The Opioid Crisis: Law and Stigma Constructing Outcomes

• In Event: Domains of Critical Drug Studies: Absent Pleasures and Risky Presents in Emerging Spaces of Harm Reduction - III

Abstract

The polydrug opioid crisis is the most urgent public health crisis in America today with 70,237 overdose deaths in 2017 (CDC). Using a harm reduction normative framework, this paper assumes that the Federal government is morally obligated to act to keep people alive until they are ready and able to receive treatment. This paper contributes to STS literature by offering a novel critique of Federal guidance on opioid treatment using Bacchi's policy analysis methodology, which employs a Foucauldian framework to investigate how social, economic, legal, and cultural structures combine to construct identities and outcomes. This paper focuses on a Federal law which imposes patient caps on physicians for buprenorphine treatment, resulting in harmful effects. For instance, one physician has reported being forced to advise a patient to continue using heroin in small doses to avoid withdrawal because that physician had already reached his patient cap for buprenorphine prescriptions and was therefore unable to provide treatment. This paper proceeds as follows: (1) Review current clinical best practices for opioid treatment using buprenorphine, including a case study of women who are pregnant or postpartum. (2) Review research on stigma in addiction and treatment to inform a Foucauldian analysis of Federal law. (3) Propose the following recommendations: (a) patient caps for buprenorphine treatment should be expanded; (b) community engagement about mitigating stigma should adopt a harm reduction framework to increase access to life-saving, community protective services.

Author

• Christopher Patrick Caulfield, Rensselaer Polytechnic Institute (RPI)