Society for Medical Anthropology

Oral Presentation Session

Never Healthy on Buprenorphine: On Pharmaceutical Cyborgs, Promises, and Analytical Labor Behind the Effects of Opioid Substitution Medications

Presenter(s)

• 

  Aleksandra Bartoszko

  Associate Professor
  VID Specialized University

As replacements for illegal heroin and prescription opioids, opioid substitution treatment (OST) medications (e.g. methadone or buprenorphine) are believed to eliminate withdrawal symptoms and are assumed to reduce cravings for heroin and other opioids. In the language of OST clinics, the medications make persons who are addicted to opioids “healthy.” Driven by a discourse of harm reduction and the growing need to reduce overdoses worldwide, anthropologists have accepted and promoted this view. Yet, OST patients tell a more nuanced story. They challenge the promises of becoming healthy, but they also raise questions that reinvigorate anthropological inquiry on this subject: What is health and what constitutes a medication’s effect? Is the absence of withdrawals a positive effect of a medication? Are cravings gone once the patient is “properly medicated”? What do we mean by “substitution”?

Based on a fieldwork among Norwegian patients who negotiated their right to switch their OST medication, I explore the breaches between OST patients and professionals in their conceptualizations of these medications’ effects and health benefits. Outlining conflicting – and often inconsistent – attitudes towards the body, normality, and meanings of pharmaceuticals, I illustrate the analytical labour behind the actors’ claims on whether and how treatment works. I ask: What constitutes health for individuals with opioid addiction? What do they expect from the pharmaceuticals? In what kind of promises do they and we as anthropologists engage while endorsing substitution treatment as a way to achieve better life quality?