Medicalization of Heroin

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This article will focus on the story of Medicalization of Heroin and cultural, scientific, and biopolitical insights into the Western understanding of health.

Timeline of total number of U.S. overdose deaths involving heroin.[1]

The medicalization of heroin as a treatment for illnesses has been present in the sociopolitical and medical lexicon for the past 100 years [2]. Heroin as a drug has been around since 3400 BC [3]. The Medicalization of Heroin encapsulates social and political narratives, including exclusatory cultural conceptions, Foucault's Biopower, and the positive and negative rhetoric of crime versus treatment.

Definitions

Medicalization

Medicalization is defined by Merriam Webster as viewing or treating something as a medical concern, problem, or disorder [4]

Culture

Foucault defines culture as "a hierarchical organization of values, accessible to everybody, but at the same time the occasion of a mechanism of selection and exclusion"[5]. The Government of Canada defines culture as something that "rules virtually every aspect of life... music, literature, visual arts, architecture or language, but more. Culture is taught and learned and shared – there is no culture of one. Culture is symbolic. Meaning is ascribed to behaviour, words and objects and this meaning is objectively arbitrary, subjectively logical and rational. [6].

Biopower

Through GRSJ 224 students learned that Biopower is "about managing the births, deaths, reproduction, and illness of a population." [7].


Cultural Insights

Canada: Heroin policy

The legislation currently regulating all drugs in Canada was brought into power in 1996 under the Chretien government. The act is called the Controlled Drugs and Substances Act (CDSA) and it created eight schedules of drugs. Each schedule of drugs have their own legal framework. The CDSA ranked Heroin as a schedule 1 drug. It follows that someone who is caught possessing Heroin could face an indictment charge and up to 7 years in prison [8]. In 2013, Health Minister Rona Ambrose followed through on the Conservative Party of Canada's hard on drugs rhetoric by banning prescription heroin from doctors ability to prescribe [9]. This banning disturbed the treatment of the most vulnerable individuals who used prescription heroin as a last resort to get rid of their addiction. However, the 2015 Trudeau government Health Minister Jane Phillipot reversed the previous Harper government's decision and reinstated the ability of doctors to prescribe heroin to patients. The Ministry's decision was based on a substantial body of scientific evidence that demonstrated the positive effects of being able use medical heroin to treat patients in Canada [10]. Through Foucault's definition of culture the government effectively outcast heroin users labelling indirectly through the law that heroin users had become a pariah. Culture, as is manifested and curated in part by political elites in the shape of the law, was proven to exclude the vulnerable.

Bio-politics of the Medicalization of Heroin

Criminal Morality

In his article "DISCIPLINING ADDICTIONS: THE BIO-POLITICS OF METHADONE AND HEROIN IN THE UNITED STATES" Phillipe Bourgois unpacks Foucault's idea of Biopower of the state in relation to users of Meth and Heroin in the United States of America. With respect to morality and heroin, Bourgois argues that the medicalization of heroin is a compromise between "criminalizing morality versus a medicalizing model of addiction- as-a-brain-disease" [11]. Criminal morality is that of which sees the user of drugs to be immoral, bad, looked down on in society. When talking about Switzerland's change in heroin legislation he notes the industrialized "criminal repression of heroin" [12]. A criminal repression sees a state rhetoric dispensed through political elites framing drug users as stymieing society, needing to be held back. Often time drug users that are addicted to illegal drugs are those without much money, education, or stability. This view of the morally bankrupt addict rearranges some of the most vulnerable groups of society to the margins, negatively effecting their life and to some extent causing their deaths.

