A Fine Line: Painkillers and Pleasure in the Age of Anxiety

298 Pages·2019·2.94 MB·English

by  George C. Dertadian

A F I N E L I N E
Painkillers and Pleasure in the Age of Anxiety
G E O R G E C . D E R T A D I A N
A Fine Line
George C. Dertadian
A Fine Line
Painkillers and Pleasure in the Age
of Anxiety
George C. Dertadian
School of Social Sciences
University of New South Wales
Kensington, NSW, Australia
ISBN 978-981-13-1974-7 ISBN 978-981-13-1975-4 (eBook)
https://doi.org/10.1007/978-981-13-1975-4
Library of Congress Control Number: 2018950494
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Foreword
At times of public health crisis, our attention is justifiably gripped by
the most devastating effects and extreme forms of suffering. We are in
the midst of what media commentators describe as a deadly epidemic
of ‘killer’ drugs. More accurately, we face an escalation and intensifica-
tion of harm associated with drug use. Rates of opiate use, especially
prescription pain medications, have risen sharply. Overdose deaths are
at unprecedented levels. People are struggling with the consequences
of their opiate use, consequences which are exacerbated and, in more
than a few cases, caused by the effects of prohibitionist and punitive
drug policies. In North America, the powerful synthetic opioid Fentanyl
has contaminated the illicit drug supply, producing dramatic increases
in risk and harm. The US Centers for Disease Control and Prevention
have described this as the worst drug overdose epidemic in history.
In this historical moment, it is easy to overlook the reality that the
majority of people who use opiates do not develop such dramatic
problems and are not represented in medical statistics. This is the
case whether their consumption is medically authorised or not. More
broadly, the use of analgesic drugs, both prescribed and purchased over
the counter, is a part of ordinary life for ordinary people. A Fine Line
v
vi Foreword
is timely and compelling because it explores the consumption practices
of such people, placing their use in the context of the challenges they
negotiate, the feelings they seek and the opportunities they desire. In
A Fine Line we read of painkillers helping men and women to contrib-
ute to family life despite chronic pain, to cope with emotional distress,
to enhance productivity, to ‘chill out’ after a night of partying, and to
save money by enhancing the effects of alcohol. While not denying
the potential harms of routine analgesic use (including dependence),
Dertadian eschews sensationalism and moral stances in his presentation
of a range of pharmaceutically mediated practices. Crucially these prac-
tices include the pursuit of pleasure. A Fine Line is therefore an insight-
ful contribution to the sociological literature on pharmaceuticalization,
the process by which medical drugs are constituted as the solution for
an increasing range of problems and conditions (Fox and Ward 2008).
However, Dertadian carefully attends to the heterogeneous experiences
of users rather than adopting a predetermined critical narrative. He
resists the constitution of medicalization and pharmaceuticalization as
singular and monolithic processes.
The large and rapidly growing body of literature on prescription
opiate use is primarily epidemiological or clinical, highlighting disease
and disorder at either population or individual level. What is missing
is the dynamic social environment and the network of relationships in
which drug use actually takes place. The epidemiological research which
produces the most authoritative ‘objective’ information on drug use
patterns and effects is necessarily abstract, isolating ‘factors’ from their
context in order to identify causal relationships at a population level.
As Steve Wing has observed, the ‘populations’ of modern epidemiology
are conceptualised as vehicles for statistical analysis rather than groups
with unique histories involving economic, social and ecological rela-
tionships (1994). At the same time, epidemiology reduces features such
as gender, class and relationship status to individual attributes. In con-
trast, the accounts of everyday painkiller use collected in A Fine Line
are based on conversational in-depth interviews with users, carried out
by the author. The book exemplifies the rich, detailed and empathetic
knowledge of social practices that can be produced by well-executed
qualitative research. This research reveals not just what people do but
Foreword vii
how they make sense of their actions and what meanings they attach to
their experiences over time.
The special value of A Fine Line resides in its combination of empir-
ical research with recent scholarship in critical drug studies. Theoretical
and conceptual examination of dominant approaches to substances and
substance use translates the evidence provided by lived experience into
a coherent argument about the regulatory effects of medico-legal struc-
tures. One of the most important messages of A Fine Line concerns the
categories we use to understand and respond to complex phenomena
such as pharmaceutical consumption. ‘Non-medical use’ has become
the standard term to refer to the consumption of prescription drugs in
ways that are not medically authorised, for example for ‘non-therapeutic
