Transcript Liquid Handcuffs”: the bio-politics of methadone

“Liquid Handcuffs”:
the bio-politics of methadone
maintenance treatment
Christopher Smith
Nov. 5, 2007
Outline
• Introduction (personal and political)
• Background:
– Origins of methadone
– First development of maintenance model
• Context:
– History of methadone in Canada (1964-2007)
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Theory: Foucault on ‘bio-politics/bio-power’
Case study: ethnographic narratives
Conclusion
Questions and discussion
Background:
Origins of Methadone
• WWII Germany, IG Farbinindustrie
• Post-WWII, Eli-Lilly, “Dolophine”
– ‘Adolph’ vs. ‘dolor’ (Latin root for pain)
• First marketed as painkiller, then used
as short-term tapering tool to wean
addicts of heroin etc.
Development of the
‘Maintenance’ model
• Dr. Vincent Dole and Dr. Marie Nyswander,
New York, mid 1960s
• Initial experiments using morphine
substitution (unsuccessful), discovery of
methadone during tapering (successful)
• Long acting qualities produced more
energetic, able-bodied subjects
(foreshadowing biopolitical implications?)
Context: MMT in Canada
• 1964-1996
– Federal regulation
– Restrictive, repressive policy climate,
largely informed by moral-criminiological
ideologies and discourses re. ‘addiction’
– Strict admission criteria, restrictions for
prescribing physicians
Context: MMT in Canada
• 1996-2007
– Provincial regulation (CPSO, MMT Guidelines:
1996, 2001, 2005)
– Shift to ‘client-centred’, ‘harm reduction’ oriented
approach
– Effects: (1) exponential expansion of client
population due to loosening of admission criteria,
(2) rapid proliferation of private, group-practice
treatment model due to relaxing of restrictions for
prescribing physicians
MMT in Ont. 1996-2006
(continued)
• Media-fuelled ‘Moral Panic’ re. Methadone in
Ontario (Feb. 2006)
– OATC:
• fraudulent billing practices?
• Accidental deaths
– Corktown: the “panic in needle park”
• Culminated in formation of Ontario
Methadone Task Force (George Smitherman
‘Liquid Handcuffs’:
MMT and/as biopolitics
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Foucault on Biopolitics:
• The History of Sexuality (volume 1)
• “technologies of power that take life as
their objective” (Foucault 1980)
• bio-power emerged with the “explosion
of numerous and diverse techniques for
achieving the subjugation of bodies and
the control of populations” (1980).
• Regulatory vs. disciplinary biopower
Disciplinary bio-power
• Focus on discipline and control of individual
bodies (vs. entire populations)
• = “the body as a machine: its disciplining, the
optimization of its capabilities, the extortion of
its forces, the parallel increase of its
usefulness and its docility” (1980)
• Examples in MMT: (1) dose, (2) urine
screening, (3) ‘carry’ doses
Regulatory bio-power
• focuses on “the species body, the body
imbued with the mechanisms of life and
serving as the basis of the biological
processes: propagation, births and mortality,
the level of health, life expectancy and
longevity” (1980)
• Examples: (1) harm reduction as regulatory
biopower?, (2) expansion of treatment
access, (3) date collection, (4) addiction
research
Dose as disciplinary biopower:
• “Dr ___ has been really good for me in terms
of getting me down [e.g. tapering], because I
was stuck with another doctor, and he wasn’t
into letting me go down at my own pace at all,
so there was lot of conflict and I moved on…”
(Miguel)
• “The doctor always explains ‘well Tara if you
were a diabetic’... he always give me that,
because I always want to get off; a couple
times I’ve almost hurt myself because I’ve
come in saying take me down…” (Tara)
Urine screening as disciplinary
biopower:
• weekly urine sample collection (compulsory,
observed) for drug screening purposes
• “That pill bottle beneath the chair you were
sitting on, it was urine. That’s how women do
it [cheat on the urine drug screen]... You
didn’t know that? That goes on a lot. Oh
yeah, I know about 10 people; they’re clean
every week and then they get rid of [i.e. sell]
all their carries.” (Tara)
Carry doses as disciplinary
biopower:
• Reward and punishment system tied to
results of urine drug screens
• Client must demonstrate ‘clinical
stability’
• ‘clean’ vs. ‘dirty’ (connotations?)
• ‘full carries’ = conformity, adherence
• vs. “low-threshold” model?
Harm reduction as regulatory
biopower?
• Examples:
– Needle exchange (critique of former ‘one
for one’ system)
– Safe Consumption Sites (SCSs): as
attempt to interiorize ‘problem’ drug use
and manage urban user communities in
the interests of ‘public order’ (surveillance,
regulation, monitoring, discipline etc.)
Expansion of treatment
access as regulatory biopower
• By increasing the accessibility of methadone
treatment services, and thereby effectively
bringing a larger segment of the opiate using
population under the surveillance of state and
medical institutions, the policy shifts in 1996
clearly represent “a matter of taking control of
life and the biological processes of man-asspecies and of ensuring that they are ...
Regularized” (Foucault 1997).
Data collection as regulatory
biopower
• Establishment of centralized patient
registry database (CPSO)
• Collection of quantitative stat.s re. dose,
retention, ancillary drug use etc.
• Used to determine statistical norms etc.
• Data used to assess success of
expanded treatment access
Addiction research as as
regulatory biopower
• Exclusive emphasis on quantitative,
epidemiologically-driven research (focus on
HIV/HCV)
– Example: Safer crack use kit funding (strategic?)
• Lack of engaged, qualitative, ethnographic
research that examines the complexity of
social suffering form the perspective of users’
themselves
Conclusions:
http://www.gardendistrict.ca/in_our_garden/
map_social_services.html
Meth clinic should go-Levy
Health clinic near campus
treats hard drug addicts,
raising safety concerns
from Ryerson’s president
(The Ryersonian, Mar 7, 2007)