teaching points

Editor’s Note: This post is brought to you by Marco Ramos and Tess Lanzarotta. Ramos is an MD/Ph.D. candidate in the History of Science and Medicine program at Yale University focusing on the production and circulation of scientific knowledge during the Cold War in the global south. Lanzarotta is a Ph.D. candidate in the same department focusing on the ways that contemporary interactions between biomedical researchers and indigenous populations are shaped by their historical antecedents. Together, Ramos and Lanzarotta are teaching a course on the history of drugs in the twentieth century and we’ve invited them to contribute to our “Teaching Points” series. Enjoy! 

The idea for our course on the history of drugs developed out of a conversation a few years ago concerning the medical management of opiate addiction in our community of New Haven, CT. We are both graduate students in the Program in the History of Science and Medicine at Yale University, and Marco is also a medical student at Yale School of Medicine. Having recently completed a clinical rotation at the hospital, Marco reflected on the patient-blaming and suspicion that often accompanies discussions of opiate prescription among physicians. During his rotation, he heard physicians and residents bemoan their patients who requested, and often demanded, opiate prescriptions. He watched as physicians speculated about whether patients were “feigning” their pain to acquire drugs and realized that physicians made judgments about who should receive opiate prescriptions based on imperfect, biased assumptions about what “addicts” looked like racially and economically. Given the large body of medical evidence that demonstrates addiction is not a matter of voluntary choice or individual responsibility, Marco wondered why physicians continued to blame and shame patients for their struggles with addiction.

Tess pointed to the utility of history in understanding opiate addiction in the United States today. She discussed the pharmaceutical companies’ role in this story, as the industry downplayed the addictiveness of opiates and encouraged their widespread use for profit in the medical community throughout the 1980s and 90s. A long history of inadequate consumer protections from the Food and Drug Administration did not safeguard patients from the rapid circulation of this dangerous class of drugs during this period. Though the pharmaceutical industry and a weak federal regulatory body were largely to blame for the growing incidence of opiate addiction across the country, drug enforcement held individual patients responsible for their addictions.

As the conversation progressed, we began to reflect on the importance of history for understanding dilemmas — like opiate addiction — presented by drugs today. We imagined a course that would focus on the history of drugs as a way of generating “useful pasts” that could inform how our students thought about drugs and drug policy in the present. As our thinking evolved, we drafted an application to co-teach a course that centered on the categorization of drugs across the twentieth century. Rather than using drugs as a lens to understand social, cultural, legal, or political history in the Unites States, we hoped to use history to reflect on drug categories themselves. We were interested in how lines dividing chemically active substances into categories and classes, such as illicit and licit or medical and recreational, have shifted across the twentieth century. Historically shifting boundaries between drugs have hinged upon changing cultural norms surrounding the characterization of “use” versus “abuse,” the prescribed treatments or punishments for drug users, and the labelling of drug use as an individual or social problem. Such beliefs continue to be wrapped up in socially-mediated understandings of identity — along ethnic, racial, gender, class, and religious lines — and in opposing ideologies of health and governance.

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