Saturday, May 29, 2010

Doctors and drugs

Clinton McCracken, a Canadian drug researcher, recently did a brave and unusual thing --  he published an article in JAMA [readers may have to view an ad] describing his own drug use.  His narrative troubles the DSM IV criteria for substance abuse and disrupts the silence of researchers and medical professionals surrounding their relationship to addiction.  He was able to use drugs consistently for years without meeting the criteria for abuse.  Indeed, in the end, the harm that came to him was less from his drug use than from the criminal justice response to it.  However, the story of his fiancee, who died following a bad reaction to injection drugs, unfortunately reminds us of the very real harm that drugs can do, especially drugs bought on the street or through overseas online pharmacies.   Given our current system of criminalizing some drugs, many people, like McCracken's partner, put themselves at risk trying obtain drugs and/or end up with drugs that contain hazardous adulterants or contaminants.  This may be one reason why many people are increasingly reliant upon prescription medications obtained from their own doctors.

What is striking about McCracken's account is how rarely we hear from researchers or medical professionals either about their own drug use or about their own role in supporting addiction.  I am not trying to demonize doctors.  In fact, some accounts suggest that doctors are prescribing opioids either to keep their patients away from heroin and the dangers associated with obtaining and using it on the street and/or to help them establish a steady source of income.  It seems to me that doctors need safer and better ways to talk about addiction -- how they deliberately or unwittingly support it, how they clandestinely treat it, how they want to treat it, and how addiction affect their own lives.   Unfortunately, doctors are silenced by the stigma and very real professional and legal consequences of talking openly about these issues.  I don't necessarily agree with everything McCracken had to say, bur I do applaud his willingness to raise these issues publicly among his peers.

Sunday, May 23, 2010

Becoming Normal: The Social Construction of Buprenorphine & the Embodiment of New Drug Treatment Technologies

  Here's the intro to my dissertation proposal.  Feedback and comments welcome.

In a radical departure from almost a century of U.S. drug policy, in October 2002, the U.S. Food and Drug Administration approved the use of the pharmaceutical, buprenorphine, to treat opioid dependence in office-based settings. Unlike methadone, which remains mired in restrictive government oversight and requires daily attendance at a highly regulated clinic, buprenorphine is available through any certified physician in any office–based setting.  As such, buprenorphine marks a profound change in how, where and by whom drug treatment is delivered.  For the first time since the passage of the Harrison Act in 1914 and subsequent court decisions (through which doctors were expressly forbidden to treat addiction by prescribing narcotics), doctors can treat addiction to opioids (heroin and prescribed opioid medications) by prescribing a drug/medication.  Buprenorphine is the first, and to date, the only medication approved for the office-based treatment of opioid addiction, but an increasing number of medications are being developed to treat a wide array of addictions.  As the leading edge of this movement to treat addiction through prescription, buprenorphine has been heralded by addiction medicine experts as the technological breakthrough that will finally move the treatment of addiction into the medical mainstream. 
Conrad and Schneider (1992) have noted the escalating medicalization of deviance through which behaviors once viewed as moral failings are increasingly viewed as illnesses.  One hallmark of medicalization has been the widespread adoption of medications to treat problems previously understood as behavioral (Diller, 1999).  However, neither alcoholism (Valverde, 1998) nor drug dependence (Smart, 1984) fit easily into the medicalization model, even though the medical model of addiction dates back to the 1800’s and has gained in prominence in the U.S. over the past thirty years.  Medical responses to addiction that frame the problem as a failure of biochemistry or genetics continue to co-exist uneasily with behavioral and legal responses that frame the problem as failure of will or a crime.  Thus, the world of addiction and addiction treatment has been and remains one of contestation, confusion, and slippage.  Buprenorphine enters directly into this contest as the first real medical “solution” to opioid addiction since the introduction of methadone four decades ago.  It represents a clear attempt by medical professionals and the pharmaceutical manufacturer to further medicalize addiction and to resolve some of the discursive ambiguity surrounding addiction treatment.  As such, it offers a unique opportunity to study the processes and conditions of medicalization and to explore how and why criminal and medical models to explain addiction continue to coexist. 
In addition to exploring processes of medicalization, this project is concerned with the sociology of body and the relationship between the social construction of addiction and the formation of the self.  The body has increasingly become a site where notions of self and identity are both produced and regulated (see for example, Budgeon, 2003; Butler, 2004; Pitts-Taylor, 2003; Shilling, 2003).  Doctors play a particularly important role in labeling and legitimizing bodies and in managing subjective experiences of our bodies (Shilling, 2003), and biomedical technologies (Persson, 2004), like buprenorphine, are intimately and importantly involved in the production of self.   However, the ways in which medical rhetoric about addiction and these new treatment technologies affect the interiorization and embodiment of medicalized identities is poorly understood.
Using interviews with doctors who prescribe buprenorphine and patients who take it as well as an analysis of documents about the introduction of buprenorphine in the U.S., I will examine how buprenorphine is being socially constructed and how new drug treatment technologies, like buprenorphine, are embodied and understood by the people who use them, how it shapes their subjectivity and identity, and what new possibilities for freedom or constraint these new identities offer. 

Friday, May 7, 2010

Paying Addicts for Sterilization

Sorry for the long silence on ye ole blog, but i've actually been focusing on my dissertation for a change.

But this just in for those of you who think there isn't an element of social control to drug treatment. reported this frightening tidbit:

The highly controversial Project Prevention, a North Carolina charity that gives cash payments to drug addicts who undergo sterilization or start on long-term birth control, is receiving a similar mixed reception as it expands into the United Kingdom.
Time magazine reported April 17 that Project Prevention founder Barbara Harris decided to form a U.K. chapter after 400 e-mails of support followed her appearance on a BBC Radio 4 program in February. The organization, which relies largely on private donations to subsidize its $300 payments to addicts, received $20,000 from an anonymous supporter to launch its U.K. effort.
Sigh.  Her goal of reducing the number of drug-exposed infants is a good one, but, really...  sterilization?  And can we talk about the ethics of offering $300 incentives to addicts?  Gah.