The “Opioid Crisis” & Blurred Boundaries Between Healthcare & Criminal Justice

• In Event: Poster Session: Science, Technology, and Environmental Politics & Health Politics and Health Policy
  In Poster Session: Poster Session: Health Politics & Policy: Opioid Politics in the United States

Abstract

The United States is caught in the throes of a relentless opioid crisis, one that has brought the fields of healthcare and criminal justice into an uneasy relationship. Today, drug overdoses are the leading cause of accidental death in the United States. There were over 72,000 drug overdose deaths in 2017 and of these around 15,000 or 21% involved a prescription opioid. Physicians contributed to the growing rate of overdose deaths by prescribing opioids liberally which resulted in a 350% increase in opioid prescribing between 1999 and 2015. These statistics may be shocking, but they tell an incomplete story. What experts call an “opioid crisis” or even an “opioid epidemic” is really the confluence of two crises—an overdose crisis and a pain crisis—at the intersection of which lie problems of chronic pain, substance use disorder, and drug diversion. These problems, medical and criminal in nature, have attracted workers in healthcare and criminal justice, fields characterized by different worldviews, tactics, and resources for addressing social problems. A popular strategy for curbing the opioid crisis is using state-based prescription drug monitoring programs (PDMPs), two-tiered big data surveillance technologies shared across healthcare and criminal justice that allow healthcare providers to monitor patients and allow enforcement agents to monitor both providers and patients. These programs currently exist in 49 states (all but Missouri).
The fact that the fields of healthcare and criminal justice are grappling with a common crisis and are doing so using shared surveillance technology raises questions about how a social problem creates opportunities for field change. How do disparate fields address a shared social problem and what implications might their efforts have for the fields themselves? This research addresses these questions. An extensive literature on medicalization and criminalization examines how social fields transform social problems, but few studies address how social problems transform social fields. My research uses the contemporary U.S. opioid crisis as a case for examining how a social problem that spans the fields of healthcare and criminal justice creates opportunities for field change. I take a micro-level approach to field change by examining how shifts in the daily behavior of frontline workers in each field are routinized into practice and become taken-for-granted aspects of organizational policy.
Drawing on a decade of research including two hundred interviews with healthcare providers and enforcement agents in three states, I demonstrate how PDMPs have facilitated changes in each field through four processes: expansion, encroachment, transformation, and routing. Criminal justice is undergoing a technological expansion. Their core tasks are the same—going after drug dealers in the name of public safety—but they are targeting a new set of drug dealers including manufacturers, distributors, physicians, and pharmacists. The PDMP helps them do so by putting extensive information at their fingertips. As criminal justice expands PDMPs help it to encroach on healthcare because, as enforcement tools, they transport criminal justice logics into the healthcare arena. Pharmacy and medicine respond to technological encroachment by reorienting themselves around criminal justice logics of surveillance and punishment and routing patients out of healthcare and into criminal justice.
Taken together, these findings suggest that efforts to combat the opioid crisis are blurring the boundaries between healthcare and criminal justice as criminal justice logics seep into healthcare and reshape healthcare work. I discuss the implications of these findings for theorizing about the microdynamics of field change and the policy implications of expanding patient surveillance.

Author

• Elizabeth Chiarello, Saint Louis University