Economically Productive Beings

Bourgois also expands on Foucaults idea of biopower suggesting that, "medical prescription of heroin the ultimate expression of an efficient and highly technified biopower in pragmatic practice" [13]. He presents the side of the medicalization of heroin as an act by the state to expand its economic interests under the guise of a moral rectitude. The person is seen as an economic unit. While addicted to heroin they are costing society, taking more resources than they produce. However, if you prescribe heroin the economic units can reform into their economic maximum, a place where they benefit the state most greatly. In his work, "Society Must be Defended", "Foucault suggests there is a device he calls “state racism,” that comes variably into play in deciding who is to receive the benefits of biopolitics or be exposed to the risk of death" [14]. Kelly's point highlights the immense power Foucault saw the state had over the health of its citizens, a power so strong that it determined who, based on a subjective inherent value would be taken care of, and who would die.

BC: Illicit drug overdose deaths over the last 10 years. [15]

Heroin in Vancouver: Opioid Epidemic and Safe Injection

Vancouver has been dubbed "Ground Zero" for the Opioid epidemic as it has seen drastic spikes in deaths by overdose due to illicit drugs including: heroin, fentanyl, and cocaine [16]. It has also been a city of controversial politics regarding the usage of safe injection sites. Under the Harper government, then Health Minister Tony Clement called Insite "a failure of public policy, and of ethical judgement", while the next Health Minister under Harper Rona Ambrose argued that Insite legitimizes drug users and takes finances away from treatment" [17]. In British Columbia deaths from illicit drug overdoses have risen drastically. A recent report from the BC Coroner's Service shows "111 suspected drug overdose deaths in June 2017. A 61% increase over the number of death occurring in June 2016" [18].


The Science of Prescribing Heroin

Studies

Providence Health Care partnered with the University of British Columbia in 2005 for a three-year heroin study called (NAOMI), which found "entrenched addicts who received prescription heroin in a supervised, medical setting experienced more physical and mental-health improvements and were more likely to stay in treatment and reduce illegal drug use and criminal activity than those on methadone" [19]. In a Maclean's piece, Ken MacQueen publishes that, "more than 40 peer-reviewed studies have been published in The Lancet, the New England Journal of Medicine, and the British Medical Journal among others, concluding that the facility and other harm-reduction strategies like free needle exchanges have slashed HIV infections and overdose death rates" [20].

Further reading

If the reader is interested in pursuing further knowledge on the topic I recommend to explore the following sources

  • Drug Policy's A Brief History of the Drug War

http://www.drugpolicy.org/facts/new-solutions-drug-policy/brief-history-drug-war-0

  • A Government of BC's report on illicit drug usage

http://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/illicit-drug.pdf

  • VICE: Canada is prescribing heroin to treat opioid addiction

https://news.vice.com/story/canada-is-prescribing-heroin-to-treat-opioid-addiction

  • Activists bring more pop-up injections sites to Vancouver's overdose 'battle zone'

http://www.cbc.ca/news/canada/british-columbia/drug-overdose-vancouver-bc-pop-up-battle-zone-insite-injection-blue-hue-1.3860193

  • Cited: The Heroin Clinic podcast

http://citedpodcast.com/41-the-heroin-clinic/

  • The Guardian's :Tough on crime' doesn't work and is destroying Indigenous women and families

https://www.theguardian.com/commentisfree/2017/may/15/i-was-on-heroin-and-homeless-at-13-and-the-system-is-still-failing-indigenous-women

