Medications, especially those accessible through prescription, occupy an increasingly prominent place in contemporary healthcare practice (Greene, 2011; Ballantyne, 2016). The prominence of medications is particularly evident in the management of chronic conditions, where medication non-adherence is a key focus of research. Medication non-adherence, attributed to different factors including perceived efficacy of medications (Lee et al., 2018), is known to contribute to treatment failure, healthcare cost increases and worsening quality of life for patients (Kvanstrom et al., 2021; Konstantinou et al., 2020). In the literature on medication non-adherence, medication-taking experiences are often taken for granted as the result of the encounter of bodies and the pharmacological constituents of medications. However, this approach is not able to explain counterfactuals such as instances where medications are perceived to be inefficacious, a category of medication-taking experience described as ‘irrelevance’ (Nascimento et al., 2019). Explaining such experiences calls for novel approaches to understanding medication-taking experiences, including those that account for the role of non-human agencies. Furthermore, medication-taking occurs in diverse places, ranging from healthcare facilities to the everyday settings of users’ homes. How place influences medication-taking experiences is not well captured in the existing literature on this topic. Apart from filling gaps in the literature, such research could reveal new approaches to promoting medication adherence.

In this study, I investigate the actor-networks through which place mediate medication-taking experiences in chronic non-cancer pain management among people who use drugs (PWUD), a structurally vulnerable social group known to be at high-risk of experiencing adverse health outcomes (Degenhardt et al., 2013). The prevalence of chronic non-cancer pain among PWUD is significantly higher than in the general population (48–60 % compared to 11–19 %) (Voon et al., 2018). PWUD experience moderate to severe pain, which interferes significantly with their daily life activities (Alford et al., 2016). They are also more likely to be compelled to live with pain, including severe pain (Wallace et al., 2021). This is often due to barriers to medical pain management especially those arising from stigma and negative attitudes of healthcare professionals, often manifested in labeling of PWUD as ‘drug-seeking addicts’ (Baldacchino et al., 2010). Conceptually, I focus on ‘medication-taking experiences’ or ‘medication experiences’, i.e., ‘an individual’s subjective experience of taking medication his in daily life’ (Shoemaker et al., 2011, p. 90), as opposed to ‘medication effects’, which is a ‘quantifiable change in disease processes that result from the pharmacological or physical properties of an active treatment-often a medication’ (Zion and Crum, 2018, p. 140). I further distinguish between positive (or desirable) and negative (or undesirable) medication-taking experiences based on the participants’ accounts.

Medications remain the most commonly used method for chronic pain management, despite most clinical guidelines recommending a multi-modal approach to chronic non-cancer pain management that prioritizes non-pharmacological approaches (McCracken et al., 2006). This is due to low affordability, availability and awareness of these alternative methods (Hopkins et al., 2022). Medications are associated with significant benefits for chronic pain patients in terms of pain relief, physical and social functioning and overall improvement in quality of life (Stein, 2013). Nevertheless, they also present the risk of adverse effects, including and especially opioid use disorder linked to long-term opioid use (Els et al., 2017). Furthermore, an emerging body of research explores experiences of daily medication use for chronic conditions. These studies show that patients’ medication-taking experiences vary. In what is possibly the only study of this kind on chronic pain, McNeilage et al. (2023) found that among healthcare patients prescribed gabapentinoid medication (e.g. pregabalin and gabapentin) in Australia, some experienced the medication as effective and safe and others experienced it as useless and harmful. Among chronic hepatitis C patients in Brazil, medications were experienced in four major ways, viz resolution, adversity (i.e. adverse reactions), ambiguity or indifference, and irrelevance (Nascimento et al., 2019). The authors argued that the same individual can experience daily medication use in different ways, depending on different factors including the disease and medication. Currently, there is no research examining the role of place in medication-taking experiences, especially those drawing on new materialist approaches.

A body of literature inspired by approaches from Science Technology and Society (STS) studies, including Actor-Network Theory (ANT), have urged the view that medications are neither secondary to, or radically untangled from, the human; instead, they are active part of the sociality that constitutes healthcare. For example, the procurement and consumption of medications involve enactment of ‘infrastructures of care’, including diverse connections among actors, locations and processes (Danholt and Langstrup, 2012). Medical devices such as metered dose inhalers, used to treat asthma, have been shown to be constituted within a shifting network of sociotechnical relations involving diverse human and non-human actors (Prout, 1996). STS-inspired studies have also examined medication experiences, showing the complex assemblages or relations through which they are produced. For example, Gagnon and Holmes (2016) have shown how embodied experiences of the side-effects of HIV medications (inflammation and hypersensitivity reactions) are produced through the same assemblages that produce viral suppression, which includes the vitality and agency of the medication as well as the multiple connections it establishes with cells, organs and other drugs.

