Forgotten Drugs of Abuse I: T’s and Blues

Stop me if you’ve heard this one before.  It’s about a new drug, a killer, raging through a major American city filling ERs and morgues and leaving a trail of wrecked lives.  Just a year ago heroin was the big problem, but now this new scourge accounts for three-fourths of drug busts and a third of all addicts seeking treatment.  Experts are saying there’s no way the drug will stay in one city: “similar to an infectious process,” it will inevitably spread across the nation.  It’s already surfaced in a handful of cities, and who knows where it will strike next.

Scourge of Our Cities

The year is 1978, and the Talwin panic is in full swing.

Wait, you don’t remember the great Talwin terror of 1978?  Maybe haven’t even heard of Talwin?  Don’t feel bad.  Despite the promising start, the Talwin scare never really got off the ground.  There were a few headlines here and there, a TV documentary, and a day of testimony in Congress, but in the annals of anti-drug crusades it was small potatoes.

Why?  1978 was a great year for drug crusades, and this one seemed to have plenty going for it:  Talwin really was causing major public health problems in Chicago; it had a hip, media-friendly street name (“T’s and Blues”); and most of its abusers were nonwhite, urban poor—classic drug-war boogeymen.  More:  one of the largest sources of Talwin in Chicago was a Medicaid clinic, where, Congress was told, the drug was “handed out literally like M&Ms.”  The headlines could have written themselves.  “Hard Working Taxpayers’ Dollars Going to Give Dope to Junkies!”  And if that wasn’t enough, how about this sound bite from the Congressional hearings:

Thank you indeed!  “Grandmothers are buying Talwin on the street”:  does it get any better than that for an anti-drug crusader? It wasn’t supposed to end up like that for Talwin.  Continue reading

The Points Interview: David Herzberg

Editors’ Note: We’re delighted to bring Points readers another installment (number sixteen) in the “Points Interview” series.  Today, we’re getting happy with David Herzberg, author of Happy Pills in America: From Miltown to Prozac (The Johns Hopkins University Press, 2009).  David Herzberg has been a Contributing Editor here at Points, and is also an Associate Professor in the Department of History at SUNY-Buffalo (where he also hosted the recent conference of the Alcohol and Drugs History Society).

Describe your book in terms your mother (or the average mother-in-the-street) could understand.

Happy Pills is a cultural history of Miltown, Valium, and Prozac—three of the best known, Cover of Happy Pills in Americamost widely used, and controversial medicines in the postwar era.  It tells their medical and commercial stories, but also asks why they became so faddish and contentious, and how their fame (and infamy) influenced medical and popular ideas about consciousness and identity.
The book begins in the 1950s, when Miltown became the first “blockbuster” tranquilizer and an early icon of biological psychiatry.  The drug’s celebrity was the product of several developments:  intensified popular marketing of prescription drugs; increased medical and public attention to anxiety as an illness, led in part by Freudian psychiatry; and a burgeoning consumer culture primed to deliver technological wonders in the name of comfort and convenience for the middle classes.
But Miltown’s popularity didn’t sit well with everyone; in fact the prospect of eradicating anxiety made some people quite nervous.  The tranquilizer and its successors quickly became embroiled in postwar gender battles and the explosive politics of the “war against drugs,” and Happy Pills traces these stories to their combined conclusion in a feminist campaign against Valium addiction in the 1970s.  This was a most unusual anti-drug campaign, targeting sexism in drug companies and the medical system rather than stoking fear of addicts.  It capped off a decade of challenges to the pharmaceutical industry, and was part of a broader effort by reformers to rethink the boundaries between “drugs” and “medicines.”

Happy Pills ends with a look at the emergence of Prozac and other antidepressants in the late 1980s and 1990s, and the accompanying revival of popular belief in wonder drugs.  Why was this resurgence so successful when the drugs themselves turned out to be far from revolutionary?  Prozac’s boosters, I argue, took new findings in brain science and used them to create a story that was as much political as it was scientific:  miraculous new consumer goods now made it possible to pick and choose personalities—identities—in a utopian free market of accessorizable selfhood.  However exaggerated such promises may have been, they proved a powerful cultural vehicle for pushback against feminist-era drug critics, and a fitting vision of identity and personal change for an increasingly conservative era.

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Michelle Bachman, Gardasil, and the Politics of Experience

Editor’s note: Contributing Editor Joe Gabriel’s fantastic “ripped-from-the-headlines” post appeared earlier this week, only to be buried by even more timely content on “The Stoned Ages.”  We’ve put it at the top of the page again so it can enjoy the adulation it deserves.

Ask Your Governor about Gardasil

I’ve been following the recent controversy over Gardasil with quite a bit of interest. As you probably know by now, the Gardasil vaccine was developed by the pharmaceutical firm Merck & Company to prevent human papillomavirus (HPV), one of the most commonly spread sexually trasmitted diseases in the United States. In 2007, after it had been on the market for about a year, Rick Perry issued an executive order requiring that all sixth-grade girls in Texas receive the vaccine. (He can do that – he’s the governor of the state.) Everyone flipped out, for various reasons, and the Texas legislature passed a law revoking the order.

