drug regulation – Page 3 – Points: short & insightful writing about the long & complex history of drugs & alcohol

Hidden Addicts: The Elderly and the Opioid Epidemic

March 1, 2021 by Points Editor

Editor’s Note: Today’s post comes from contributing editor Michael Brownrigg. Michael recently received his PhD in US history from Northwestern University, where he studied the relationship between emotion, white masculinity, and capitalism to explain the emergence of an antinarcotic consensus in America at the turn of the twentieth century.

elderly and opioids — Photo courtesy of Sharon McCutcheon on Unsplash.

“The face of the nation’s opioid epidemic increasingly is gray and wrinkled,” wrote The Washington Post in 2018, “but that face often is overlooked in a crisis that frequently focuses on the young.” Since the early 2000s, medical experts have grown alarmed by the precipitous rise in opioid-related hospitalizations and deaths among the elderly and deeply concerned that the burgeoning crisis among the geriatric population was going unnoticed.

They pointed to several factors to explain the phenomenon but primarily blamed polypharmacy—the practice of prescribing patients multiple, often dozens of, medications—for the dramatic increase in addiction rates. “An increasing number of elderly patients nationwide are on multiple medications to treat chronic diseases,” one specialist claimed, “raising their chances of dangerous drug interactions and serious side effects. Often the drugs are prescribed by different specialists who don’t communicate with each other.” Older Americans are essentially being pharmaceuticalized, medicated to death, or, at the very least, subjected to extreme distress.

Narrative Medicine

Overprescribing, as the Washington Post article noted, often results from a fractured medical community that impedes the type of collaboration and communication between practitioners necessary for providing integrated regimens tailored for specific patients. Instead of individualized care, elderly patients often receive standardized treatments, that emphasize the use of pharmaceuticals to alleviate chronic pain.

To better serve their patients, physicians need to listen more intently and more empathetically to fully understand the causes of their distress. In other words, they need to practice what Dr. Rita Charon, Professor of Medicine at Columbia University’s Irving Medical Center, has called “narrative medicine.”

By asking pointed questions about both mental and physical health, practitioners can prompt patients to explain their suffering and to situate their pain in narratives and stories that help foster more thoughtful patient-doctor relationships and, consequently, provide intimate and targeted care. Charon writes that:

Turning Back the ‘Diol: CBD Hemp Prices Crash; History Repeats Itself?

February 9, 2021 by Points Editor

Editor’s Note: Today’s post comes from contributing editor Nick Johnson, a historian and editor based in Fort Collins, Colorado. His book Grass Roots: A History of Cannabis in the American West (2017) is a history of cannabis agriculture that explores the environmental and social dynamics of the nation’s most controversial crop. He also blogs (and occasionally podcasts!) about all things cannabis on his website, Hempirical Evidence.

The booming market in Cannabidiol (CBD) products has gone bust. The boom was touched off by the federal re-legalization of hemp in the 2018 farm bill, which led many farmers, investors, and entrepreneurs to stake their hopes on a new crop supplying a rapidly expanding market of CBD-enhanced products—from gummies to lotion to lip balm. The benefits and risks of such products are still being substantiated by science, but consumers gobbled them up, anyway, looking for relief from ailments ranging from arthritis to insomnia.

Now, there are simply too many CBD products and companies on the market, using far too little hemp. Places like Colorado, Kentucky, and the Ohio Valley report an oversupply of hemp, and per-pound hemp prices have plummeted. The Food and Drug Administration’s (FDA) reluctance to approve CBD products has irked some in the industry, but the driving factor for the bust appears to be simple economics.

Akin to WWII Program

This is not the first time Americans have produced too much hemp for their own good. In 1942, the federal government suspended its cannabis prohibition to create a domestic hemp industry to supply cordage for the US military during World War II. After years of being told that the crop was a dangerous and addictive drug, American farmers were suddenly encouraged to grow thousands of acres of hemp. In a flash, the government built 42 hemp processing facilities across the Midwest, providing hundreds of jobs and invigorating depressed rural areas.

Points Interview: “‘Tropical Stupor’: Drug Regulation, Public Surveys, and State-Building in Brazil (1930–1950)” with Mariana Broglia de Moura

January 31, 2022February 3, 2021 by Points Editor

Editor’s Note: Points continues its series of interviews with authors from the latest issue of ADHS’s journal Social History of Alcohol and Drugs (vol. 34, no. 2; Fall 2020), published by the University of Chicago Press. Today we feature Mariana Broglia de Moura, a doctoral candidate at the Ecole des Hautes Etudes en Sciences Sociales (Paris, France). You can see her article here. Contact the University of Chicago Press to subscribe to the journal or request access to this article, or any other article from SHAD’s history.

Tell readers a little bit about yourself

I am a PhD student at the Ecole des Hautes Etudes en Sciences Sociales (EHESS) in Paris. During my doctoral studies, I benefited from a scholarship from the Labex TEPSIS, and I am attached to the laboratories Centre Maurice Halbwachs (ENS) and Mondes Américains (EHESS) under the supervision of Benoît de l’Estoile and Mônica Schpun. My research has been greatly enriched by a stay at the Centre for the Social History of Health and Healthcare of the University of Strathclyde (Scotland) where I studied with Jim Mills. I’ve had the opportunity to publish various articles about the history of Brazilian drugs policies.

