Cops and Doctors: The Hidden Drug War

Siobhan Reynolds’ most recent guest post to this blog does an outstanding job of making the case that we (meaning both society writ large and the medical profession more generally) have utterly failed to address problems of chronic pain, and that these failures have a great deal to do with “the context of drug prohibition.”  Reynolds observes: “The system-wide denial of humane and effective treatment is covered up by the fear campaign that has been hammering away at our consciousness since the dawn of drug prohibition–a fear campaign masquerading as a public health initiative.”

The phrase “the dawn of drug prohibition” led me to ask myself–just what are the roots of our contemporary struggle to employ opiate analgesics effectively and appropriately, and how deep are they?  Here’s a bit of what we, as historians, know about the case of the United States.Continue reading “Cops and Doctors: The Hidden Drug War”

Summer School!

This is Your Brain Responding to the Physiological Actions of Drugs--and There Will be a Quiz Tomorrow

The good souls over at DoseNation offer a link today to a series of classes taught in 2006 by UC Berkeley Behavioral Pharmacologist Dave Presti. “The major focus of the course is on the relationship between behavior and the physiological actions of drugs. Emphasis will be placed on effects of pharmacological agents on complex mental processes such as attention, motivation, learning, and memory.” The lectures are available through a link or as series of podcasts, all free gratis, courtesy of the late great state of California.

Getting Relief in Wartime: Opioids, Pain Management, and the War on Drugs

In her second guest post for Points, pain relief activist Siobhan Reynolds looks at the ways in which drug war hysteria has warped public and political perceptions of pain management prescribing practices.  

On April 20, the FDA, the DEA and the Office of National Drug Control Policy, along with a host of other federal agencies, announced the rolling out of REMS, or “Risk Evaluation and Mitigation Strategy,” a new federal policy that purports to confront what these agencies call the “epidemic” of prescription opioid abuse. Among REMS’ proposed solutions to the problem is physician education by DEA agents– federal law enforcement officers

"Does this clarify things for you?"

with no medical training. Alongside the REMs announcement, of course, came a propaganda campaign justifying the action: articles in newspapers, magazines, law journals and even medical outlets that decried the sharp rise in overdose deaths that have resulted, the government claims, from doctors’ increased prescription of opioids over the past several years.  There’s only one problem with all the hype: the data upon which such frightening claims are made is wholly unreliable.

Continue reading “Getting Relief in Wartime: Opioids, Pain Management, and the War on Drugs”

Raise a Glass to Harm Reduction!

Benoit Denizet-Lewis (himself a recovering addict) offers a brief commentary in today’s Times  on St. Anthony House, a residential facility for hardcore alcoholics that allows them to keep drinking.

The Road to St. Anthony's

This kind of harm reduction focused program, which aims not to reform the (often homeless) alcoholics, but to mitigate the damage theydo to themselves and society, receives frequent coverage in the mainstream press of the “man bites dog” variety.  (See, for example, Malcolm Gladwell’s “Million Dollar Murray” in the The New Yorker a few years ago.)  Central in such stories is always the argument that this kind of program is far less expensive than sending the alcoholic on another trip through the revolving door of treatment– the St. Anthony House website itself foregrounds this fact.  Umm… is that neoliberalism?  Or is that just a canny deployment of fiscal conservatism in order to cover a radical agenda?  Points would like nothing more than to get the perspective of social scientists and historians working in this area.

Teaching Drugs and Alcohol through the Filter of Student Life

In his second week as a Points Guest Blogger, Eoin Cannon reflects on the difficulties of talking intelligently about addiction with a roomful of undergraduates who may still be hungover from the night before.

Last fall, I taught a course called “Stories of Addiction” for my university’s Freshman Seminar program. It was the first opportunity I’d found to teach my scholarly interest in a sustained way. As in approaching any new course, I gave some thought during my preparation to what beliefs, assumptions, and values students would bring to the topic. In departmental courses, I think, you can count on your discipline’s critical tools, and your students’ developing comfort with them, to create analytical distance. Not a space, hopefully, in which personal experience is unwelcome, but one colored by the implicit understanding that our main purpose here is not to do therapy or reproduce conventional wisdom.

