QMJC January 2019: Naloxone works: The politics of knowledge in ‘evidence-based’ drug policy

Article: ‘Naloxone works’: The politics of knowledge in ‘evidence-based’ drug policy. Kari Lancaster, Carla Treloar, Alison Ritter. (2017) Health, 21(3): 278-294.

Vancouver reading group – January 2019 meeting: Alex Collins, Samara Mayer, Taylor Fleming, Michelle Olding, Cara Ng, Loulou Chayama, Jennifer Lavalley, Scott Neufeld, Ryan McNeil

How is knowledge constituted and validated in drug policy process, which voices may be heard, and how do knowledge producers secure privileged positions of influence? These questions are posed in this month’s reading, which employs post structuralist policy analysis to examine how ‘particular kinds of knowledge’ are made useful in policy debates around peer-administered naloxone. In doing so, Kari Lancaster and colleagues raise a compelling critique of assumptions underpinning evidence-based drug policy.

The article is an exemplary application of Carol Bacchi’s ‘What’s the problem represented to be? (WPR) approach which interrogates how problem representations are constituted through policy processes. The primary data for this study are interviews with 19 policy-makers, clinicians and researchers involved in discussions surrounding peer-administered naloxone programs in Australia. The analysis illuminates how the evidence-based policy discourse employed by these actors privileges some types of evidence over others, and legitimates the voices of researchers and clinicians over those deemed less ‘rational’ or ‘objective’ (i.e. advocates, people who use drugs). A second finding is that while researchers and clinicians expressed frustration at the problematic barriers posed by requirements for ‘gold standard’ research, they nonetheless felt compelled to pursue ‘objective evidence’ to retain legitimacy.

The paper is well-written and manages to communicate complex theoretical insights in accessible language. Our QMJC reading group particularly appreciated the presentation of the study findings, which brought the empirical data into conversation with larger debates about the relationship between knowledge production and power.

In our discussion, we reflected on our own position as researchers within drug policy debates. The article spurred us to critically consider the extent to which ethnographic, participatory and community-based approaches to knowledge production can disrupt power inequities engendered by the evidence-based policy paradigm. We appreciated the authors’ analytical attention to how researchers and clinicians already routinely invoke other ways of knowing about “what works” beyond the gold standard of Randomized Controlled Trials (e.g. though appeals to common sense and logic). This finding suggests that evidence-based policy discourses are not monolithic and that there is indeed the possibility for ‘re-problematization and resistance.’

This article was a timely read for our group as we see these tensions between evidence-based medicine and other ways of knowing play out in policy debates around overdose deaths in Canada. This paper encourages us to think creatively about how we can make room for other knowledges and voices in our research.

Additional readings:

• Bacchi C (2009) Analysing Policy: What’s the Problem Represented to Be? Sydney, NSW, Australia: Pearson Education.
• Fraser S and Moore D (2011) Governing through problems: The formulation of policy on amphetamine- type stimulants (ATS) in Australia. International Journal of Drug Policy 22(6): 498–506.
• Lancaster K (2014) Social construction and the evidence-based drug policy endeavor. International Journal of Drug Policy 25(5): 948–951.