violence“. Feminist Criminology 15 (4): 1–28.

Foucault, Michel. 1977. Discipline and Punish: The Birth of the Prison. New York: Random House.

Gruber, Aya, Amy J. Cohen, und Kate Mogulescu. 2016. „Penal welfare and the new human trafficking intervention courts“. Florida Law Review 68 (5): 1333–1402.

Musto, Jennifer. 2019. „Transing Critical Criminology: A Critical Unsettling and Transformative Anti-Carceral Feminist Reframing“. Critical Criminology, Nr. 27: 37–54.

Shore, Chris/Wright, Susan. 1997. Anthropology of policy: critical perspectives on governance and power. New York; London: Routledge.

Sufrin, Carolyn. 2017. Jailcare: Finidng the safety net for women behind bars. Oakland, CA: University of California Press.