Painkiller (ab)use : the discursive construction and lived experience of non-medical consumption

The ‘misuse’ or ‘abuse’ of pharmaceutical pain medications is of growing interest among medical practitioners and has received increasing media attention over the last decade. Concerned with the health harms of non-medical consumption, medical and media attention has focussed on the potential to ‘abuse’ and become ‘addicted’ to pharmaceutical opiates. This thesis seeks to contextualise this emerging discourse of pharmaceutical ‘abuse’ within the social and political histories from which it has emerged. It is divided into two parts: the first addresses the discursive construction of painkiller (ab)use as it is articulated in dominant and expert accounts; the second part provides an empirical investigation that draws on the lived experience of those who actually engage in non-medical consumption. This thesis critically analyses expert knowledge by asking how it constructs substance use, addiction, medical authority, the body and pain. It canvasses history, research and policy to articulate how dominant understandings of drug consumption and pain shift over time and within different contexts. The thesis outlines the way official accounts of drug consumption not only describe but also constitute non-medical consumption as a ‘social problem’ for policy intervention. It articulates how research about non-medical consumption often conflates a range of levels of drug consumption and can exaggerate its relationship with criminality. This increased criminalisation of painkiller consumption in policy and research is juxtaposed with a social context in which the definition of pain has begun to encompass a broader range of human experiences. Broadening definitions of pain have contributed to increased cultural expectations about the therapeutic potential of pharmaceuticals. The narratives and life experiences of people who engage in non-medical consumption are also explored. An empirical investigation in the thesis builds on qualitative traditions of drug research that indicate that drug use is a social practice inseparable from the context in which drugs are consumed. It reveals a range of practices that are not limited to ‘abuse’ and which occur in everyday contexts often at a distance from the criminalised image of policy and research accounts. Pain medications are an ideal complement to everyday cycles of restraint and release. This also extends to people who use opiates to treat chronic pain and who use medications for recreation. Analysis of interview data indicates that neoliberal and commercial discourse, which argue for individualised modes of medication consumption, are in tension with official accounts that posit the need for the strict control of opiates and those who consume them. The work conducted in this thesis demonstrates that painkillers are intermediary objects that slip between the categories of legal and illegal, medical and non-medical, and moral and immoral, depending on the context of consumption. For those who use these medications, an intimate relationship between pleasure seeking, health practice and productive citizenship appears to dominate motivations for consumption