References

  1. ↑ Overdose Death Rates. By National Institute on Drug Abuse (NIDA).
  2. ↑ Lopez, German. “The Case for Prescription Heroin.” Vox, Vox, 12 June 2017, www.vox.com/policy-and-politics/2017/6/12/15301458/canada-prescription-heroin-opioid-addiction.
  3. ↑ (http://www.pbs.org/wgbh/pages/frontline/shows/heroin/etc/history.html)
  4. ↑ “Medicalize.” Merriam-Webster, Merriam-Webster, www.merriam-webster.com/dictionary/medicalize.
  5. ↑ Foucault (2001). L'hermeneutique du sujet. Cours au College de France, 1981-1982. Paris: Gallmard Seull, p.173
  6. ↑ Government of Canada, Foreign Affairs Trade and Development Canada, Deputy Minister of Foreign Affairs, Assistant Deputy Minister Human Resources, Learning. GAC, Government of Canada, 12 Sept. 2014, www.international.gc.ca/cil-cai/what_is_culture-quest_ce_que_la_culture.aspx?lang=eng.
  7. ↑ O'Brien, Michelle Week 1 Module, Some key terms. UBC, GRSJ 224. Online.
  8. ↑ Branch, Legislative Services. “Consolidated Federal Laws of Canada, Controlled Drugs and Substances Act.” Legislative Services Branch, 1 Aug. 2017, laws-lois.justice.gc.ca/eng/acts/C-38.8/.
  9. ↑ Woo, Andrea. “Showing Promise in B.C., Prescription Heroin Now in Peril.” The Globe and Mail, VANCOUVER — The Globe and Mail, 5 Oct. 2013, www.theglobeandmail.com/news/british-columbia/showing-promise-in-bc-prescription-heroin-now-in-peril/article14713663/.
  10. ↑ Woo, Andrea. “Health Canada Overturns Ban on Medical Heroin.” The Globe and Mail, The Globe and Mail, 24 Mar. 2017, beta.theglobeandmail.com/news/national/health-canada-proposes-to-allow-doctor-requests-to-prescribe-heroin/article30020597/?ref=http%3A%2F%2Fwww.theglobeandmail.com&.
  11. ↑ Bourgois, Philippe. "Disciplining Addictions: The Bio-Politics of Methadone and Heroin in the United States." Culture, Medicine and Psychiatry, vol. 24, no. 2, 2000, pp. 165-195.
  12. ↑ Bourgois, Philippe. "Disciplining Addictions: The Bio-Politics of Methadone and Heroin in the United States." Culture, Medicine and Psychiatry, vol. 24, no. 2, 2000, pp. 165-195.
  13. ↑ Bourgois, Philippe. "Disciplining Addictions: The Bio-Politics of Methadone and Heroin in the United States." Culture, Medicine and Psychiatry, vol. 24, no. 2, 2000, pp. 165-195.
  14. ↑ Kelly, Mark. “Michel Foucault: Political Thought.” Internet Encyclopedia of Philosophy, Internet Encyclopedia of Philosophy, www.iep.utm.edu/fouc-pol/#H7.
  15. ↑ Canada. BC Coroners Service. Illicit Drug Overdose Deaths in BC January 1, 2007 – June 30, 2017. 42nd Legislature. 4th Session. Accessed August 2017.
  16. ↑ Clancy, Natalie. “A Night in Canada's Busiest ER for Drug Overdoses: St. Paul's Hospital in Vancouver.” CBCnews, CBC/Radio Canada, 19 Dec. 2016, www.cbc.ca/news/canada/british-columbia/fentanyl-overdose-er-1.3889942.
  17. ↑ MacQueen, Ken. “The Science Is in. And Insite Works.” Macleans.ca, Macleans, 21 July 2015, www.macleans.ca/news/canada/the-scientists-are-in-insite-works/.
  18. ↑ Canada. BC Coroners Service. Illicit Drug Overdose Deaths in BC January 1, 2007 – June 30, 2017. 42nd Legislature. 4th Session. Accessed August 2017.
  19. ↑ Woo, Andrea. “Showing Promise in B.C., Prescription Heroin Now in Peril.” The Globe and Mail, VANCOUVER — The Globe and Mail, 5 Oct. 2013, www.theglobeandmail.com/news/british-columbia/showing-promise-in-bc-prescription-heroin-now-in-peril/article14713663/.
  20. ↑ MacQueen, Ken. “The Science Is in. And Insite Works.” Macleans.ca, Macleans, 21 July 2015, www.macleans.ca/news/canada/the-scientists-are-in-insite-works/.
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