EDITOR’S NOTE: Points is delighted to welcome Kim Sue, a previous contributor (check out her earlier posts here and here), medical anthropologist, and dual degree MD/PhD candidate at Harvard University. On the heels of Points’ recent posts about the difficulties of reconciling clinical and scholarly perspectives on addiction treatment and the media frenzy about the recent prescription opioid epidemic, Sue offers a historical and ethical reflection on having the power to dispense prescriptions.
I first met Anita in the Boston jail where she was doing time for passing bad checks related to a prescription opioid addiction. She had first been introduced to opioids after giving birth to her first child several years earlier. “I was prescribed percs [percocets] for pain related to the delivery,” Anita explained. “I just remember taking them and being high and cleaning … I took four or five at a time.” Anita’s drug use spiraled out of control, as her physiological tolerance to the opioids increased and she needed to buy more and more pills to get the same effect. One day, Anita’s dealer offered her heroin, and off she went.
Ethnographers and historians of drug use are all too familiar with stories that resemble Anita’s. As an anthropologist who studies prisons and addiction treatment, I find it relatively easy to point the finger at doctors for their professional complicity in “epidemics” of opioid addiction.
But as a medical student in my final year, destined to start residency in July in an internal medicine-primary care program, I also worry I won’t be able to refuse prescriptions for opioids for patients presenting to me in distress and pain.
Historians of medicine and drug use have detailed how physicians—whether they wanted to or not—became central to the distribution and administration of opioids in the United States. In the wake of the Harrison Narcotics Act, addicts had to obtain prescriptions for their drugs, and so-called “dope doctors” would provide them for cash. The alternative to the dope doctor was the street druggist, the so-called “pusher.”
Doctors and opiates have a long, complex history. In the era of magical formulations, Dr. Thomas Syndenham compounded laudanum by mixing “two ounces of opium and one ounce of saffron dissolved in a pint of Canary or sherry wine” with a “drachm of cinnamon powder and of cloves powder,” as historian Richard Davenport-Hines noted in his history of the subject. At the time, opiates (plus or minus alcohol) were among the few medicines that were actually effective pain relievers (working at the μ pain receptors in the brain). They were instrumental in bolstering the medical profession’s emerging reputation for dispensing effective interventions rather than simply bearing witness to suffering. Indeed, enterprising pharmacists and doctors alike created their own patented formulations of various narcotics marketed as cure-alls– a mix of magic, profiteering, and chemistry.