Abstract
The problem of lying as a feature of medication compliance has been well documented in anthropological and clinical literatures. Yet the role of the lie—its destabilizing effects on the continuity of drug treatment and therapy, as a technology of drug misuse, or as a way to understand the neuro-chemical processes of treatment (pharmacotherapy “tricking” or lying to the brain)—has been less considered, particularly in the context of opioid replacement therapy. The following paper is set against the backdrop of a three-year study of adolescents receiving a relatively new drug (buprenorphine) for the treatment of opiate dependency inside and outside of highly monitored treatment environments in the United States. Lies give order not only to the experience of addiction but also to the experience of therapy as well. In order to better understand this ordering of experience, the paper puts the widely discussed conceptual duality of the pharmakon (healing and poison) in conversation with a perilously overlooked subject in the critical study of pharmacotherapy, namely the pharmakos or the personification of sacrifice. The paper demonstrates how the patient-subject comes to represent therapeutic promise by allowing for the possibility of (and often performing) deceit.
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Notes
Will to Power, translated by Walter Kaufman (New York: Vintage, 1967), 451.
Pronounced (byoo-pre-NOR-feen)
Throughout the paper I use “buprenorphine” to refer to the pharmaceutical used to treat opiate dependence in the group of adolescents with whom I worked. In all cases, these adolescents were prescribed the drug Suboxone®, a buprenorphine and naloxone combination drug. Suboxone® was the most common buprenorphine treatment prescribed in Baltimore, Maryland during the time of my research.
Recently, Deborah Sontag reported in The New York Times (November 16, 2013) on the complicated and often contradictory story of buprenorphine as an effective treatment for opiate dependency (almost exclusively upon prescription painkillers), highlighting the treatment’s inconsistent profile as a new drug of abuse and dependency in the U.S.
Over the past few years I have begun to think with the concept of anesthesia in order to step away from the binary of “abuse” or “therapeutics,” since the relationship between abuse and therapy is so very porous (and legal/illegal or licit/illicit designations often lead to the worst analytical dead ends when concerned with subjects acting). Anesthesia or anesthetic use refers to the observable sedation that comes with opiate use as well as its intention to block pain––pain that is social, interpersonal, the self-management of chronic pain or forms of chronic suffering that are not always, but often, corporeal. I also find Natasha Dow Schüll’s (2006) discussion of “sensitizing” and “anesthetizing” materials in the case of psychotropic medications useful in this regard.
What I find important here is that neither Cedric nor Megan conceptualized the “trick” buprenorphine played on the brain as placebo, but instead they viewed it simply requiring a kind of pathway.
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Acknowledgments
I would like to thank Michael Oldani for his persistence in organizing this special issue of Culture, Medicine & Psychiatry; otherwise, I would have likely neglected the topic of lies for many more years. I appreciate the generous insights of Hermann Herlinghaus, particularly with helping me wrangle the tricky dimensions of pharmakos and its vast genealogy. I would also like to thank Annette Leibing, Johanne Collin, and the members of the MÉOS Research Group (Médicament comme Objet Social) at the Université de Montréal for their feedback on an earlier iteration of the paper. The paper benefited greatly from suggestions made by two anonymous readers. The majority of this research was conducted under a training fellowship from the National Institutes of Health/National Institute on Drug Abuse [F31-0202039—Sponsor: Dr. Jonathan M. Ellen, Johns Hopkins University, School of Medicine, Department of Pediatrics]. The Johns Hopkins University, Homewood Institutional Review Board approved the research [HIRB No. 2006021 “Therapeutic Contexts for Substance Abusing Adolescents”]. The names of the informants are pseudonyms.
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Meyers, T. Promise and Deceit: Pharmakos, Drug Replacement Therapy, and the Perils of Experience. Cult Med Psychiatry 38, 182–196 (2014). https://doi.org/10.1007/s11013-014-9376-9
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DOI: https://doi.org/10.1007/s11013-014-9376-9