On September 21 and 22, 2018, we hosted the symposium, Addiction as a chronic illness? Promises and perils of a new drug policy paradigm. Activists and physicians have worked hard to end punitive responses to addiction and recast it as a chronic illness treatable, in part, with medications like buprenorphine. But the “chronic illness” paradigm raises new questions: How to avoid the stigma and social limitations associated with chronic illness? How to prevent pharmaceutical industry influence over medication assisted treatment (MAT)? This symposium brings together leading scholars of addiction, pharmaceuticals, and chronic illness to explore the promises and perils of applying this paradigm to drug dependence and addiction.
The symposium is sponsored by The Baldy Center for Law and Social Policy and the Jacobs School of Medicine and Biomedical Sciences.
David Herzberg, UB College of Arts and Sciences Department of History, Faculty Profile.
Nils Kessel, Université de Strasbourg, Département d'histoire des sciences de la vie et de la santé, Faculté de Médecine.
Amidst an opioid-related public health crisis, American drug policy is slowly, unevenly, and unequally embracing opioid maintenance (“medicine-assisted treatment” or MAT) as a tool for treating those with opioid dependence. A central strategy of “harm reduction,” MAT provides a stable, predictable supply of opioids so that dependent consumers can focus on other aspects of their lives including work, family, and health issues. In the U.S., MAT developed distinctly from other forms of medical treatment because of its historical genesis within the framework of the punitive “war against drugs.” More recently, in the wake of rising addiction rates among more favored social groups (i.e., middle- and working-class whites), there has been an effort to reconfigure MAT as a private, unstigmatized medical treatment centered around use of buprenorphine (another long-acting opioid). In this setup, addiction is treated as a chronic disease, and patients receive their opioid in more traditional medical contexts. This shift from policing to medical treatment counts as a significant victory in the context of American drug policy.
Yet integrating addiction into America’s pharmaceutical-medical-industrial complex is not without risk. Medical treatment might be preferable to a “drug war,” but it also needs to be recognized for what it is: a market with very strong forces that have spent decades perfectly optimizing their tools and sales strategies. In the past century, treatments for chronic illness have been profoundly shaped by a pharmaceutical industry that has spent over a century inflating harmful medical fads. It would be tragic indeed to rescue MAT from the prison, only to land it in Big Pharma’s marketing department. Careful thinking is thus required to configure MAT so that it navigates the two largest and most obvious social traditions in which it participates (the drug war and chronic illness). Because so many of the problematic aspects of those traditions are historical—built slowly over time in response to social, cultural, and political contexts now forgotten—a successful reckoning must involve understanding and navigating those historical legacies. MAT policy is not made only in the present; it is made with conceptual and practical tools that come pre-formed by history in ways that can limit and distort even well-intended action.
To reveal these historical legacies, and explore how to navigate them in the pursuit of public health, we will bring together historians of MAT (from Europe and the U.S. to gather a diversity of experiences) with historians who study the pharmaceutical management of chronic illness. This conference will be organized around a few big questions: --Why and how do some human experiences get categorized as “chronic illnesses” to be managed pharmaceutically, and what are the social, economic, and political ramifications of doing so? –What medical, legal, and political structures have governed the pharmaceutical treatment of “chronic illnesses,” and what lessons can be drawn from the successes and failures of past governing regimes? --How well does addiction fit into established frameworks of “chronic illness,” and how well does MAT fit into established frameworks of long-term pharmaceutical therapy? Does including addiction and MAT change our conceptions of “chronic illness” and its governance? --How do political struggles over MAT’s status compare to political struggles over the status of other chronic illnesses? What can MAT advocates learn from past examples of successfully established chronic illnesses? --How does MAT, once implemented, affect economic relations between health professionals, hospitals, insurance companies, and the pharmaceutical industry? Our overall goal is to remove the policy residues of criminal stigma from MAT, while imagining structures and practices that can make MAT both effective and safe from marketing-and-lobbying-driven booms and busts. Ultimately, we hope to push beyond stale debates over criminalization-vs.-legalization, and look instead towards a practical task: balancing care for people with health problems, with regulation of commerce that, in a market system, is the primary way such care is delivered.
George Weisz, PhD, is Cotton-Hannah Chair of the History of Medicine at McGill University. He is the author of Chronic Disease in the Twentieth Century: A History (Johns Hopkins, 2014), as well as numerous other books, articles, and editied works. He has been a Visiting Professor at the École des Hautes Études en Sciences Sociales (Paris), the Max Planck Institute for the History of Science (Berlin), the Université de Paris 1 (Sorbonne), and INSERM (Paris). Learn more.
Nancy Campbell, PhD, is Professor of Science and Technology Studies at the Rensselaer Polytechnic Institute. Her work focuses on the social significance of legal and illegal drugs to those who govern and use them, produce scientific knowledge about them, and seek to treat drug problems. Among her multiple books and articles is Discovering Addiction: The Science and Politics of Substance Abuse Research (U Michigan Press, 2007). Her work has been supported by the Freiburg Institute for Advanced Studies, the National Science Foundation and the University of Michigan Substance Abuse Research Center, among other places. Learn more.