But three factors made the issue of distance particularly salient in my seminar. First, it was for freshman only, during their fall semester. They had no experience with college-level critical thinking. Second, the seminar context, combined with my own approach to the topic, put the course outside of any single disciplinary framework and its implied critical distance.

Your Experience Here

It wasn’t “addiction in literature,” it wasn’t “the history of addiction,” it was just “addiction stories,” and the shapes they take, the work they do, in various contexts. I was using the category of narrative to develop an interdisciplinary framework that would not be obvious to students. Third, and most important, alcohol/drugs is a topic freighted with official and unofficial discourses that play key roles in the social identities of college students. Continue reading “Teaching Drugs and Alcohol through the Filter of Student Life”

Addiction is a Brain Disease (But Not Always?)

Closing out her stint as a Guest Blogger, Helen Keane notes the gap between the way pain management experts and neuroscientists think about addiction.

The currently dominant scientific paradigm of addiction is that of a ‘chronic, relapsing, brain disease’ which develops as a result of persistent consumption of drugs of abuse. Over time, according to this model, drug use produces long-term changes in brain structure and function, and what began as a voluntary behaviour becomes an uncontrollable compulsion. The process is driven by the effect of dopamine on brain reward pathways, and the ability of drugs to ‘hijack’ these pathways which evolved to reinforce behaviours necessary for survival such as eating and sex.

In addiction science journals the brain disease paradigm is celebrated as a major breakthrough which promises a new era of enlightened treatment, prevention and research.

This Explains Everything!

But as David Courtwright outlined in a recent article  it has also been met with ‘indifference’, ‘suspicion’ and ‘resistance’ from a range of  interested parties including politicians, clinicians and (perhaps least surprisingly) social scientists.[i]  From a sociological and historical perspective there are many things questionable about the neuroscientific discourse of addiction, including, to cite Joseph Gabriel’s recent post, the idea that drug effects on the body can be understood as theoretically prior to the social and cultural contexts in which they occur. But the apparently limited impact of the brain disease model on medical understandings of addiction is more surprising.Continue reading “Addiction is a Brain Disease (But Not Always?)”

Meth and Moral Panics, Part One

Today, I’m posting the first in a short series on the concept of “moral panic” and its utility for those of us who write and think about the history of drugs and alcohol. I’ve been promising this series to co-managing editor Trysh Travis (and to my students) for some time, so I’m glad to get things underway.

While there’s been no “moral panic” tag here at the Points blog (until today), there’s no shortage of references to it here, either. You can find Trysh Travis dropping the phrase here and here. In keeping with the spirit of Trysh’s posts, I thought I’d use the history of methampetamine (and its place within the moral panic literature) as the focusing point of this series.

Let’s go back, for a moment, to 1990. Early in my graduate career, I was just beginning my long engagement with drugs history when I ran across an article in the February 8, 1990 issue of Rolling Stone magazine. On the cover, right alongside a photo of the old-even-then Paul McCartney, was the lead: “The Ice Age: A New Drug Epidemic Threatens America.” The actual article, written by contributing editor Mike Sager, was scarcely less scary and foreboding than the words on the cover. Effectively, Sager was warning readers in “The Ice Age” that an epidemic of smokable crystal methamphetamine use was on its way from Hawaii to the U.S. mainland, soon to surpass heroin and cocaine as the nation’s major drug problem. I confess to having found Sager’s article compelling reading—the gritty realism of his style as a Rolling Stone contributing editor during these years was and is of the sort you can see in much greater detail in a collection of his work entitled Scary Monsters and Super Freaks: Stories of Sex, Drugs, Rock ‘n’ Roll and Murder. At about the same time, Sager spelled out the central claim in the Chicago Sun-Times: “The Age of Ice is a new era in drug abuse” and ground zero for this new age was Hawaii, “where use of the drug has recently been declared ‘epidemic.’”

