By Corey Goergen
Now, Gupta has penned a follow-up piece noting an “unintended consequence” of these reforms: because of the increased the cost of Oxycontin in legitimate and black markets there has been a dramatic increase in heroin use. Gupta admits that “[w]hile all of this was unexpected, it was likely also predictable.” He’s correct: history has long demonstrated that people will continue to seek drugs despite efforts to stop them. But Gupta’s failure to foresee these consequences in 2012 stems in part from the distinctions he draws between accidental addicts and drug abusers, which are rooted as much in class assumptions as in biology.
Dr. Howard Kushner, professor of behavioral sciences and health education at Emory University, has argued that addiction is best understood not as a single disease but as patient-specific “syndromes of dependence.” In other words, each drug user is an individual actor whose drug use has a unique etiology with biological, cultural, and psychological components. Reducing those spectrums of differences to a simple binary between accidental addict and abuser, as Gupta does, effaces those differences and employs medical and legal authority to reinforce systemic injustices.
Thus, while it might seem like quibbling to critique Gupta’s rhetoric, the language we use to talk about drug users has a significant impact on how we treat them. Emeritus William L. White, senior research consultant at Chesnut Health Systems, has demonstrated that negative terms like “hophead” and “junkie” are popularized by moderate drug users to define more excessive users in ways that normalize their own habits. Thus, the middle class male who gets Oxycontin from his doctor needs treatment while the heroin user is a junkie who belongs in prison. The history of drug use, from the eighteenth century gin craze to the regulation of opium in Victorian England to the American crack baby panic of the 1980s, is littered with examples of privileged groups downplaying their own drug habits by problematizing those of marginalized populations.
A similar moral logic informs the conclusion of the story’s accompanying video. Gupta, speaking in forceful voiceover, suggests that people avoid the dangers of opiates by seeking pain relief through exercise. The suggestion subordinates opiate users to patients whose pain, related injuries, and economic situation allow for strenuous exercise. The argument betrays the extent to which assumptions about class and bodily ability predetermine Gupta’s thinking.
Near the end of Deadly Dose, Gupta broaches a different way of thinking about opiate use. An interview with Christi Goeller, who experiences chronic back pain as a result of a car accident 16 years ago, says that because of restrictions on Oxycontin prescriptions enacted in Washington state, she has been unable to find a doctor willing to write her a prescription. But rather than consider her perspective, Gupta transitions immediately to a call for the nation to follow Washington’s example. In Gupta’s concluding voiceover, Oxycontin becomes a “quick fix” offered by “naïve prescribers.” The abrupt shift reduces Goeller’s experience to a brief gesture towards journalistic balance. But it is precisely her voice—and the voice of others working through their own “syndromes of dependence”—that is so often missing from these debates. Goeller says she is tired of going to doctors’ offices and “being treated as a liar.” That treatment is enabled by conventional thinking about drug use. By listening to what drug users have to say, we can accept (and, when necessary, respond to) the complexities of incentives that convince them to do so..
 Kushner, Howard I. “Toward a Cultural Biology of Addiction,” BioSocieties, 5(1), March 2010, 8-24.