Current research on psychotropic medications have challenged the view that the different embodied experiences of medications (e.g., perceived effects and side-effects) are separate phenomena. They show how these experiences emerge through various entanglements of body, mind, discourse, institutions and wider social processes that shape medication-taking (Wilson, 2011; Morrison et al., 2015; Flore et al., 2019). For example, Flore et al. (2019) have shown that treatment is never straightforward since medication experiences are not linear and predictable, but emerge through the ‘intra-action’ of subjects, bodies, medications and power relations. Such findings trouble dominant accounts wherein medication experiences are ascribed solely to pharmacology; they show how these experiences emerge via intricate social, affective and material entanglements. This means that medication experiences do not only result from their contact with bodies, but are also linked to wider social processes such as unequal power relations with health workers and how these reshapes patients’ subjectivities. This study aims to contribute to the STS-inspired literature on medications through an exploration of the role of place in medication-taking experiences.

The primary research for this study was conducted in Nigeria, and is framed within the country’s huge chronic pain burden and persistent healthcare challenges. The 2008 world mental health survey, which produced the most comprehensive population-level data available, found that approximately 30 % of Nigerians aged 18 years and older had chronic pain (Tsang et al., 2008). Chronic pain is exacerbated by precarious living conditions and low access to healthcare services (Igwesi-Chibode et al., 2018). Studies have reported infrequent assessment, poor diagnosis and inadequate treatment of pain in Nigeria’s formal healthcare facilities (Faponle et al., 2001; Kolawole and Fawole, 2003), foregrounding the emergence of alternative places of care. Healthcare service provision is plagued by numerous challenges, including under-funding, inadequate infrastructures and negative attitudes of healthcare workers towards patients, which has been attributed to stress and poor working conditions (Kress et al., 2016). In 2018, only 4 % of the federal budget was allocated to health (far below the 15 % commitment in the 2005 Abuja Declaration). Healthcare services are mostly financed through out-of-pocket expenses (65 % of total health expenditures), resulting in low access to healthcare for the poor (Odunyemi, 2021). Structurally vulnerable groups, including PWUD, face significant barriers to medical pain management and some have reported negative encounters with healthcare providers, including discrimination in service provision and labeling as ‘drug addict’ (Nelson, 2022; Nelson and Alichie, 2022). Restrictions on dispensing of opioid analgesics imposed by the Nigerian state in response to increased extra-medical use of these medications has resulted in reluctance to prescribe opioids for chronic non-cancer pain patients with a history of drug use, contributing to undertreatment of pain among PWUD (Nelson, 2022). These barriers have encouraged self-medication with over-the-counter medications purchased from patent medicine dealers (Nelson, 2024), which, as shown in this study, are consumed in different places. These structural and health system factors may be seen as constitutive of a broader actor-network that is 'healthcare' in Nigeria, mediating medication-taking experiences in different places, including those places not conventionally associated with healthcare. All these further emphasize the importance of place and its broader actor-networks in mediating medication-taking experiences.

Drawing on solicited audio-diaries, along with individual interviews, from PWUD living with chronic non-cancer pain in south-south Nigeria, this study analyses accounts of medication-taking in different places to answer the question, how does the experience of place mediate medication-taking experiences? It draws theoretical insights and conceptual resources from STS/ANT, to analyse the spatio-temporal processes and associations through which medication-taking experiences are constituted. It also traces the network of social, affective and material forces that facilitate and enable these experiences. Specifically, the study draws on the conceptual logic of ‘enabling places’, premised on an ANT-inspired analysis of ‘enabling resources’ (Duff, 2011), focusing on how these resources enable medication-taking experiences. Duff (2011) argued that enabling places are made up of diverse actor-networks that facilitate access to crucial resources that support the development of novel agencies and capacities. He identified three types of enabling resources. ‘Social resources’ refer to the various place-based ‘processes and relations that facilitate the creation of novel associations and the distribution of diverse agencies’ (p 153). ‘Affective resources’ describe the body’s capacity to affect and be affected through its encounter with other bodies and things within place as well as the capacities and capabilities that such encounters enable. ‘Material resources’ include the various objects, actants and entities that constitute the materiality of place.

The conceptual logic of enabling places emphasize the material and relational production of place, wherein enabling places are constructed from ‘diverse social, affective and material resources in an active process of association’ (Duff, 2011, p. 155). Enabling places facilitate ‘unique therapeutic encounters prompting the production and circulation of discrete enabling resources in the on-going mediation of health and wellbeing’ (p. 155). I draw on this logic to explore ‘enabling places for medication-taking experiences’, where these experiences are produced through network associations that afford social, affective and material resources in different places at different times. The study contributes to current discussions on medication-taking experiences by analysing the role of place and its constitutive network associations in mediating such experiences. It also helps to enhance current efforts to address medication non-adherence by showing the importance of creating enabling places for positive medication-taking experiences through interventions that shape the production of enabling resources.