Editor’s Note: Today we’re thrilled to feature SHAD co-editor Nancy Campbell discussing her new book, OD: Naloxone and the Politics of Overdose (The MIT Press, 2020). Campbell is Professor and Department Head of Science and Technology Studies at Rensselaer in Troy, New York. Her other books are: Gendering Addiction: The Politics of Drug Treatment in a Neurochemical World (co-authored with Elizabeth Ettorre; Palgrave, 2011); Discovering Addiction: The Science and Politics of Substance Abuse Research (University of Michigan Press, 2007); The Narcotic Farm: The Rise and Fall of America’s First Prison for Drug Addicts (co-authored with JP Olsen and Luke Walden; Abrams, 2008); and Using Women: Gender, Drug Policy, and Social Justice (Routledge, 2000). Although she has a PhD in the History of Consciousness from the University of California at Santa Cruz, she has been granted a green card as a historian.
Describe your book in terms your bartender could understand.
Some of my favorite bartenders include grad students and PhD alums. They’ve had rough days “pivoting” to incorporate COVID-19 into their dissertations. I’d introduce my book as dense, dark, and handsome, like the cover. OD is spelled out in old-school Franklin Gothic Condensed type—headline type. But scribed through the letters is a 45-degree angle, signifying the US opioid overdose death rate from 2000-2017.
OD: Naloxone and the Politics of Overdose is a lively book about death. Preventable deaths haunt its pages. The protagonists of OD all have a touch of mordant wit tinging their heartfelt dedication to harm reduction. Their badassery has been quite effective—these compassionate cynics were galvanized to remodel their social worlds over the past 30 years. Many were touched by profound losses. Many knew people who died because naloxone and the knowledge to use was not ready to hand. Their stories intertwine with those of policy and public health, wars on drugs and drug users.
Every bartender knows that people grieve their losses differently. Some drown their sorrows. Others turn them into art, poetry, protest, or testimony. Some turn them into science, research, evidence. I included as much of the cultural production that has occurred in response to overdose as I could muster. There are 40 illustrations, some 20 of which came from Santa Cruz Needle Exchange’s ‘zine Junkphood. These keep the book’s pulse strong. You can learn a lot from people who believe, as Lee Hertel of Lee’s Rig Hub in Minneapolis, that “nobody deserves to die because of how they choose to navigate life.”
That’s something every bartender needs to hear and pass along.
What do you think a bunch of drug and alcohol historians might find particularly interesting about your book?
Following the pharmacological imagination intrigues me as a historian of the present. Nalorphine/Nalline, the first narcotic antagonist that everyone got excited about in the 1950s, was cast as a “hound dog drug” for sniffing out drug users. Police injected it, measured changes in the pupils, and argued it would deter drug users from moving into districts like Oakland, LA, or Humboldt County, California. They argued the Nalline test could be therapeutic because it was such a dysphoric experience that users would stay away from heroin. Lawrence Robinson, the petitioner in the 1962 US Supreme Court case, was enrolled in a Nalline program. Found dead of overdose almost a year prior to the decision on his behalf, he didn’t find Nalline therapeutic or deterrent.
Nalorphine hung around into the 1970s, even after naloxone was FDA approved to reverse opioid overdose. Emergency medicine was just gearing up in the 1970s, and naloxone soon became an oft-used tool of paramedics and EMTs. Studies done for the FDA approval process were pretty interesting for someone interested in the history of addiction research and the use of human subjects in the addiction arena. Naloxone itself has fed pharmacological dreams since the 1960s. Could it be used to prevent people from getting high? Could it make for a safer painkiller? Could it prevent tampering? Was there a “magical ratio” of narcotic agonist to antagonist that could be therapeutic? It was used as a pharmacological “tell” in the search for opioid receptors. Scientists thought it might be the key to the holy grail, something that would strip away potential for abuse.
Magic often comes up in relation to naloxone, and I’ve long been interested in how historians talk about the spirits that animate the drugs we follow. I’ve talked to hundreds of people about naloxone, and it was striking how often I heard terms like “miracle medicine” or “pure antidote.” Naloxone gained an international following—people dedicated their lives to getting naloxone out of the hands of medicine and into the hands of people who were most likely to witness an overdose. There are Naloxone Ninjas and harm reduction photographer Nigel Brunsdon made T-shirts—one of which I proudly wear—that say “Keep Calm and Carry Naloxone.” As a historian, I was delighted to discover what I called naloxone’s nine lives—it has multiple pasts, presents, and futures. Today in the midst of COVID-19, there are states where you can now get curbside delivery.
Now that the hard part is over, what is the thing YOU find most interesting about your book?
The book is part of the MIT Press’s Inside Technology series. As a Science and Technology Studies (STS) scholar, I’ve long fallen on the science and medicine side. My previous books have been history of science (Discovering Addiction) and history of treatment (The Narcotic Farm, with co-authors JP Olsen and Luke Walden; Gendering Addiction, a history of gender-specific drug treatment in the US and the UK, co-authored with Elizabeth Ettorre). So this technology story opened up some new vistas for me, namely on “epistemologies of ignorance,” to which David Hess’s concept of “undone science” is central. Doing the sciences of overdose—and the sciences of naloxone—requires much more recognition of the role of social and political context in determining which “situated knowledges” get done and which merely beckon to a thin veneer of situational specificity.
