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Purpose – To compare the histories of two opioid medications that are pharmacologically similar but subject to contrasting regulations in their use in treatment of opiate dependence in the United States – methadone and buprenorphine – in order to analyze the role of racial imagery and racial politics in the legalization and clinical promotion of their use.

Methodology/approach – Historical methods of archival analysis of published articles and unpublished governmental records were used in researching methadone. Ethnographic methods of participant observation and semistructured interviews were used in researching buprenorphine.

Findings – Contrasting uses of racial imagery played a major role in shaping the current regulatory differences between the two treatments. The association of methadone with black and Latino heroin users has contributed to its increased federal regulation, while the association of buprenorphine with white, middle class prescription opioid users enabled its use in deregulated private physicians’ offices.

Originality/value of paper – Advocates of biomedicalization of behaviors and conditions thought of as social or moral, such as addiction, argue that biomedicalization reduces the stigma of the condition and imply that, in turn, it also reduces the racial inequalities associated with the condition. This study of the biomedicalization of treatment for opioid dependence indicates that the very process of biomedicalization depended on heightened racial imagery associated with each treatment and ultimately intensified, rather than reduced, the stigma of addiction for black and Latino low-income patients.

Neuroscientific technologies have begun to change the ways in which we understand, respond to, and treat drug addiction. According to addiction researchers, neuroscience marks a new era because of its potential to locate the causes of addiction within the brain and to treat addiction through altering neurochemistry. However, little is known about how addiction neuroscience and new neurochemical treatments shape individuals' experience of addiction and constitute new arrangements of knowledge and power that shape subjectivity and governance. This chapter addresses these domains by drawing on an analysis of scientific literature about addiction neuroscience and qualitative interviews with people being treated for addiction with buprenorphine, a pharmaceutical treatment for opioid dependence. The chapter charts four major themes in the addiction neuroscience literature (pleasure and the limbic system, rationality and the role of the prefrontal cortex, theories of plasticity, and the role of volition) and explores how each of these is incorporated, adapted, or rejected by individuals being treated for addiction with a pharmaceutical. This analysis demonstrates how neuroscientific ideas are mediated by the lived experiences of those being treated under a neuroscientific model. It also suggests that while neuroscientific interventions, like pharmaceuticals, shape the experience of those being treated for addiction, so too do many other forces, including social circumstances, moral frameworks, the drive for autonomy, and the quest to be “normal.”

Purpose – The chapter examines the historical pattern of interconnections between drug policy, research, and treatment in light of recent theoretical developments in the medicalization thesis advanced in the sociology of medicine.

Methodology/approach – The chapter uses interpretive methods to examine how the social construction of addiction as a “chronic, relapsing brain disorder” converges with or diverges from the conceptual framework offered by sociological theorists of medicalization and biomedicalization.

Findings – The approach adopted shows how the meanings of the bio/medicalization of addiction shifted and circulated within and beyond the institutions developed to respond to drug addiction as a hybrid social, medical, and biomedical condition during the 20th century.

Social implications – Bio/medical frameworks for addiction are the outcome of historical attempts to influence public attitudes and develop effective methods to treat and prevent this “disease” in ways that would positively affect the quality of life of people living with addictions.

Originality/value – This original contribution addresses both strengths and limitations of bio/medical models, assessing how their influence has changed over time.

So much has been written about addiction, one can reasonably ask why we need another volume on the subject now. The pieces gathered here take up a number of current trends that make this exactly the right time to take a fresh look at addiction. These include: debates over the nosology of addiction as part of the revision to the Diagnostic and Statistical Manual of Mental Disorders (DSM); the expansion of addiction's meaning and spheres of control beyond alcohol and illicit substances; the rise of neuroscience; the increasing ‘pharmaceuticalization’ of everyday life and new pharmaceutical treatments for addiction; growing awareness about the intersection of the drug war and the mass incarceration of people of color; and new theoretical frameworks for understanding the role of addiction as a fundamental technique of social control. These trends are reshaping addiction in both new and not-so-new ways that warrant the interrogation this volume provides.

