Grappling With the “Promise and Perils” of Public Health

    Speakers on a November 7 panel at the Drug Policy Alliance’s Reform conference in St. Louis eloquently examined the complex issue of how public health interventions around drug use—sometimes lifesaving, and often promoted as benign alternatives to criminalization—can be co-opted as mechanisms of coercion and control.

    On the panel”Public Health and Medicalization: Promise or Peril?” Dr. Jules Netherland, managing director of DPA’s Department of Research and Academic Engagement, asked the speakers a series of pointed questions. One of them was: “What do we mean by public health, and is it an approach that is more benevolent, and if so, in what ways?”

    Rebecca Tiger, associate professor of Sociology at Middlebury College in Vermont, replied: “Public health is not separate from the criminal justice system. Both systems have punitive aspects and are impacted by stigma. People with an addiction are managed by multiple systems that use coercion.”

    Tiger described in particular how drug courts embody aspects of both public health and criminalization. People who are arrested and end up in drug court are offered treatmentbut if they relapse, they can be punished. She added that methadone is still very controversial in drug courts, and that if there are disagreements between a prosecutor who opposes methadone and a doctor who favors its use, “The prosecutor’s recommendation wins every time.”

    David Showalter, a doctoral candidate in Sociology at the University of California, Berkeley, answered Netherland’s question with the simple statement that, “Public health techniques are extremely coercive.”

    He further described how the disease model of addiction has been applied differently over time and is full of contradictions. Originally, the model arguably somewhat countered the widespread idea that addiction was a moral failing. The newer iteration of the disease model medicalizes addiction and calls it a brain disease; but having a “brain disease” is criminalizedwith hundreds of thousands of people with a substance use disorder ending up in jails and prisons.

    Medicalization, Showalter stated, leads to the “expansion of the medical professions, market forces and [in some cases] in social movements.”

    Panelists Ricky Bluthenthal, Rebecca Tiger, Kate D’Adamo, Ingrid Walker and David Showalter


    Ingrid Walker, associate professor of US Studies at the University of Washington, centered how the medicalization of drug use, and how it is applied, is dependent on “race, place and class.”

    Kate D’Adamo, a prominent advocate for sex workers’ rights, explained how a public health approach to sex work could be better than criminalization. But she also noted that the constant testing of sex workers for sexually transmitted diseases, applied in a controlling way, leads to a “loss of bodily autonomy.”

    In a fascinating discussion, panelists grappled with the problems raised by achieving short-term victories that do help people who are “sitting in front of you” but don’t lead to structural change. In some cases, they noted, “helping people” might not be helping at all.

    When asked to step outside of these two systems—the criminal justice and public health  models—and imagine radical new policies, Walker emphasized: “Drug users need to be at the table.” Dr. Ricky Bluthenthal, the associate dean for Social Justice at the Keck School of Medicine in Los Angeles, added that the difficulties being discussed were generally “not policy problems; they’re political problems.”    

    Photos by Helen Redmond.

    • Helen is Filter‘s senior editor and a multimedia journalist. She is on the methadone, vaping and nicotine train. Helen is also a filmmaker. Her two documentaries about methadone are Liquid Handcuffs and Swallow THIS. As an LCSW, she has worked with people who use drugs for over two decades. Helen is an adjunct assistant professor and teaches a course about the War on Drugs at NYU. She lives in Harlem.

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