Deserving Patients or Potential Addicts? Narrative Analysis of an FDA Hearing on Prescription Opioid Labeling

• In Event: 368 - Section on Alcohol, Drugs, and Tobacco Refereed Roundtable Session and Business Meeting
  In Refereed Roundtable 60min: Table 03. The Labeling and Treatment of Opioid Users

Abstract

In this paper, I examine how stories about opioids, pain and addiction told in an FDA public hearing construct moral boundaries between “deserving patients” and “potential addicts” and serve to justify a label change that reduces access to treatment with opioids for people with chronic non-cancer pain. I employ Loseke’s (2012) method for the empirical analysis of formula stories to analyze the text of an FDA public hearing held in February of 2013 entitled, “Impact of Approved Drug Labeling on Chronic Opioid Therapy.” I found that taken together, the stories told in the hearing form a larger causal narrative about an opioid “epidemic” that must be solved through reducing access to opioids for “potential addicts” while simultaneously preserving access for “deserving patients.” Due to the subjective and invisible nature of pain, decisions about who is deserving or undeserving of pain treatment with opioids cannot be made based on biological evidence, but must be informed by cultural understandings of moral worthiness and what it means to be a “legitimate patient” versus a “potential addict.” Patients whose pain stems from conditions that fit neatly into biomedical understandings of disease (e.g. cancer) are constructed in the hearing as deserving of treatment with opioids. On the other hand, patients with chronic non-cancer pain are constructed as potential addicts who are presumed to be less deserving of pain treatment with opioids and more deserving of burdens imposed by the label change. This paper demonstrates how culture enters the policy-making process and informs decision-making through narratives.

Author

• Loren Wilbers, University of Wisconsin-Whitewater