The whole episode was filled with drama and theatrics, but the hoopla seemed to have died down until Perry entered the presidential race. Michelle Bachman, bless her twisted heart, latched onto the issue and accused Perry of pushing the vaccine at the behest of Merck–which, as it turns out, doesn’t seem that implausible, given that his former chief of staff was once a lobbyist for the company. It looks like there may have been a lot of money involved in the decision after all, though of course it is difficult to know about such things from the outside. Continue reading

The Elephant in the Newsroom: Drug Policy and Michele Bachmann’s Migraines

Ed. Note–This post originally appeared on August 1. We removed it briefly while pursuing an opportunity to speak with Rep. Bachmann about the questions posed below. Unfortunately, the Bachmann camp did not respond to our query. We welcome readers’ insights into the candidate’s stances on these issues and urge fellow bloggers and mainstream journalists to ask Bachmann about her approach to drug policy – and pain management praxis in particular – if given the chance.

Tucker Carlson: Trouble-Maker

Points has been investigating the regulation and increasing criminalization of opioid pain medications in the U.S. with posts like Siobhan Reynolds‘  on DEA meddling in pain management practices, Joe Spillane‘s on historical accounts of law enforcement interference in medicine, and Kenneth Tunnell‘s look at the first OxyContin scare. Conservative political news site the Daily Caller (run by formerly bow-tied pundit Tucker Carlson) alleged in late July that Republican presidential candidate Michele Bachmann takes “all sorts of pills” to deal with “incapacitating” migraines. Since narcotic pain relievers are one of several tools in many a migraineur’s survival kit (as well as that of at least one president), that story got us thinking about how the congresswoman’s experience with chronic pain might affect her approach to drug policy. The response to the allegations also illuminates the way in which media discourses work to reproduce normative representations of gender and power, even when media commentators attempt to upend those discourses.

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We Are the Drug War: Prohibition as Success

In her final guest post for Points, Siobhan Reynolds asserts that the oft-repeated claim that the War on Drugs has failed should be reassessed from the point of view of those who profit from its outcomes. Looked at from that perspective, Reynolds sees opiate regulation as central to the drug war’s astonishing success.

Protesters Rail against the Drug War with Puns

Drug policy reformers have rallied for an end to drug prohibition calling it a dismal failure. To my mind, however, in order to understand this thing that has taken on a life all its own and to ultimately change course, if that is possible, one has to stop looking at the drug war as a failure and instead regard it as a spectacular success. There’s no denying that drug war policies and practices have turned physicians against the interests of their patients, been wildly expensive, destroyed the criminal justice

Activists Protest Drug War Over-Incarceration

system, and facilitated the incarceration of people in the United States to a degree that would make Stalin or the Chinese envious. People who value civil liberties above all other social goods undoubtedly consider such developments evidence of failure. But these chilling outcomes do benefit some. A mature view would necessitate that we look at who profits under drug prohibition in order to truly judge what it has become. Continue reading

Remembering Betty Ford

“Have you heard the news?”  I received a flurry of emails like this from family members and friends in the hours and days after Betty Ford’s death.  They know of my work on the history of alcoholic women, so it was a logical question.  Of course, I was saddened to hear of her passing, and in the aftermath I have found myself grappling with questions of periodization and pondering the sense of ownership we sometimes attach to the issues and people we study.  On the one hand, Ford was “outside my period” as we say in the trade, since my research has concentrated on the nineteenth and early-to-mid twentieth century era.  In fact, I was acutely uncomfortable writing about someone who was still living, and so I had relegated Ford to the epilogue of my book-in-progress.  On the other hand, I have found to my surprise that I have cultivated some proprietary feelings about her as well.   As a girl growing up in Michigan during the 1970s, I was aware that my mother and her friends—regardless of their formal political affiliations—admired Ford’s down-to-earth character as First Lady, believing it reflected a regional, gendered identity which they shared, that of the capable, unpretentious Midwestern woman.  This image, in turn, shaped Ford’s cultural meaning as a female alcoholic and addict.

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Final Dispatch from Buffalo: Licit Drug Wars

Editors’ Note: The following is the final installment in our series of reports on the biennial ADHS conference held in Buffalo.  Our thanks to Michael Durfee, Nancy Campbell, Joe Gabriel, and Michelle McClellan for their earlier posts.  This time, Joe Spillane tries his hand at post-conference reflection.

