今晚藥不藥？安眠藥物使用者之就醫、用藥歷程分析

Abstract

近年來，台灣的安眠藥使用人數增加。但相關的研究中，多以藥物政策、醫療的角度，而較少著墨於藥物使用者的社會面向。本文以使用者的經驗出發，討論台灣近年的安眠藥使用情況。以特定網路社群中徵求的安眠藥物使用者為主要對象，以深度訪談的方式，討論他們的就醫及用藥的歷程。

本文將這個歷程分為三個階段：進入醫療使用藥物、就醫及用藥的過程，以及累積用藥經驗之後的轉化，並依受訪資料歸納出結論如下：（一）睡眠的醫療化，將醫療與睡眠結合，提供了失眠者一個自我分類的架構。社會網絡、轉介制度與世代的特質，促使了某一些人選擇了西醫為解決失眠的管道。而台灣目前的西醫醫療環境，傾向以開藥為解決方式。當這些人依舊受到社會作息的規範，服用藥物對他們而言是長期、必須的事情；（二）在失眠者求診的過程當中，醫病互動的類型，直接、間接的促發了病人不同的用藥模式。本文嘗試將精神科的醫病互動放入社會學醫病互動的框架下，並討論受訪者的就診感受，對於用藥的影響；（三）當持續用藥一段時間後，身體經驗變成了用藥者的知識與資源。他們得以反思就醫的過程，更為了解自己的處境。由於網路的發達，這些經驗化為文字，得以不受時間與空間的限制，讓有共同經驗的人，能夠深入的分享自己的處境，建立了一種團體認同。

In Taiwan, it seems that more and more people taking sleeping pills. Related researches of the issue are about drug policy and medicine with little attention to actual sleeping pills users. Most of the time, the answers to “Why do they take pills” are personal. Somehow, Sociology gives a different explanation: social context. This research tries to unveil the invisible factors. By semi-structured interviewing 21 users, I try to picture the actual experience of sleeping pill users for three stages: their entering in Western medicine and using drugs, their doctor-patient interaction, and how their collected experiences become their own knowledge and resources. First, institutional sleep is the main reason for insomnia sufferers to ask for help. The medicalization of sleep provides a framework for them to check insomnia problems. Because of the affinity of social network, institutions and generational traits, makes Western medicine a choice for solution. After their entering into medicine, for institutional reasons doctors in Taiwan inclined to prescribe sleeping pills. Second, after these people choose medical solutions, they face different kinds of doctors and have various doctor-patient relationship experiences. The kinds of relationship have direct or indirect influences on the image of how they see themselves, the modes how they take pills. Last, as patients have become more experienced, they are more knowledgeable and reflecsive users about the pills and aware of themselves. The internet group works as a platform for patients/users share and help to produce a collective, more sophisticated discourse of using drugs and “drug identification.”