I’m personally most interested in the parts of the book where I get to indulge in the crucially interpretive work of cultural studies that I think I was brought up to do. It took me seven years to write this book. Maya Doe Simkins, one of the Boston activists who is now the media maven at the Chicago Recovery Alliance, brought it to me after reading my article on the history of buprenorphine, co-authored with Anne Lovell. She turned me on to what activists were doing with naloxone. But it still took me a while to realize that it was a book, and not just an article about what the harm reduction movement was up to or an extension of my think-piece chapter for Hermann Herlinghaus’ conference volume on The Pharmakon: Concept Figure, Image of Transgression, Poetic Practice.
Over those seven years, I spoke with a lot of people whose lives had been touched by overdose and overdose deaths. Over the course of those years, overdose stopped being something whispered and shamefully hidden; it became so much more culturally central and accessible. Naloxone itself went from being a word no one knew how to say to becoming a household word. I named it a “technology of solidarity,” and I tried to situate it within the circuits where it mattered. The writing process was really interesting, because every day, it seemed, overdose unfolded.
Every research project leaves some stones unturned. What stone are you most curious to see turned over soon?
Harm reduction is global. Overdose and overdose prevention are happening in places other than those to which I could go. I limited the book to the US and the UK, but naloxone has many more lives beyond that. My book anchors a certain kind of history—like several of my other books, it plants a stake in rocky ground. There was also a lot of art—graphic art, installation art, performance art, theatrical productions, protest art—that I just could not fit into the book. Rivers run deep beneath those stones.
BONUS QUESTION: In an audio version of the book, who should provide the narration?
The audio version should be narrated by a ghost—the spirit of Dan Bigg #bigglove pervades the book and the movement. Dan died of an overdose, surrounded by cases of naloxone, while I was finishing the manuscript and helping my Pennsylvania family clean up after yet another 100-year flood in 2018. Although I’d had interviewees die before, this one felt like a gut punch. My interview with Dan was punctuated by a sudden trip to one of his favorite Chicago diners, during which I kept the recorder running—you can hear my occasionally sharp intake of breath at his driving. His voice was compelling and is deeply missed the world over.
Another possibility would be a goddess—Edith Springer, from whom dubbed the movement drew much inspiration. When I consider the voices of harm reduction—understand that I often hear protagonist voices as much younger, as well as relying on the terrific ACT UP Oral History Project—I’d say Richard Elovich, the aforementioned Lee Hertel. If resurrection and “renimatology” are off the table, Nicolas Cage, who played the haunted paramedic in Bringing Out the Dead, who turned to his partner and says, “Break out the Narcan,” would be an obvious choice. Or why not go for broke: Martin Scorsese, director of “Bringing Out the Dead,” or Irvine Welsh, author of Trainspotting.
Many of today’s harm reduction gods and goddesses are people of color, like Kassandra Frederique of the Drug Policy Alliance and Monique Tula of HRC. All of them would be great choices if the audiobook could bring the story into the present and catch up on what’s actually happening with the harm reduction community’s response to COVID-19. Historian Samuel K. Roberts, who is writing about harm reduction in communities of color, would also make a great narrator.
Historians are often befuddled by how to tell a story when so many events happen simultaneously in different places. We can only attend to so much, and there are so many more stories to be told. The present is always unfolding, and we are in the business of producing useable pasts. To attend to the multi-dimensional stories that inhabit this book, I’d go for Bruce.
Springsteen, that is. Because no one can tell a ghost story like Bruce.
1 thought on “The Points Interview: Nancy Campbell”
Many moons ago my job was to train physicians and paramedics on using naloxone. The approval of this medication in 1973 came after the worst of the heroin epidemic had ended. The chemical structure and pharmacology of naloxone gave hope to scientists of developing a non-addicting opioid analgesic. Instead, they ended up developing a revolutionary new medication that could potentially end the scourge of heroin. The drug is naltrexone and the development, funded as part of Nixon’s War on Drugs. Naltrexone is identical to naloxone except its half is 24 hours as opposed to 30 minutes for naloxone and can be administered orally. For the first time clinicians had a radically different medication that would bring the treatment of opioid addiction into the mainstream of medicine. Since it was a non-opioid, there was no concern about overdoses, abuse and diversion. No more standing in line to ingest a daily dose of methadone. Rarely in the history of medicine, two pharmacologically opposite drugs, methadone and naltrexone were offered as treatment for the same problem. Methadone belongs to a class of opioids called agonists and naloxone and naltrexone belong to a class called antagonists.
The introduction of naltrexone in 1984 upended the entrenched belief that opioids cause permanent mutation of the opiate receptors and therefore, Opioids Substitution Treatment (OST) is the only viable treatment. Instead of looking at this new medication as a quantum leap in protecting detoxed heroin addicts from relapsing, it was needlessly seen as an existential threat to OST. The rejection of naltrexone created deep-seated divisions within the treatment field and continue to handicap treatment to this day. Harm reduction – OST, widespread distribution of naloxone, needle exchange programs dominate ‘treatment’ and naltrexone is pretty much relegated as a treatment for ‘motivated’ patients like healthcare professionals, business executives etc.
Medical historians should seriously consider writing the history of naltrexone, an amazing medication approved for the treatment of opioid addiction and alcoholism but a victim of the politics of opioid treatment.
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