The War on Drugs at the Pharmacy Counter: Frontline Workers Facing Discrepant Institutional Logics

• In Event: 464 - Regular Session. Law and Society II - Law, Expertise and the Interplay of Professions

Abstract

Increasingly punitive attempts to curb prescription drug misuse constitute an expansion of the “War on Drugs” into mainstream medicine, leaving frontline healthcare providers caught between competing institutional logics of treatment and punishment. This study brings an institutional approach to frontline work by empirically examining how pharmacists manage discrepant logics while deciding whether to provide abusable medications and devices. Analysis of semi-structured interviews with 71 retail pharmacists in the US reveals that pharmacists manage discrepant logics by engaging in two professional gatekeeping processes—medical and legal—that lend themselves to different identities, epistemologies, field foci, patterns of action, and inter-personal orientations. Decisions pharmacists make have implications for patients’ access to care and exposure to the criminal justice system. Findings advance theories of frontline work by systematically examining the interplay between elements of institutional environments and decision making and yield policy considerations as states increasingly monitor patients and providers through Prescription Monitoring Programs.

Author

• Elizabeth Chiarello, Saint Louis University