To Be Free and Normal: Addiction, Governance, and the Therapeutics of Buprenorphine

Abstract

Methadone maintenance has dominated opiate addiction treatment in the United States for decades. Since 2002, opiate addiction has also been treated in general medical settings with a substance called buprenorphine. Based on interviews and participant observation conducted in northern California, this article analyzes how discourses of freedom and normalcy in patient and provider narratives reflect and affect experiences with this treatment modality. I discuss how buprenorphine treatment, in contrast to methadone maintenance, offers patients and providers a greater sense of autonomy and flexibility in how they receive and deliver treatment. It presents them with new obligations, responsibilities, and choices around care and conduct. It simultaneously perpetuates and shapes a desire to be "free" and "normal." I argue that the therapeutics of buprenorphine govern patients and providers through this desire for freedom and normalcy. Buprenorphine is thus a technology of governmentality that extends neoliberal discourses and values and produces self-governing subjects.

Re‐racialization of Addiction and the Redistribution of Blame in the White Opioid Epidemic

“…Ethnographers of addicted patients and their doctors have found that their relationships are often laden with mutual mistrust, feeding patients' fears of stigmatization and mistreatment (Merrill et al 2002), and that a narrow biomedical concept of addiction that ignores the social processes and power relations that underlie addiction stigma can paradoxically enhance stigma (Hansen and Skinner 2012;Kaye 2012). Nevertheless, other ethnographies have found that individuals on buprenorphine maintenance treatment experience greater autonomy and a heightened sense of ability to lead "normal" lives closer to that of individuals without substance dependence (Harris 2015). Class and geography are important factors, along with race, that ethnographers have shown to shape perceptions of substance dependence.…”

The becoming‐methadone‐body: on the onto‐politics of health intervention translations

“…Importantly, this emphasis on the materiality of implementation practices also helps attune research to the onto-political effects that intervention translations can generate (Law 2004, Mol 2002. Methadone and drug intervention effects, for instance, affect a particular kind of body, making-up a particular kind of subject, normalising a particular kind of conduct, in relation to a particular kind of problem, according to a particular implementation context (Bourgois 2000, Dennis 2016, Fraser 2006, Harris 2015, Keane 2013, Malins 2004, Nettleton et al 2013, Valentine 2007. Taken together, we can ask what methadone treatment translations perform in the context of Kyrgyz prisons: What bodies and subjects do they make?…”

Polluting pharmaceutical atmospheres: Compulsion, resistance, and symbolism of buprenorphine in Norway

“…Hence, patients did not have the same long, complicated history with methadone as their counterparts in the United States, where local history had generated many negative experiences of both patients and providers. Therefore, I argue, when buprenorphine was introduced in the United States in 2002, the medication's "social" contexts and effects in particular were often compared with those of methadone and considered more "favourable" (Harris, 2015) as a result.…”

“…Second, the material connection to the clinic, which Meyers (2014) called "a spatial locus of therapeutic promise" (p. 188), differs across the globe. In the United States, methadone was distributed in stigmatised and racialised clinics, while buprenorphine was marketed as "GP friendly", a doctor's-officebased treatment (Bourgois, 2000;Hansen & Roberts, 2012;Harris, 2015;Netherland, 2011). In Norway, however, methadone treatment, despite patients' criticism, was often distributed through pharmacies and never acquired this type of negative connotation.…”

“…Patients described Suboxone ® as the worst alternative among opioid substitution treatment (OST) medications and as having many side effects, the most disturbing one being dizziness and debilitating anxieties (see also Muller, Bjørnestad, & Clausen, 2018). Available ethnographic studies on buprenorphine (e.g., Harris, 2015;Lovell, 2006;Meyers, 2013) do not report the negative experiences so prevalent in Norwegian treatment discourse, nor do they distinguish between pure buprenorphine and buprenorphine-naloxone. Therefore, in this study, I was driven to ask these empirical questions: What may have conditioned buprenorphine products, particularly Suboxone ® , to be such an unpopular medication among patients in Norway?…”