Licit Drug Wars

Historians of so-called “licit” drugs face a number of challenges in their work.  Where does that term–licit drugs–even take us, and what does it mean?  In general, of course, it means a focus on regulated-but-legal products of the pharmaceutical industry, but the boundaries of the term are pretty fuzzy.  Still more challenging, it seems to me, is the task of navigating a field where contemporary thought is so dominated by two strong, competing narratives.  The first I’d call the “consumer protection” narrative, in which licit drugs are generally viewed with suspicion as products of an exploitative corporate culture that dupes physicians and victimizes consumers.  The liberal drug warriors, in effect.  The second is what I’d call the “social control/moral panic” narrative, in which efforts to control licit drugs reflects an aggrandizing tendency of state bureaucracies to control all aspects of human behavior, and in which licit drugs (like other substances) are subject to panicked reactions by a society viewing them through the distorting lenses of race, gender, and class.  Four intrepid souls made the journey on this panel. Continue reading

Bound by Law? Questioning the “Lobster Trap” of the Controlled Substances Act

In her fourth in a six-post series for Points, Siobhan Reynolds reviews the policies and judicial precedents that leave doctors unwilling to prescribe opioids to patients in pain. Reynolds focuses in particular on how federal control of the medical profession undermines the political structure of the United States and the opportunities for freedom and experimentation federalism provides.

In an earlier blog post I suggested that I would explain the reasons why physicians are loath to treat pain with opioids despite their noted efficacy; I’ve mentioned that medical professionals don’t like to admit that they are afraid to prescribe these medicines, preferring instead dole  out far more dangerous non-controlled drugs on the grounds that opioids are “bad” in some special way having nothing to do with their actual utility or safety profile. In this post, I will examine how the profession developed such a seemingly irrational blind spot where opioids are concerned. This blind spot has its roots in the interpretation and enforcement of the Harrison Narcotics Tax Act of 1914 and the more recent Controlled Substances Act (initially passed in 1970).

Years ago, when I sat at my computer in my kitchen in New York City, wondering how in the world it was that doctors simply refused to effectively manage their patients’ pain, I researched the law myself. Continue reading

Warring Cultural Icons? Addiction and Mental Illness as Brain Diseases

Points readers packing for the big Alcohol and Drugs History Conference next week will want to take a break from stuffing their toiletries into quart-size ziploc bags in order to welcome Guest Blogger Stanton Peele, psychologist, author, and principled opponent of the addiction-is-disease industry.  Peele is the author of numerous books, including The Truth About Addiction and Recovery, The Diseasing of America and Addiction-Proof Your Child; he blogs at Stanton’s Blog. Below, he trains his incisive gaze on two recent print media discussions of brain chemistry, mental illness, and addiction.

The two primary (New York) intellectual organs, the New York Review of Books and New York Times, have recently featured two powerful cultural icons saying exactly opposite things about  prescription pharmaceuticals and “brain disease.”

The New York Media Wants a Piece of Points' Action

In an ongoing two-part series in the NYRB (part 1 is in the June 23rd issue), Marcia Angell, the first woman editor-in-chief of the New England Journal of Medicine and now at the Harvard Medical School, argues against the firmly ensconced American view that mental illness can be–it has been–resolved to brain functioning.  The Times, for its part, once again supports the slightly-more-come-lately view of addiction as a brain disease with a profile of Nora Volkow, the visionary director of the National Institute on Drug Abuse (NIDA).

Angell has fought her way to cultural icon status by combating the medical-pharmaceutical-industrial complex, Continue reading

Abusive Treatment: Drug Prohibition and the Erosion of the Doctor/Patient Relationship

In her third guest post for Points, pain relief activist Siobhan Reynolds traces the unraveling of the doctor-(pain)patient relationship under drug prohibition.

Siobhan Reynolds Looks for the Missing Connections Between Doctor and Patient

Perhaps the most disturbing consequence of opium prohibition, and the one least talked about in polite company, is the steady degradation of the doctor/patient relationship that has occurred since prohibition’s inception. In poor countries, where opioids are not at all available, physicians speak truthfully to their patients when they tell them that they have nothing with which to relieve their pain. In countries like the United States, where opioid pain medications are ostensibly legal but where physicians have been intimidated into withholding pain treatment, the doctors feign their impotence. There is certainly a great deal of pain relief to be found in opioid medications, and they are stacked on the pharmacist’s shelves. But physicians in the US are jailed – often arrested by SWAT teams, de-licensed and destroyed financially – for treating pain in a manner inconsistent with the opinions of government lawyers and agents. If you ask the physician who refuses to treat pain with opioids if his fear of official attention is the cause of his failure to serve his patient, you will likely meet with something quite different than such a humble confession. Instead, you will hear about how addictive the opioids are, or the doctor will say that their use should be confined to the care of the terminally ill, when addiction is not a concern. And he will extol the virtues of the anti-inflammatory and of psychiatric drugs. He will talk about the miracle of biofeedback and the importance of a positive outlook on life in the treatment of pain.

All of these responses have their place in the treatment of pain after the pain has been medically controlled. But recommending these adjustments as if they replace the pain relief provided by opioids is like telling a woman whose house is burning that a simple glass of water will fix her problem or a diabetic that he must exercise to earn his insulin. To a person in suicidal levels of pain, this kind of dissembling amounts to psychological and physical abuse. And yet this conversation between doctor and patient is par for the course under drug prohibition. It is a refrain patients hear over and over, until they finally stop searching for relief and eventually give up on living all together.

The fundamental truth that confronts anyone concerned with the quality of the doctor/patient relationship under drug prohibition – namely, that doctors have in essence been turned against the interests of their patients – remains almost entirely unacknowledged by the profession as a whole. Continue reading