To underscore the significance of international health care management, we focus on three themes: the problem of global blindness; global health care challenges and opportunities; and learning from international health care management. The problem of global blindness highlights how health care managers’ inattentional blindness to competitors’ operational performance and market strategies lead to avoidable and expensive failures. To address global challenges and opportunities, health care organizations are employing two different strategies: (1) building and marketing a world-class health care facility internationally, and (2) organizing and integrating multinational health care operations. The first strategy exploits the medical-tourism market. The second strategy requires either multinational health care networks or transnational health care organizations. One of the lessons to be learned from international health care management is that an organization can create a meta-national competitive advantage. Another lesson is that by examining best practices from around the world, health care organizations can obtain new insights and become more innovative within their home markets. A corollary and third lesson is that while health care organizations can learn a great deal from examining international best clinical practices, sometimes the most important management lessons are lost in clinical translations. The fourth and last lesson is that worst cases – serious international management failures – offer perhaps the most valuable insights into the role of culture, complexity, and leadership for health care organizations.

The United Nations General Assembly Special Session on drugs has provided countries with internationally agreed recommendations to adapt their drug policies for more efficiency and better outcomes. This chapter focusses on the Russian Federation’s role in international drug policy, through an analysis of its national approaches and their design, as well as on its diplomatic efforts at the bilateral and multilateral levels to oppose drug policy reform. A systematic review of peer-reviewed, grey literature, policy documents, UN reports and news reports on the country’s response to drugs internally and externally was conducted between September and December 2017. Despite its efforts to oppose drug policy reform and the prioritisation of public health, the Russian Federation faces major epidemics of imprisonment and HIV. Internationally, while it has not been successful in addressing the ongoing reforms in Europe and the Americas, it has been effective in preserving its international priorities by opposing harm reduction and maintaining the prohibition paradigm at the multilateral level.

This case study examines unique overdose risks and prevention strategies for women who have used heroin during pregnancy in New York City. The overdose crisis has resulted in increased efforts to implement drug user health services; yet, pregnant and parenting women who use drugs continue to be left behind. Three women who currently use heroin and had experienced at least one pregnancy during their heroin use history were interviewed using semi-structured qualitative interviews. Their experiences documented in this case study illustrate several gender-specific considerations when responding to the overdose crisis in New York City. Overwhelmingly, barriers to healthcare and overdose prevention were correlated with perceived stigma and the fear of or actual loss of child custody. Compassionate, gender-responsive interventions remain largely absent in policy and practice, especially for pregnant women. The shared experiences highlighted in this case study should be used to develop improved drug user health policies and practices as well as increase overall advocacy efforts for women of reproductive age who use drugs.

Purpose – This chapter provides an overview of the importance of seeing personal troubles as public issues when examining the mass incarceration of people of color, specifically Black Americans in the United States. A response to the mass incarceration of Black Americans unrooted in a sociological understanding may lead to victim-blaming. This chapter demonstrates how personal problems are often intertwined with public issues. The chapter concludes with a discussion on the importance of shifting blame away from the victim and appropriately addressing systemic challenges.

Methodology/approach – This chapter applies sociological theories to examine high rates of incarceration of people of color that get attributed to personal problems. The authors based the analysis on previous research and governmental reports.

Findings – Sociological theory can offer new solutions to transforming the criminal justice system to alleviate injustices in communities of color. The criminal justice system has negative consequences, but resistance to accepting new ideas perpetuates inequality and limits opportunity for social change. The authors recognize that policy changes must occur at the institutional and structural levels to expose social injustice.

Originality/value – A dearth of research examines the approach of framing personal troubles as public issues to reduce mass incarceration. The authors intend to expand the discourse on how personal troubles intersect with public issues and how the authors must examine mass incarceration as the typical response.

A growing body of research finds a consistently negative relationship between medical cannabis access and aggregate measures of opioid use. Nothing is currently known about the types of opioids that are being most impacted by cannabis access. Using the Callaway and Sant’Anna (2021) difference-in-differences (DID) estimator for the main analysis and data on all opioid shipments to every United States (US) pharmacy from 2006 to 2014, the authors found no evidence of overall change in the total number of morphine milligram equivalent (MME) units of opioids shipped to pharmacies, following the opening of medical cannabis dispensaries. However, across all opioids, the authors found a reduction in the highest MME dosage strengths (8.8% decrease in 50–89 MME doses and 11.3% decrease in 90+ MME doses). This decrease appears to be driven predominantly by commonly diverted opioids, where the authors found a reduction in the highest MME dosage strengths (12.2% in 50–89 MME doses and 13.8% in 90+ MME doses). Further, the authors see a 6.0% increase in low-to-moderate dose opioids (0–49 MMEs). This is consistent with patients using cannabis concomitantly with opioids in order to achieve a lower opioids dose.