The Pain Project

About Project

Between the Medicine Cabinet and the Street: Prescription Opioids in Canadian Culture

In February 2012, in the face of mounting public anxiety about the addictive potential of the prescription painkiller OxyContin, the province of Ontario announced the removal of long-acting oxycodone from coverage under the Ontario Drug Benefit Program (ODB). Concurrently, with its patent for OxyContin about to expire, drug maker Purdue Pharma introduced OxyNEO, a supposedly tamper-proof version of oxycodone which is designed to be less appealing to people who seek to circumvent the drug’s time-release formula by snorting or injecting it. While OxyNEO will only be available to recipients of ODB under exceptional circumstances, individuals who pay for their own prescriptions or who are privately insured will still have access to the drug.

This project represents the second phase in a two-part CIHR-funded research program on prescription opioids as sites of political contestation. The first phase, which will conclude in 2013, has employed interview, policy and media analysis to trace how painkiller use came to be understood as a major social problem and how conflicting evidence about this concern is produced, negotiated, and resisted by key stakeholders. The second phase has three main objectives: 1) To explore how moral discourses helped shape the high profile policy shift around oxycodone; 2) To examine the health and social consequences of the new regulations for prescription painkiller users, service providers, and clinicians in Ontario; 3) To theorize the meanings of OxyContin/OxyNeo in the contemporary historical moment.

This is an interdisciplinary project situated at the intersection of the sociology of health and illness, drug and addiction research, and cultural studies of moral panics, consumption, and the state. The theoretical goal is to engage two scholarly literatures that are rarely used together— critical research on pharmaceuticals and critical research on illicit drugs—in order to develop a theory of prescription opioids. Our research team is especially interested in assessing the contradictory social structures that on the one hand devolve responsibility for health to the individual, in part by enabling the constant expansion of the purposes for which drugs are used, and on the other hand propel the intensification of punitive approaches to an increasing variety of “illicit” drugs, their users and suppliers. We will derive our data from interviews with people who use painkillers, service providers, and clinicians; policy documents; materials from advocates occupying a variety of perspectives; and media coverage.

In 2008, there were 180,000 regular users of prescription opioids in Ontario and many more whose consumption is not captured by statistics measuring official disbursements. In exploring the antecedents and consequences of a policy that will end or complicate access to oxycodone, by far the most prescribed opioid at present, our research team is primarily interested in issues that are marginalized or erased in polarized debates about these drugs. The proposed work does not attempt to identify the real culprits or the real victims in the war on pain or the war on drugs, or to ascertain what counts as legitimate use of painkilling substances—an ultimately futile exercise. Rather, it is guided by the notion that the realities of painkilling drug use, both its pleasures and its dangers, lie in the social contexts that give meaning to this mutable practice. If we are to find healthy and humane solutions to pain and painkiller dependence, and to give credence to the pleasures bound up with both experiences, these contexts offer a promising place to start.

This project is generously funded by the Canadian Institute for Health Research.