Sager wasn’t the only one working the ice beat in late 1989 and early 1990. A substantial volume of news stories and longer article appeared in the local and national press, most echoing the basic tone of Sager’s warning piece. Indeed, Sager and his fellow journalists were hardly the only ones at this party–the story had grown from a big issue in Hawaiian local politics to the national political stage. Less then one month before Sager’s article appeared in Rolling Stone, ice was the subject of a Congressional hearing “Drug Crisis in Hawaii” [Drug crisis in Hawaii : hearing before the Select Committee on Narcotics Abuse and Control, House of Representatives, One Hundred First Congress, second session, January 13, 1990]. Indeed, the phrase “ice age” was borrowed by Sager from the ongoing political conversation–the phrase had been employed multiple times to describe the looming crisis.

While I was credulously absorbing Sager’s tale of drug menace, historian Phillip Jenkins was taking a different and more critical approach to this and other writings on the subject. What happened next? I’ll let Jenkins tell the rest of the story, which shows me to have been pretty gullible, and Jenkins fairly savvy: Continue reading “Meth and Moral Panics, Part One”

Addiction and Pseudoaddiction

Guest Blogging at Points for a third day, Helen Keane addresses the need for some refinements in the concept of “drug dependence.”

In my previous post I talked about the need to distinguish pain patients from addicts in the pain clinic. Both may be dependent on opiates, but the addict manifests aberrant drug-seeking behavior and an unhealthy obsession with drugs. However the problem of legitimate pain patients who behave like addicts has lead to a refinement of the addicted/non-addicted binary.

Just Say "Manage It"

“Pseudoaddiction” is a concept developed by pain specialists in the 1990s to describe desperate drug-seeking, produced not by true drug addiction, but by the under-treatment of pain. The behaviour of patients exhibiting pseudoaddiction mimics the out of control conduct of  the addicted: they may increase their dose without approval, complain aggressively, or lie to get more drugs and turn to street drugs or doctor shopping to increase their supply. Pseudoaddiction looks like addiction but it is not addiction. Continue reading “Addiction and Pseudoaddiction”

Opiate Users: Deserving and Undeserving?

In her second day as a Guest Blogger, Helen Keane of Australian National University examines how “niceness” and the lack thereof shape our understandings of heavy drug use.

In the previous post I discussed the distinction between dependence and addiction. Here I’d like to raise a few issues about the psychological/behavioural model of addiction developed in pain medicine. I’ve written about this topic with Kelly Hamill in this paper.[i]

In the context of pain treatment, opiates are not dangerous illicit substances but effective and safe analgesics appropriate for long-term use in selected patients.

The At-Risk & Predisposed Individual

Because the prescription of opiate drugs is central to its clinical practice, pain medicine has developed a definition of addiction which does not implicate drugs as the primary agents of addictive disorder.Instead it constructs addiction as a psychological disorder recognisable by the addict’s out of control behaviour, her drug-focused lifestyle and her destructive patterns of drug use. The prevention of addiction in the pain clinic therefore centres on the identification of certain “at risk” and predisposed individuals, including those with a past history of substance abuse. Continue reading “Opiate Users: Deserving and Undeserving?”

Non-Addicted Drug Dependence

Guest blogging at Points continues this week with a series of pieces by Helen Keane, who teaches gender studies and sociology at the Australian National University in Canberra. Keane is the author of What’s Wrong with Addiction?  (NYUP 2002), and has written widely on the social and cultural aspects of alcohol and illicit drug use, pharmaceutical drugs and addiction. Her current research interests include ADHD and constructions of childhood; intoxication and gender; and theories of medicalization.

Coming Soon: the Fifth Dimension

Much of my work is focused on the concept of addiction and its mix of medical, ethical and social elements. I don’t see this mix as reducible: it seems to me that this collection of biological markers, clinical evaluations, and ethical and cultural judgements is what addiction is. While I think that untangling the strands that make up the idea of addiction is intellectually and politically important, dis-entanglement does not necessarily clarify the true nature of the disorder.  What it does reveal is what is at stake in such classificatory and definitional exercises. In this series of posts I want to look at some different medical definitions of addiction:  in pain medicine, in the draft DSM-V, and in addiction neuroscience.Continue reading “Non-Addicted Drug Dependence”

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