What got you interested in drugs (and their history)?

My interest in drugs came initially as a result of my Master’s Thesis, which lay at the intersection of the anthropology of health and of the history of science. I wrote about the emergence of the categories of behavioural addictions—specifically sexual addiction—in France. I wanted to understand the transformations in the field of sexuality since the 19th century, which have led us to frame a relationship to sexuality in terms of “addiction.” And, in the field of addiction, how addiction—which initially referred to the use of substances—was then extended during the 20th century to encompass a whole range of behaviours. This went hand-in-hand with a reflection about the extension of the new medical power of addictology, which led to the emergence of new social and professional actors. I also investigated preventive policies for behaviours which are socially and economically incited, but whose abuses need to be controlled.

The year I finished my Master’s Thesis, the city of São Paulo, Brazil, began to implement a very interesting public policy on drugs called “Open Arms,” which focused on Cracolândia, a long-standing site of crack cocaine consumption in the city. This program aimed to help drug users improve their precarious situations, by providing them with access to housing, work, training, and healthcare, without requiring them—at least theoretically—to abstain from drugs. This program was part of a broader policy of gentrification of the inner city.

Points Interview: “The Drug War Dialectic in Early Twentieth-Century Chicago” with Richard Del Rio

January 31, 2022January 27, 2021 by Points Editor

Editor’s Note: Points continues its series of interviews with authors from the latest issue of ADHS’s journal Social History of Alcohol and Drugs (vol. 34, no. 2; Fall 2020), published by the University of Chicago Press. Today we feature Dr. Richard Del Rio, a Provost’s Postdoctoral Fellow within the Department of Behavioral Science and Social Medicine at the Florida State University College of Medicine. You can see his article here. Contact the University of Chicago Press to subscribe to the journal or request access to this article, or any other article from SHAD’s history.

Tell readers a little bit about yourself

Yikes! In my view you’re starting with the hardest part of this interview. In the professional sense, I am a historian trained in the social history of the United States and the histories of Latinx and African American peoples. My academic specialty and research focus is to contribute to these fields of history through the stories of pharmaceuticals and drugs. In case you’re asking for something a little more personal, I’ll just mention that I’m a lover of Caribbean culture, admirer of martial arts, enjoy building community/fellowship, and always try to learn from others. And just in case there are any gamers checking this interview, when I have the time for it (and I rarely do), I really enjoy a competitive bout of Super Smash Bros.!

What got you interested in drugs (and their history)?

Scholars across academic disciplines have recognized the pervasive influence of the United States’ policy regime known as the “War on Drugs” in the late twentieth century. Along wIth the more recent “War on Terror,” the War on Drugs has served as an important pretext for American foreign interventions and international ambitions. Domestically, I think the broad public calls for reforms to our drug laws and the complete legalization of cannabis highlight the recognition that the War on Drug’s impact on the public’s health and wealth was mostly damaging. Its emphasis on punishment and supply side controls contributed to the militarization of police, the alienation of the citizens they serve, and the controversial growth of publicly traded corrections companies. There is a growing recognition that we need some new ideas about how to approach or shape the public’s consumption of strong, potentially addictive, psychoactive drugs. I am part of a generation of historians in my field who have been working to understand “how did things get so bad in the first place?”

Ergot and the First Roots of the FDA

September 24, 2019 by emilydufton

Editor’s Note: Today’s post comes from Naomi Rendina. Rendina is a PhD candidate at Case Western Reserve University. She is expected to defend her dissertation, Pushing Too Hard: Pharmaceuticals and the Nature of Childbirth, in early March 2020. Here she explores the role a controversy of ergot played in creating the Food and Drug Administration (FDA), which was first formed in 1906.

Screenshot 2019-09-23 at 6.25.04 PM — Naomi Rendina

Pharmacists and historians celebrated the 200th anniversary of the United States Pharmacopeia (USP) at the 44th International Congress for the History of Pharmacy, on September 5- 8, 2019, in Washington, DC. Founded in 1819, the USP remains the non-profit organization responsible for creating the standards for medicines, food ingredients, and supplements. These standards ensure that each compound is appropriately identified, and is of consistent strength, quality, and purity. For three days, historians and pharmacists presented their research on drugs, as well as histories of the profession and institutions that shape pharmacy.

What most stood out to me was a comment that FDA historian Dr. John Swann made during his portion of the Opening Ceremony comments. He said that the period between 1906 and 1938 were formative years of what became the Food and Drug Administration. This statement underlined one of my frustrations in researching the history of ergot (a group of fungi that have been used to treat a variety of medical issues, including inducing contractions and controlling bleeding after childbirth). The incident fascinated me, but I stumbled through reasons why anyone else would find this as amazing as I did. Dr. Swann argued that these years were foundational to the institutionalization of science and of the regulation of food and medicine in the United States, but are all too often only given a cursory glance.