More Dispatches from Buffalo: Biomedicine and its Critics

Editors’ Note: Here’s the second of Michael Durfee’s reports from the recent ADHS conference.  Readers interested in more about Michael should consult his first post.

Biomedicine and its Critics in Addiction
On Saturday, Caroline Acker spun the tale of methadone’s multiplicity.  Acker presented a case for the five lives of methadone:  First, as a powerful German analgesic and replacement for morphine.  Second, as a detox drug in the Lexington Narcotic Hospital.  Third, as a maintenance drug intended to treat what doctors believed to be the metabolic disease of addiction.  Fourth, as a crime-fighting aid, as methadone decreased the likelihood that addicts might commit crimes to score.  And finally, in its fifth incarnation, methadone tethered itself to the language of harm reduction.  Following the five lives of methadone, Acker astutely informed the audience of concurrent paradigm shifts regarding the causes of addiction.  For Acker, the major shift comes with methadone as a maintenance drug.  In this instance, Acker sees a direct challenge to the classic era’s attempt at eradication and abstinence.  Rather than point to an essentialist model which highlighted character flaws amongst addicts, a program of maintenance began to look at other possible causes for addiction.  The next major shift comes under harm reduction, posing a direct challenge to the baseline of national drug policy—that of criminalization.  While we are not likely to see safe injection sites in states throughout the U.S. anytime soon, harm reduction has made important strides in changing the direction of the national conversation on addiction as well as given addicts a place at the table of health care and addiction services.
For her part, Claire Clark added complexity to the methadone narrative by analyzing the philosophical divide between treatment communities and methadone maintenance.  Clark smartly identified the height of the conflict in the late 60s (1965-1971) as treatment communities like Synanon and Daytop Village diametrically opposed practices of methadone maintenance.  Aiming to fix the presumed character defects of addicts, treatment communities believed that methadone could only hinder the prospects of rehabilitation.  As Clark acknowledges, the antagonism between treatment communities and practices of methadone maintenance eventually diminished as Vincent Dole (pioneer of methadone maintenance) and William O’Brien (founder and president of Daytop) presented on the same stage at a 1980 NIDA conference.  Increasingly, treatment communities have integrated the use of methadone and other maintenance drugs in an attempt to provide more comprehensive, effective treatment for addicts.  Instead of taking on adversarial postures, competing authorities in the world of addiction might be better served through open dialogue across ideologies, disciplines, and other lingering divides.  Ideally, said dialogue should provide more nuanced, effective treatment for those battling addiction.

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Joe Spillane is Professor of History at the University of Florida. He has authored Cocaine: From Medical Marvel to Modern Menace in the United States (Johns Hopkins Press, 2000) and co-edited Federal Drug Control: The Evolution of Policy and Practice (Haworth Press, 2004).  More recently, he authored Coxsackie: The Life and Death of Prison Reform (Johns Hopkins Press, 2014). His current drug-related research agenda includes: the history and development of drug abuse liability assessment; reflections on the nature of drug epidemics; and examinations of drug war “harms” in historical context.

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