De-medicalising opiate addiction in the USA

HPSC2665 short essay (week 2), S2 2006

The complementary processes of medicalisation and de-medicalisation can shed light on the history of opiate addiction in the USA from its acceptance as a proven therapy at the turn of the century to a proscribed substance by 1914. The changing demographic of the average addict, from inadvertent middle-class habitué to transient, antisocial hedonist made the care and treatment of opiate addicts less appealing to the medical profession, whilst making the social problem of opiate addiction the perfect cause for adversarial politics, fresh from the success against Chinese immigration. In this way opiate addiction came to be passed on from the medical sphere to the political.

Understanding reasons why opiate addiction was at first the domain of the medical profession may help us understand why it was then passed on. At first, the majority of addicts were from the respectable middle class, affluent enough to afford medical care and addicted inadvertently as a side effect of treatment for pain or other ills (Jonnes, 1995). Given the wide availability of such drugs as morphine, cocaine and heroin, and that those who were addicted were no doubt well able to afford them, drug addiction could be constructed as relatively harmless and addicts as non-threatening to society at large. Where doctors and pharmacists were also addicts, there was the reputation of scientific medicine and the public's faith in it to uphold. In addition, there was no doubt money in it for doctors with addict patients, who would of course be expected to supervise them. Thus, while there remained money and the professional reputation of medicine to uphold, opiate addiction would continue to be medicalised.

However, when the average addict was no longer a member of middle class, addicted accidentally as part of routine medical treatment, reasons for keeping opiate addiction in the medical domain were less convincing to the medical profession. The new addicts were pleasure-seekers and hardly likely to hold medicine responsible for their habit or to seek the help and advice of doctors. With no money and less prestige on offer for curing what many people thought of as a disease created by medicine to begin with (Jonnes, 1995), medicine had little reason to hold on to drug addiction as tightly, especially when political interest in this new social group was growing.

According to Jonnes (1995), Americans were introduced to recreational drug use in opium dens established by Chinese immigrants. Anti-Chinese sentiment was high in America and Australia, especially after the Boxer uprisings of 1900, and “a racist rhetoric of loathing and fear, with talk of “mongolization,” tainted blood, and disease, became part of political electioneering” (Spence, 1990; p.8). From the 1880s barriers to Chinese immigration were established in the United States, culminating in total exclusion of Chinese immigrants by the 1900s. Having successfully dealt with the problem of Chinese people, it would seem reasonable for politics to target opiate addiction as a legacy of Chinese vice which needed to be dealt with harshly, thereby making opiates and opiate use prime candidates for legislation and restriction. Doctors still retained the right to prescribe opiates, at least at first, but a sharp distinction was drawn between medical use of opiates and the illegal recreational use. Thus it was not so much the drug that was de-medicalised, but the addict.

In the case of opiate addiction around the turn of the twentieth century, the processes of medicalisation and de-medicalisation can help us understand why medicine's proprietary interest in opiate addicts waned to the extent that addiction was criminalised and opiates proscribed. The changing demographic of the average addict meant it became less necessary and much less profitable for doctors to protect the reputation of opiate users, who were instead recast by political institutions first as having fallen into vice and degenerate behaviour, and eventually (with the sole exception of medical addicts) as abnormal and fundamentally different to respectable people (Jonnes, 1995).

References

Jonnes, J (1995) 'The rise of the modern addict', American Journal of Public Health. 85(8):1157-1162.

Spence, J (1990) 'Western perceptions of China from the late sixteenth century to the present', in Heritage of China: Contemporary Perspectives on Chinese Civilisation, ed. Paul S Ropp. University of California Press, Berkeley. pp. 1-14.