QMJC March 2023: ‘Pharmaceutical prosthesis’ and the suburban opioid epidemic

Colleagues from Deakin University (Australia) held a meeting of the Qualitative Methods Journal Club in March 2023 to discuss the dynamics of the opioid epidemic in America, including differences in how White, middle-class women are positioned compared with Black and Latina women.

Summary

Helena Hansen’s (2017) article on the ‘suburban opioid epidemic’ examines how gender, race, and class intersect in news coverage and clinical accounts of opioid consumption in the US. Applying an intersectional lens, she argues that public and clinical discourses surrounding the contemporary opioid crisis produce a racialised, feminised ‘suburban opioid epidemic’ in which the futures of middle-class, White suburban women are seen as under threat.

The article draws on multiple qualitative data sources to build this argument. First, Hansen examines news stories and talk show episodes posted on YouTube referencing women and heroin, as well as the 20 most-read online media stories from 2012–2016. She identifies a common tendency to depict White suburban women in sympathetic terms as blameless, unwitting victims of addiction due to neglectful doctors (who overprescribe opioids for pain relief). Via appeals to humanising biographies, middle-class, White women are portrayed as caring wives and mothers who manage heroin addiction without disrupting their families. Second, Hansen analyses interviews with community physicians working in Staten Island, a White suburban enclave of New York City experiencing three to four times the opioid overdose rate of any other city borough. In these interview-based accounts, physicians reproduce similar themes of “feminised blamelessness and the urgency of protecting White social reproduction in the midst of opioid overdose”.

In the third and final section of the article, these accounts are contrasted with the perspectives of patient narratives of opioid maintenance therapy, in which White, middle-class women “experience pharmacotherapy as prosthesis for reproduction of their professional and sexual selves”, while Black and Latino men experience pharmacotherapy as disciplinary regimes of social control.

In sum, Hansen argues that gender and Whiteness are central to the racialised discourses and imagery surrounding illicit drugs. These dominant discourses function to buttress prohibitionist policy responses and support for successive waves of drug wars in the US, which have disproportionately impacted Black and Latinx communities.

As scholars and activists for people who use drugs have argued, discriminatory drug law enforcement, which targets marginalised communities under the guise of the ‘war on drugs’, is actually a ‘war on people’ – generating profoundly unequal outcomes and suffering for people of colour (1 2).

Discussion

In our discussion, we noted that the analysis is socially and historically well-situated. Importantly, Hansen contextualises the opioid and overdose epidemic in relation to wider discussions of pharmaceuticalisation and prescription medicine, policy and clinical responses to opioid consumption and addiction, cultural anxieties about race, and the criminalisation of Black people and the crack cocaine epidemic. We discussed how good qualitative research should aim to be sensitive to the political and historical antecedents of contemporary health and social phenomena that have come to be labelled ‘problems’ or ‘crises’ – in this case the suburban opioid epidemic in the US.

The article is ambitious in its analytic reach and use of multiple forms of qualitative data. Members of the group liked the development of an intersectional approach, in which notions of gender were analysed alongside notions of race and class to interrogate the complex and multifaceted character of the opioid epidemic in America. As we discussed, this approach clearly illustrates how normative constructions of gender and race produce different renditions of addiction that shore up existing gender, race, and class hierarchies, for example, White, middle-class women who are dependent on drugs as blameless victims who continue to care for their families versus their Black and Latina counterparts as neglectful mothers “who traded sex for crack and abandoned their children”.

We also thought a strong feature of this article was the development of the theoretical concept of “pharmaceutical prosthesis”, in which pharmaceuticals such as opioid maintenance medication are conceptualised as a ‘prosthesis’ for racial privilege. Hansen employs the metaphor of prosthesis to consider how White suburban women’s opioid addiction is reframed as “the result of a biological drive to ‘self-medicate’ physical or emotional pain and how pharmaceutical industries reframe opioid maintenance medication as a tool for maintaining the productivity of White, middle-class, addicted women as mothers and professionals”. This attention to drugs as social actors involved in reproducing existing social systems and normative values is important for challenging biomedically-reductive accounts of drug effects as confined to the individual body.

In sum, this article demonstrates the value of a wide-ranging, intersectional lens for tracing the dynamics of race, class, and gender in localised figurations of the opioid epidemic.

by Dr Renae Fomiatti, Dr Kiran Pienaar, Dr Kyja Noack-Lundberg, and Dr Ashleigh Haw

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