Mine workers in Hpakant, Kachin State. Photo by Kachinland Research Centre (KRC)

In this Medical Anthropology article, Tim Rhodes, Khine Wut Yee Kyaw and Magdalena Harris explore how precarious livelihoods intersect with precarious treatments for heroin dependency in a setting affected by longstanding conflicts and an illicit drug economy as well as by recent events of pandemic and political change.

Working with 33 qualitative interviews with people who inject drugs in Kachin State, northern Myanmar, they explore how drug dependency treatment, especially methadone substitution, is made to work in efforts to sustain everyday livelihoods.

The analysis attends to the work that is done to enable therapeutic trajectories to emerge as “generous constraints” in precarity, and traces methadone substitution as an emergent intervention of livelihood survival.