There's an interesting piece about the mythical OxyContin epidemic by Maia Szalavitz in Slate this week. The piece goes in two oddly conflicting directions, however. On the one hand, Szalavitz offers a refreshing breath of sanity as she debunks the idea that OxyContin can cause "accidental addiction" simply by being prescribed:
[T]he entire OxyContin "epidemic" is based on a false narrative that asserts that the majority of OxyContin addicts begin as drug-naive pain patients. ... addiction is the exception, not the rule, among people exposed to opiates. Studies consistently show that pain patients taking opiates are no more likely to become addicts than people in the general population (i.e., exposure alone does not cause addiction).
This is all true. The conventional wisdom's narratives about addiction are very misleading. They present the notion that the drug itself makes the choices against the addict's will, that there is no choice involved, and that taking the drug, because entirely compelled, is devoid of meaning. Nothing could be further from the truth. People take drugs for much the same reason they do anything else: to provide structure and meaning in their lives, to have something to do, to produce a desired subjective effect.
Some people become "addicted", that is, they devote abnormal and damaging amounts of their time to the use of the drug, and give up other activities, damage their bodies, etc. But at the root of all of this, there is a choice that the person has made. The concept of addiction is a way to explain why a person continues to take damaging drugs in the face of disastrous consequences. Such behavior seems irrational, and humans are assumed to be essentially rational, so pathology -- "the addiction" -- is invoked to explain the unreasonable nature of the addict's behavior.
Szalavitz recognizes this, in part, by showing that pain patients do not necessarily become addicted. That is, they are taking the drug for a reason -- pain -- and when the pain goes away they will stop, because they have no more reason to take the drug. The "addict" has a prior reason -- depression, or schizophrenia, or whatever -- which is unlikely to go away without other intervention, and so they will continue taking the drug.
That's the good part of Szalavitz's essay. But she is still tied to the good drug/bad drug dichotomy, and her article moves in the service of corporate interests. A good drug (OxyContin) comes from a corporation, and is prescribed by a doctor. A bad drug comes from the black market, and is sold on the street. Her organization, STATS, has some very intriguing and critically engaged articles on drug use and drug war policy. But ultimately, Szalavitz seems to put all her faith in corporate pharmaceutical companies to prevent innocent people from becoming addicted:
Good drugs and good doctors are being defamed by reporters and prosecutors based on conventional -- and discredited --wisdom about addiction. ... Where is big pharma's clout when we need it?
Given big pharma's role in the construction of addiction and the maintenance of prohibition on unpatentable drugs, it's very peculiar that Szalavitz's voice of reason also comes with an unspoken committment that there's a capitalist solution to every problem. Her essay proves that you can quit the conventional dogma, but it's not so easy to get the capitalist monkey off your back.