| Keywords [eng] |
Street-level bureaucracy, policy implementation, healthcare, harm reduction, interventions, opioid substitution, drug policy, centres for addictive disorders. |
| Abstract [eng] |
Drug Policy (non)change in Lithuania: the Role of Street-Level Bureaucracies Summary This paper is an attempt to analyse the barriers to drug policy change from punitive to harm reduction based in Lithuania. The analysis is set within the theoretical framework developed by Michael Lipsky and seeks to examine the forms that policy takes at its last stage of formation, which is the policy implementation. It is assumed that street level bureaucrats, i. e. specialists who are involved in service provision, are the last actors on the chain of policy coining and thus provide it with the final shape. With the aim of peeking into and analysing the possible causes of drug policy stagnation, three centres for addictive disorders – in Vilnius, Kaunas and Klaipeda – have been chosen as direct implementers of harm reduction drug policy in the country. The analysis focused on implementation of one specific harm reduction intervention, the opioid substitution treatment in Lithuania. Interviews with several kinds of specialists – medical doctors, social workers, nurses and the managers of the centres – have been conducted. In order to present a better picture of policy implementation, clients of the treatment programmes have been interviewed as well. I split the analysis into three parts, looking into goals and perceptions of opioid substitution treatment, patterns of service rationing in order to reduce the demand, and patterns of locating responsibility for service effectiveness. Having completed my research I arrived at the conclusion that the role of authorities in providing the street-level bureaucrats with in-depth knowledge and understanding of harm reduction goals is of key importance to ensure successful policy implementation. Clients’ empowerment might serve as a means to develop internal organisation’s values corresponding the essence and goals of harm reduction and thus ensure that evidence-based drug policy gains momentum. |
