|Image source: Students for Sensible Drug Policy (www.ssdp.org)|
Saturday, February 25, 2012
Is the medicalization of addiction benign?
I've been revisiting my dissertation for a book project. Here are some of my conclusions based on my analysis of buprenorphine, a pharmaceutical treatment for opioid dependence.
Elizabeth Pisani (2008) in The Wisdom of Whores argues that a substantial portion of the funding devoted to HIV/AIDS is wasted on ineffective programming because science and good public health policy are trumped by politics, ideology, and "morality." The same is true for current U.S. drug policies. As my analysis of the social construction of bup has illustrated, the current classification of drugs as legal or illicit is at best irrational and at worst driven by racism (Mosher & Yanagaisako 1991). In a culture that is increasingly medicalized and pharmaceuticalized, problematizing all “non-medical” use of substances will further exacerbate our already unjust and ineffective policy responses to drug use.
The use of illicit drugs is spread throughout society fairly evenly, but the harm that results from them and our responses to them are not. Legal drugs, in fact, cause far more social and health problems than illicit ones (Mosher & Yanagaisako 1991), and our response to illicit drugs (arrest and incarceration) causes profound harm to individuals, families and communities (Global Commission on Drug Policy 2011). One the face of it, medical approaches to drug use seem kinder and more benevolent than criminal justice approaches. But, as I have argued, one does not preclude the other; both have and will continue to co-exist. It seems increasingly likely that some drug users will be treated medically, and others will be locked up, escalating rather then diminishing the racial disparities that characterize U.S. drug policy. Moreover, I have also argued that medicalized approaches do not necessarily reduce individual blame or stigma but rather merely cloak moralistic arguments in the language of science. More perniciously, medicalized approaches, especially neuroscientific ones, radically individualize the problem of drugs and erase the effects of social factors, like racism and poverty.
We need a drug policy that recognizes the role that racism, poverty and the lack of opportunity play in fostering drug use and our responses to it and works to resolve them. Medicalization mutes racism and inequality and then blames individuals for not being able to overcome them. Instead of isolating and blaming those who use drugs, we need to restore communitarian responses that will help all people lead lives of dignity.
In addition to working towards building strong, vibrant communities where everyone has the opportunity to thrive, we need a drug policy that rationalizes our approach to substances, not arbitrarily judging them legal or illicit, but helping individuals understand the real risks and benefits each poses. To the extent that we want to control and limit the use of some substances, we should focus on the real harm they cause, not our irrational and/or racist fears about particular substances. Imagine a drug policy where there are not arbitrary lines between bup, Oxycontin, methadone and heroin -- making some demon drugs that lead to incarceration and some cures to that same addiction. Imagine a drug policy that does not draw a distinction between “medical” marijuana and “illicit” marijuana but simply explains the benefits and risk of marijuana use and trusts that people can make informed decisions about their own embodied experiences and health. We believe that most people can moderately consume alcohol, Oxycontin, and Prozac without the threat of arrest. Why not some opioids? Imagine instead of stigma, fear, ambiguity and confusion, we offered information and support for whichever substance (or no substance at all) helps people.
The features of buprenorphine that helped people in my study the most were its legality and availability, the autonomy it gave it them over their own drug use and treatment, and its relative freedom from stigma. These qualities can and should guide or drug policies. But our drug policies must also include a commitment to understanding and dismantling systemic forms of oppression, racism, and inequality and to challenging neoliberal efforts to undermine communitarian responses to social problems.