purposes’ or ‘without a valid prescription’. The abbreviation NMUPD
reflects the reification of this classificatory framework and the problem
of illegitimate consumption it constructs. Dertadian’s analysis highlights
both the regulatory function of the category ‘non-medical’ and its insta-
bility. As he points out, patients with chronic pain seek out analgesics
for the feeling of relief, which is difficult to demarcate from a positive
experience of pleasure, although the latter is labelled as ‘non-therapeu-
tic’ and therefore suspect. He also points out how medical and legal
discourse constitutes the sharing of drugs through a lens of ‘non-adher-
ence’ and ‘diversion’, ignoring the elements of care that are expressed
through informal networks of distribution.
By placing twenty-first century painkiller use in a historical context,
A Fine Line reveals another effect of medical authority. Concentrating
on the risks of users’ unauthorised and non-compliant consumption of
medications can act to distract attention from iatrogenic harms. In the
current opiate crisis, the actions of Purdue Pharma and the prescription
practices of physicians have come under the spotlight, but this has not
undermined the confident assertion of a clear distinction between medi-
cal (beneficial) and non-medical (harmful) use. Alongside contemporary
analgesia, Dertadian includes an instructive discussion of the popular-
ity of over-the-counter headache powders such as Bex and Vincents in
Australia in the 1950s. These accessible medications included a com-
bination of aspirin, phenacetin and caffeine (APC). High levels of
use produced a sharp increase in gastric ulceration and kidney failure,
viii Foreword
especially among women. However, as Dertadian notes, there was reluc-
tance among the medical profession to connect normalised and domes-
ticated use of a ‘safe’ medication with severe harm. He also notes that
‘the circumstances of women’s lives were left out of the equation in
medical accounts of APC consumption’. The repetition of this form of
exclusion continues to limit responses to drug use risks and harms.
Despite its critical perspective on medical power, A Fine Line does
not imagine or hope for a space of freedom, nature or authenticity
where individuals live their lives free from the constraint of medical
rationality or the corruption of pharmaceutical agents. As modern indi-
viduals we are thoroughly and inescapably medical in our understand-
ing of our bodies, our selves and our relationships with the world (Rose
2007). In A Fine Line, Dertadian records the capacity of contemporary
consumers of medicine to develop their own forms of practical pharma-
cological expertise and actively negotiate a medicalized terrain in order
to work toward their own goals. As he puts it, ‘people’s individualised
appropriation of medical discourse and practice may well provide a
compelling alternative to the psycho-pharmacological perspectives that
have dominated much of the current literature about non-medical con-
sumption.’
A Fine Line is a highly readable and engaging book based on up to
date research and the author’s extensive and detailed knowledge of the
field. It introduces readers to the richness and complexity of an issue,
which is too often discussed in simplistic and one-dimensional terms.
Not only does it reveal the diverse forms of pharmaceutical self-inter-
vention practiced by human beings in search of relief, self-improve-
ment, pleasure and hope; it contributes to our understanding of the
medical form of life that is inseparable from contemporary modes of
existence.
Canberra, Australia Associate Professor Helen Keane
Head of School, School of Sociology
Australian National University
Foreword ix
References
Fox, N. J., & Ward, K. J. (2008). Pharma in the Bedroom… and the
Kitchen…. The Pharmaceuticalisation of Daily Life. Sociology of Health &
Illness, 30(6), 856–868.
Rose, N. (2007). Beyond Medicalisation. Lancet, 369(9562), 700–702.
Wing, S. (1994). Limits of Epidemiology. Medicine and Global Survival, 1(2),
74–86.
Preface
Are painkillers mundane medications safe for use to ameliorate human
suffering? Or are they drugs of abuse that cause addiction and death?
Do they ease pain, or do they cause it? The answer to these questions is
a source of tension in professional and public understandings about the
way people use painkillers.
It is hard to deny the benefit of the use of painkillers for chronic
pain, in order to stem the constant, debilitating throb of pain that
would otherwise not subside for physical health, nor for work or pleas-
ure or rest. It is also hard to deny the pain these medications can cause
to those who become dependent, and to the family and friends of those
who lose their life to overdose. The later has, however, been brought
into sharp focus by public health professionals ever since the slow-re-
lease opiate-based medication OxyContin® was released to market in
1996 in the US. The impact that the sale of this medication would have
on American society and its public health would have been hard to
fathom at the time.
Following the release of OxyContin®, Purdue Pharma, the company
that owns the drug, utilized a sophisticated marketing machine that was
largely directed by its majority owners, the Sackler family. A string of
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