The Commercial Construction of Knowledge: Industry, the Opioid Crisis, and the Figure of the Addict

• In Event: Science, Knowledge & Technology Section Roundtables
  In Refereed Roundtable (60 minute): Table 3: Expertise, Knowledge Production, and Authority

Abstract

This work examines how industry and industry-aligned scientists in North America developed and propagated discourses related to opioids, clinical practice, risk, and addiction during the 2000s and 2010s. These industry efforts often borrowed and remixed tropes about problematic substance use from previous eras. We argue that these conceptual developments advanced a particular ontological account of substance-use disorders that emphasized person over process: instead of dependence being a predictable outcome of long-term opioid exposure that could be prevented through more careful pharmaceutical stewardship, dependence was presented as a rare side effect, with abuse attributable to an “addict”, defined as a person with an innate inclination toward substance abuse, who could be identified and excluded from care.Our analysis focuses on these taxonomies by drawing upon internal industry documents and scientific literature produced by industry-aligned scientists. We trace the development, contours, and dissemination of these taxonomies in venues ranging from academic publications, presentations for pharmaceutical companies and regulators, and in continuing medical education. The opioid manufacturing industry worked to minimize clinicians’ apprehension about prescribing opioids through medical education, scientific communications, policy recommendations, and public and political advocacy, while emphasizing scrutiny on patients, who were viewed as addicts-in-waiting. The goal and effect of this campaign was to maintain expansive patient access to opioids as a clinical best practice, ensuring profitability for opioid manufacturers, while deflecting blame and scrutiny for increasing concerns about misuse onto a category of specific individuals, so-called “abusers” and “addicts.” Through our analysis we develop an account of what we term the “commercial construction of knowledge” at the intersection of multiple literatures: sociologies of medicine and knowledge, social studies of science and technology, the political economy of the pharmaceutical industry, and commercial determinants of health.

Authors

• Anthony DiMario, University of California San Francisco

• Dan Kabella, University of California, San Francisco

• Kelly Knight, University of California, San Francisco

• Dorie Apollonio, University of California, San Francisco