Deserving Abandonment: Governing Pain and Addiction across U.S. Opioid Landscapes
My dissertation focuses on mechanisms of abandonment, marginalization, and punishment produced in the name of care through biomedicalized responses to “opioid crisis.” I examine exacerbation of abandonment as an effect of new state-mandated oversight of opioid prescribing and dispensing on patients seeking opioid-related care for pain, addiction, or both. I draw on immersive ethnographic research in a public hospital system and a largescale encampment in California, as well as interviews of patients and addiction treatment providers in New York City. Building on prior research that documents two tiers of drug law enforcement in the U.S., I examine how two tiers are produced and maintained not only by segregating individuals into punishment through spatially structured enforcement and criminalization, but also by segregating people out of treatment. I examine how individuals and communities come to be segregated out of treatment and abandoned through state and capital investments in science and health care. In particular, describing the intersections of bureaucratic mandates, biomedical constructions of risk enacted through guidelines, policies, clinical decisions, the circulation of paperwork, the embodiment of moral reasoning, and the encroachment of drug law enforcement, I document the enactment and legitimization of patient discharges from public health care settings. Finally, I examine how people’s historicized and embodied relationships to state power affect the efficacy of buprenorphine as a treatment for opioid dependence. I propose that targeted state support for pharmaceutical interventions in response to social suffering can be understood as a mechanism of organized abandonment through investment.