A pensive stone figure sits outside the National Archives Museum in Washington, D.C., atop a platform reading, “what is past is prologue.” But if a new exhibit, “Spirited Republic: Alcohol in American History,” is any indication, perhaps it should more appropriately read, “what is past is pregame.”
EDITOR’S NOTE: Points is delighted to welcome Kim Sue, a previous contributor (check out her earlier posts here and here), medical anthropologist, and dual degree MD/PhD candidate at Harvard University. On the heels of Points’ recent posts about the difficulties of reconciling clinical and scholarly perspectives on addiction treatment and the media frenzy about the recent prescription opioid epidemic, Sue offers a historical and ethical reflection on having the power to dispense prescriptions.
I first met Anita in the Boston jail where she was doing time for passing bad checks related to a prescription opioid addiction. She had first been introduced to opioids after giving birth to her first child several years earlier. “I was prescribed percs [percocets] for pain related to the delivery,” Anita explained. “I just remember taking them and being high and cleaning … I took four or five at a time.” Anita’s drug use spiraled out of control, as her physiological tolerance to the opioids increased and she needed to buy more and more pills to get the same effect. One day, Anita’s dealer offered her heroin, and off she went.
Ethnographers and historians of drug use are all too familiar with stories that resemble Anita’s. As an anthropologist who studies prisons and addiction treatment, I find it relatively easy to point the finger at doctors for their professional complicity in “epidemics” of opioid addiction.
But as a medical student in my final year, destined to start residency in July in an internal medicine-primary care program, I also worry I won’t be able to refuse prescriptions for opioids for patients presenting to me in distress and pain.
Historians of medicine and drug use have detailed how physicians—whether they wanted to or not—became central to the distribution and administration of opioids in the United States. In the wake of the Harrison Narcotics Act, addicts had to obtain prescriptions for their drugs, and so-called “dope doctors” would provide them for cash. The alternative to the dope doctor was the street druggist, the so-called “pusher.”
Doctors and opiates have a long, complex history. In the era of magical formulations, Dr. Thomas Syndenham compounded laudanum by mixing “two ounces of opium and one ounce of saffron dissolved in a pint of Canary or sherry wine” with a “drachm of cinnamon powder and of cloves powder,” as historian Richard Davenport-Hines noted in his history of the subject. At the time, opiates (plus or minus alcohol) were among the few medicines that were actually effective pain relievers (working at the μ pain receptors in the brain). They were instrumental in bolstering the medical profession’s emerging reputation for dispensing effective interventions rather than simply bearing witness to suffering. Indeed, enterprising pharmacists and doctors alike created their own patented formulations of various narcotics marketed as cure-alls– a mix of magic, profiteering, and chemistry.
EDITOR’S NOTE: Today’s post is written by Points contributing editor Michelle McClellan.
Like many others, I read the story in Rolling Stone magazine about a gang rape at the University of Virginia with a sense of mounting horror. Then, when I began to hear hints and then assertions that the victim’s story might not hold up, I felt angry and confused—for a lot of reasons. The fallout from this story and its aftermath has been extensive, and will likely change again before you read these words. The cover page of the December 5, 2014 Chronicle of Higher Education includes the headline “UVa Rocked by Account of Rape” but that is overshadowed on the page by a photo of recycling bins heaped high with Bud Light cans to illustrate a special report called “Alcohol’s Hold on Campus.” How, if at all, do these stories go together?
Editor’s Note: We’re delighted to welcome Ingrid Walker, an Associate Professor of American Studies at the University of Washington-Tacoma, and a past guest contributor to Points. In today’s post, Walker makes several cultural observations about marijuana as it joins beer, coffee, and wine to become the newest psychoactive substance legally produced and consumed for fun in Washington.
The much-anticipated first months of marijuana legalization in Washington have been consumed with building a regulatory system and marketplace from the ground up. Users ready to enjoy their substance of choice endured a 19-month waiting period between the passage of I-502 in November 2012 and the moment the first retail shops opened for business in July 2014. The Liquor Control Board quietly established the infrastructure for the regulation and licensed both growers and retail businesses. In the meantime, we have been left to anticipate how the new “recreational” market would affect life in Washington.
