Disciplining Addictions: The Bio-politics of Methadone and Heroin in the United States

Abstract

Biomedical understanding of methadone as a magic-bullet pharmacologicalblock to the euphoric effects of heroin is inconsistent with epidemiologicaland clinical data. An ethnographic perspective on the ways street-basedheroin addicts experience methadone reveals the quagmire of powerrelations that shape drug treatment in the United States. The phenomenonof the methadone clinic is an unhappy compromise between competingdiscourses: A criminalizing morality versus a medicalizing model ofaddiction-as-a-brain-disease. Treatment in this context becomes a hostileexercise in disciplining the unruly misuses of pleasure and in controllingeconomically unproductive bodies. Most of the biomedical andepidemiological research literature on methadone obscures these powerdynamics by technocratically debating dosage titrations in a socialvacuum. A foucaultian critique of the interplay between power andknowledge might dismiss debates over the Swiss experiments with heroinprescription as merely one more version of biopower disciplining unworthybodies. Foucault's ill-defined concept of the specific intellectualas someone who confronts power relations on a practical technicallevel, however, suggests there can be a role for political as well astheoretical engagement with debates in the field of appliedsubstance abuse treatment. Meanwhile, too many heroin addicts who areprescribed methadone in the United States suffer negative side effectsthat range from an accentuated craving for polydrug abuse to aparalyzing sense of impotence and physical and emotional discomfort.