Johan Edman, PhD, is Associate Professor of History and Senior Lecturer at the Department of Criminology at Stockholm University. His work explores social exclusion, marginalization, and substance abuse treatment’s role in the 20th Century Swedish welfare state. He is editor (with Kerstins Stenius) of On the Margins: Nordic Alcohol and Drug Treatment 1885-2007, (Nordic Centre for Alcohol and Drug Research, 2007) as well as numerous articles and book chapters.
Jeremy A. Greene, MD/PhD, is the Elizabeth Treide and A. McGehee Harvey Chair in the History of Medicine at Johns Hopkins University. He is the author of Prescribing by Numbers: Drugs and the Definition of Disease (Johns Hopkins, 2007), Generic: The Unbranding of Modern Medicine (Hopkins, 2014), and numerous articles. He also practices internal medicine at the Hopkins-affiliated East Baltimore Medical Center. Learn more.
Helena Hansen, MD/PhD, is Associate Professor of Anthropology and Psychiatry at New York University. She is author of Addicted to Christ: Remaking Men in Puerto Rican Pentacostal Ministries (University of California Press, 2018), as well as multiple articles on race and the 21st century “opioid crisis.” She has received awards and fellowships from the NIH, Robert Wood Johnson, Mellon and Kaiser Foundations. Learn more.
David Herzberg, PhD, is Associate Professor of History at the University at Buffalo (SUNY). His work explores addictive pharmaceuticals in the 20th century’s consumer culture. He is the author of Happy Pills in America: From Miltown to Prozac (Johns Hopkins University Press, 2009) as well as multiple articles and book chapters. Among other places, his work has been supported by an NIH fellowship for Scholarly Works in Biomedicine and Health. Learn more.
Marie Jauffret-Roustide, PhD, is on the faculty at Cermes3 at Paris Descartes University and a Research Fellow at Inserm. Her research explores drug use practices among people who inject drugs and/or use “crack” cocaine. In addition to having published more than 100 articles, she also leads an international comparative research project on the biomedicalization of addiction, the history of harm reduction, peer education, and the impact of repression on at-risk practices among drug users. Learn more.
Nils Kessel, PhD, is Associate Professor of History of Medicine and Health at Strasbourg University. His work explores drug use, pharmaceutical consumerism and market research in 20th century’s Germany. His publications include articles and book chapters on psychotropic drug marketing, the thalidomide disaster, pharmacovigilance and the presence of old drugs on innovation-driven markets. Learn more.
Joshua J. Lynch, DO, EMT-P, FACEP, is Clinical Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo. Lynch has a drive to fight addiction. He serves on the Erie County Opioid Epidemic Task Force, and the NYS Buprenorphine work group. Lynch is a medication assisted treatment (MAT) specialist for the Erie County Department of Health, and a technical advisor for the NYS Department of Health. He educates first responders, the medical community, and the general public about naloxone, overdose, and addiction treatment options. Currently, Lynch is leading a project to provide widespread access to buprenorphine and expedited linkage to treatment centers in the emergency departments across the Western New York region. In cooperation with regional treatment organizations, Lynch aims to have each emergency department in Western New York providing these services by December2019. Learn more.
Todd Meyers, PhD, is Associate Professor of Anthropology at NYU Shanghai. He is the author of The Clinic and Elsewhere: Addiction, Adolescents, and the Afterlife of Therapy (University of Washington Press, 2013) and Chroniques de la maladie chronique (Presses Universitaires de France, 2017). Among his many awards and fellowships is the Ruth L. Kirschstein Individual Fellowship at the National Institute of Drug Abuse. Learn more.
Alex Mold, PhD, is Associate Professor in History at the London School of Hygiene and Tropical Medicine. She is the author of Heroin: The Treatment of Addiction in Twentieth-Century Britain (Northern Illinois University Press, 2008) as well as numerous articles on illegal drugs, the history of health rights, the emergence of patient consumerism, and the place of the public in public health. Learn more.
Jules Netherland, PhD, is the Director of the Office of Academic Engagement for the Drug Policy Alliance. In addition to her work building dialogues between scholarly researchers and policy reformers, she is also editor of Critical Perspectives on Addiction (Emerald Press, 2012) as well as multiple articles and book chapters on a wide range of drug and policy topics. Learn more.
Samuel K. Roberts, PhD, is Associate Professor of History at Columbia University and Associate Professor of Sociomedical Sciences at the Mailman School of Public Health. He is the author of Infectious Fear: Politics, Disease, and the Health Effects of Segregation (UNC Press, 2009) as well as multiple publications from a new project tentatively titled “ ‘To Enter a Society Which Doesn’t Want Them’: Race and Recovery in America’s Heroin Capital.” Among other places, his work has been supported by the Schomburg Center for Black History and Culture and the Woodrow Wilson Foundation. Learn more.
Paul F. Updike, MD, specializes in Internal MEdicine and Primary Care for Catholic Health in Buffalo, NY, a non-profit healthcare system that provides care to Western New Yorkers across a network of hospitals, primary care centers, imaging centers, and several other community ministries. Learn more.
Elizabeth Watkins, PhD, is Dean of the Graduate Division, Vice Chancellor of Student Academic Affairs, and Professor of History of Health Sciences at the University of California, San Francisco. She is the author of The Estrogen Elixir: A History of Hormone Replacement Therapy in America (Johns Hopkins, 2007) as well as author or editor of several other books and numerous articles. Her work has been funded by the National Endowment for the Humanities, the NIH/National Library of Medicine, the National Academy of Education, and the National Science Foundation. Learn more.