“Liquid Handcuffs”: the bio-politics of methadone

maintenance treatment

Christopher Smith

Nov. 5, 2007

Outline• Introduction (personal and political)• Background:

– Origins of methadone– First development of maintenance model

• Context:– History of methadone in Canada (1964-2007)

• Theory: Foucault on ‘bio-politics/bio-power’• Case study: ethnographic narratives• Conclusion • Questions and discussion

Background: Origins of Methadone

• WWII Germany, IG Farbinindustrie• Post-WWII, Eli-Lilly, “Dolophine”

– ‘Adolph’ vs. ‘dolor’ (Latin root for pain)

• First marketed as painkiller, then used as short-term tapering tool to wean addicts of heroin etc.

Development of the ‘Maintenance’ model

• Dr. Vincent Dole and Dr. Marie Nyswander, New York, mid 1960s

• Initial experiments using morphine substitution (unsuccessful), discovery of methadone during tapering (successful)

• Long acting qualities produced more energetic, able-bodied subjects (foreshadowing biopolitical implications?)

Context: MMT in Canada

• 1964-1996– Federal regulation– Restrictive, repressive policy climate,

largely informed by moral-criminiological ideologies and discourses re. ‘addiction’

– Strict admission criteria, restrictions for prescribing physicians

Context: MMT in Canada

• 1996-2007– Provincial regulation (CPSO, MMT Guidelines:

1996, 2001, 2005)– Shift to ‘client-centred’, ‘harm reduction’ oriented

approach– Effects: (1) exponential expansion of client

population due to loosening of admission criteria, (2) rapid proliferation of private, group-practice treatment model due to relaxing of restrictions for prescribing physicians

MMT in Ont. 1996-2006 (continued)

• Media-fuelled ‘Moral Panic’ re. Methadone in Ontario (Feb. 2006)– OATC:

• fraudulent billing practices?• Accidental deaths

– Corktown: the “panic in needle park”

• Culminated in formation of Ontario Methadone Task Force (George Smitherman

‘Liquid Handcuffs’:MMT and/as biopolitics

QuickTime™ and aTIFF (LZW) decompressor

are needed to see this picture.

Foucault on Biopolitics:

• The History of Sexuality (volume 1)• “technologies of power that take life as

their objective” (Foucault 1980)• bio-power emerged with the “explosion

of numerous and diverse techniques for achieving the subjugation of bodies and the control of populations” (1980).

• Regulatory vs. disciplinary biopower

Disciplinary bio-power

• Focus on discipline and control of individual bodies (vs. entire populations)

• = “the body as a machine: its disciplining, the optimization of its capabilities, the extortion of its forces, the parallel increase of its usefulness and its docility” (1980)

• Examples in MMT: (1) dose, (2) urine screening, (3) ‘carry’ doses

Regulatory bio-power

• focuses on “the species body, the body imbued with the mechanisms of life and serving as the basis of the biological processes: propagation, births and mortality, the level of health, life expectancy and longevity” (1980)

• Examples: (1) harm reduction as regulatory biopower?, (2) expansion of treatment access, (3) date collection, (4) addiction research

Dose as disciplinary biopower:• “Dr ___ has been really good for me in terms of

getting me down [e.g. tapering], because I was stuck with another doctor, and he wasn’t into letting me go down at my own pace at all, so there was lot of conflict and I moved on…” (Miguel)

• “The doctor always explains ‘well Tara if you were a diabetic’... he always give me that, because I always want to get off; a couple times I’ve almost hurt myself because I’ve come in saying take me down…” (Tara)

Urine screening as disciplinary biopower:

• weekly urine sample collection (compulsory, observed) for drug screening purposes

• “That pill bottle beneath the chair you were sitting on, it was urine. That’s how women do it [cheat on the urine drug screen]... You didn’t know that? That goes on a lot. Oh yeah, I know about 10 people; they’re clean every week and then they get rid of [i.e. sell] all their carries.” (Tara)

Carry doses as disciplinary biopower:

• Reward and punishment system tied to results of urine drug screens

• Client must demonstrate ‘clinical stability’

• ‘clean’ vs. ‘dirty’ (connotations?)• ‘full carries’ = conformity, adherence• vs. “low-threshold” model?

Harm reduction as regulatory biopower?

• Examples:– Needle exchange (critique of former ‘one

for one’ system)– Safe Consumption Sites (SCSs): as

attempt to interiorize ‘problem’ drug use and manage urban user communities in the interests of ‘public order’ (surveillance, regulation, monitoring, discipline etc.)

Expansion of treatment access as regulatory biopower• By increasing the accessibility of methadone

treatment services, and thereby effectively bringing a larger segment of the opiate using population under the surveillance of state and medical institutions, the policy shifts in 1996 clearly represent “a matter of taking control of life and the biological processes of man-as-species and of ensuring that they are ... Regularized” (Foucault 1997).

Data collection as regulatory biopower

• Establishment of centralized patient registry database (CPSO)

• Collection of quantitative stat.s re. dose, retention, ancillary drug use etc.

• Used to determine statistical norms etc.

• Data used to assess success of expanded treatment access

Addiction research as as regulatory biopower

• Exclusive emphasis on quantitative, epidemiologically-driven research (focus on HIV/HCV)– Example: Safer crack use kit funding (strategic?)

• Lack of engaged, qualitative, ethnographic research that examines the complexity of social suffering form the perspective of users’ themselves

Conclusions:

http://www.gardendistrict.ca/in_our_garden/map_social_services.html

Meth clinic should go-- Levy

Health clinic near campus treats hard drug addicts, raising safety concerns from Ryerson’s president

(The Ryersonian, Mar 7, 2007)