So far, the development of a recreational marijuana industry has come with a set of issues that typify the legacy of drug prohibition in the United States. The cultural reverberations of marijuana legalization reflect the attempt to normalize the use of a substance in a state and country that has no public language for that recreational practice. The law’s implementation has evoked questions about how a newly legal substance’s use-practice sits alongside the use of other psychoactive substances that we take for granted (alcohol, caffeine, and tobacco). In particular, there are many stereotypical expectations that suggest unfamiliarity with marijuana and its users.
That knowledge deficit is somewhat understandable; the paradigm shifts about marijuana use have required Americans in some states to radically reconceive the drug—first from a completely illegal substance to a medically approved substance, now to a fully legal one. In a country that has long-standing propaganda and stereotypes about marijuana use and users, perceptions are slow to change. I titled this post “Drugs and Rec” to echo Parks and Rec, the television comedy that touches on the often absurd aspects of public policy, local campaigns and government, as well as the concept of providing services for public “recreation.” While marijuana has always been “recreational,” the term distinguishes it from “medical marijuana”—the first toehold in the path to full legalization. Ultimately, should marijuana become legalized across the country, that descriptor will fall away as marijuana use becomes as normalized as alcohol use is.
Editor’s Note: This summer will mark the 100th anniversary of World War I’s outbreak. Today, contributing editor Nicholas K. Johnson brings us the third installment in a five-part series on alcohol, drugs, and the Great War. You can read Part One here and Part Two here.
The experience of American soldiers and Marines with alcohol on the Western Front was fundamentally different than that of their allies from France, Belgium, and the British Commonwealth. Unlike the French and British armies, the men of the American Expeditionary Forces were not issued alcohol in the trenches. This would have been anathema to the powerful temperance movement on the home front. The temperance movement issued anti-alcohol propaganda during and after the war and connected it with the American cause. Behind the lines, YMCA camps offered “wholesome” entertainment for American troops free from alcohol and other vices. However, the temperance movement and YMCA ultimately failed to prevent American troops from consuming alcohol during the war.
New York mayor Michael Bloomberg’s attempted ban on the sale of sodas larger than 16 ounces suffered a defeat in court a few weeks ago. But criticism of the industry that has been termed “Big Sugar” or “Big Food” shows no signs of abating. Those critical names are spinoffs from a down-market brand we all remember: Big Tobacco. Public health advocates from the populist food writer Michael Pollan to the lauded obesity researcher Kelly Brownell draw a direct comparison between the tactics of today’s convenience-food conglomerates and the tobacco industry of the twentieth century. Michael Moss’s recent bestseller Salt, Sugar, Fat reads like a journalistic sequel to historian Allan Brandt’s Cigarette Century.
Moss’s book begins with a series of comparisons between cigarette manufacturers and Big Food companies like Kraft and General Mills (both, he notes, now owned by Philip Morris). Moss draws from a series of executive testimonials and previously secret industry documents that detail the familiar tactics the companies used: scientific breakthroughs that exploit our basic biological impulses for consumption, collusion with government regulators, marketing targeted at children—all of which, he concludes, resulted in a growing chronic disease burden. With this common history established, the analogy seems straightforward: cigarette manufacturers are to cancer as food companies are to obesity-related illnesses. But it has a subtext that should interest alcohol and drugs historians as well as regulators: the suggestion that sugary substances aren’t just physiologically harmful—they’re addictive.
Critics like Moss are already alleging that the “Food Giants Hooked Us.” While I’m not sure I buy the argument, I can see how the threat of “addictive potential” might be politically useful for activists seeking to establish new regulations to curb the consumption of processed food and drinks.
Editor’s note: Today guest blogger and medical anthropologist Kim Sue offers her observations on how changing marijuana laws have slowly begun to impact the world of the opiate-addicted patients she studies–and the wider society’s assumptions about drugs and the reasons people use them.
I have been closely following the campaign for and roll-out of medical marijuana in Massachusetts as I conduct ongoing ethnographic fieldwork on opiate use and incarceration. Given marijuana’s prominent place in the historical, political, and cultural framings of the War on Drugs, it is critical to consider evolving legal frameworks and cultural attitudes toward the drug.
Last fall, advocates for medical marijuana managed to get it enacted via referendum. Continue reading →