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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Methodology/approach – Historical methods of archival analysis of published articles and unpublished governmental records were used in researching methadone.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.

This study aims to describe and analyse an approach in the city of Bremen (Germany) to establish streetwork-supported tolerance zones for local open drug and alcohol scenes to reduce related disorder and nuisance in public spaces.

The qualitative methodology included systematic participant observations at public sites of drug and alcohol use, and problem-centred interviews with different groups of respondents (residents, passers-by, trades people, drug users, experts from addiction help and police).

In residential districts, tolerance zones were well accepted by their target group and found to reduce perceived disorder and nuisance in public space. However, their success depends on the social and spatial conditions of the chosen location, its surrounding urban infrastructure, cooperation among local actors and characteristics of drug using groups.

Usually, policing of open drug scenes focuses on repression and law enforcement. The example of Bremen suggests that streetwork-supported tolerance zones dedicated to the drug scene can substantially reduce disorder and nuisance in public space.

The United States has an uncomfortable relationship with pleasure. Cultural ambivalence is evident in discourses surrounding pleasure and the labeling and treatment of those who act on their desires. Pleasure seeking, generally understood in moral terms, is often medicalized and criminalized (as in the case of pregnancy prevention and drug use), placing questions of how to manage pleasure under the purview of medical and legal actors. At the macrolevel, institutions police pleasure via rules, patterns of action, and logics, while at the microlevel, frontline workers police pleasure via daily decisions about resource distribution. This chapter develops a sociolegal framework for understanding the social control of pleasure by analyzing how two institutions – medicine and criminal justice – police pleasure institutionally and interactionally. Conceptualizing medicine and criminal justice as paternalistic institutions acting as arbiters of morality, I demonstrate how these institutions address two cases of pleasure seeking – drug use and sex – by drawing examples from contemporary drug and reproductive health policy. Section one highlights shared institutional mechanisms of policing pleasure across medicine and criminal justice such as categorization, allocation of professional power, and the structuring of legitimate consequences for pleasure seeking. Section two demonstrates how frontline workers in each field act as moral gatekeepers as they interpret and construct institutional imperatives while exercising discretion about resource allocation in daily practice. The chapter concludes with a discussion of how understanding institutional and interactional policing of pleasure informs sociolegal scholarship about the relationships between medicine and criminal justice and the mechanisms by which institutions and frontline workers act as agents of social control.

Previous attempts to develop theory from qualitative case study research have employed the underlying principles of John Stuart Mill's system of logic, albeit in different ways (Mill, 1973). In his analysis of inductive proof, Mill proposed a set of formulae, or methods, to guide the process of induction. The two most important methods are considered to be the methods of agreement and difference. In the method of agreement, a constant association is sought across cases between the phenomena of interest, effectively identifying necessary conditions, but excluding extraneous conditions unconnected with the theory. Using the method of difference, however, the search is for sufficient conditions, those that must be present for a particular outcome to occur. Used together, the cannons comprise a stronger test than when employed individually, since the method of difference offers some security against the threat of alternative interpretations. Following the logic of both methods implies a search for conditions, which are always present when a particular phenomenon is present and which are never present when that phenomenon is absent. The basis for theoretical inference therefore rests on the comparison of similar and dissimilar cases as stated in Mill's methods of agreement and difference, and which finds its ultimate expression in experimental method (Cook & Campbell, 1979).

Ibogaine therapy offers a viable alternative to mainstream treatment for opiate addiction. The combination of the addiction‐arresting and fast‐acting properties of ibogaine, with the slow and thoughtful conversation of psychoanalytical psychotherapy is a novel approach to what still remains a difficult condition to overcome.Safer than methadone, ibogaine use is steadily increasing world‐wide, and is becoming a more accepted treatment for opiate addiction. This year it has become a prescription medication in New Zealand. Howard Lotsof, who discovered the anti‐addictive properties of ibogaine 47 years ago, and who died in January 2010, devoted his life to improving access to ibogaine treatment, and instigated the first ibogaine providers' conference in Mexico in 2009.This paper explores the use of ibogaine and psychoanalytic psychotherapy in the clinic for the treatment of opiate dependency, the relationships between the two approaches, and how they differ from other treatment modalities.

The purpose of this paper is to evaluate the clinical practice for management of opiate dependence in a general hospital in‐patient population based on agreed standards and changes of clinical practice after the introduction of a guideline.

A complete cycle of audit was carried out based on the agreed guideline, which was introduced after the first cycle. Data were obtained, using a standardized audit form, over two one‐year periods, by cross‐sectional analysis of case notes for patients identified as having been dispensed methadone whilst an in‐patient.

There were significant increases in: referral to the specialist service whilst an in‐patient (p=0.01); referral to the addiction services on discharge (p<0.001) and providing information about the addiction diagnosis to GP (p<0.001). However, there was no improvement in the documented history and examination related to aspects of addiction, some of which were consistently low. Of most concern were significant decreases in the history documented for opiate withdrawal symptoms and alcohol consumption.

The method used may not reflect actual clinical practice, only captures opiate‐dependent patients prescribed methadone and does not establish the extent of awareness of the new guideline.

The paper identifies a variation in clinical practice of management of patients with opiate dependence in the general hospital. Though there were some significant improvements, further improvement and continual evaluation are needed.

The paper identifies the need to study how co‐morbid opiate dependence is managed in the acute hospital setting.

There is limited research documenting recovery experiences of residential service users. The purpose of this paper is to explore the perceptions service users on methadone have about recovery. In depth, semi structured 1-1 interviews with seven poly drug using homeless males between the ages of 37 and 46 and analysed using NVivo software. Results are presented thematically. Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to former addict identities. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms that equate recovery with abstinence. Tensions were revealed in true motivations for active rather than passive participation in adopting group work norms.

A qualitative design utilises small numbers of participants to gather rich data. In depth, semi structured 1-1 interviews conducted with seven poly drug using homeless males who have completed between ten and 15 weeks of a minimum 26-week residential treatment programme. Participants were aged 37-46. Results were analysed thematically using NVivo software.

Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to a former stigmatised addict identity. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms regards recovery and abstinence. A significant process of recovery involved adopting the norms of 12-step groups and TC therapy to gain enough trust to leave the therapeutic community (TC) unsupervised. This created tension regards motivation, were these individuals in recovery, or merely “faking it”?

A female perspective may have provided a more balanced discussion and yielded greater depth in results. Only one service was studied and the findings may be specific to that cohort. The duration of stay at the service of ten to 15 weeks is a relatively short time and excluded participants resident for six months or more. Longer term residents may have been more reflective and informative.

Encourage active options and increased debate on the variety of treatment options available to long term homeless opiate users who have failed to comply with previous treatments. While this is a small modest study, the rich data yields practical advice for policy makers and service providers.

This research study adds to an informed perspective by encouraging debate on methadone as a challenge to definitions of recovery that infer abstinence as a key definition of success.

There is a paucity of research documenting a Scottish TC service user perspective using qualitative methods on experiences of addiction, treatment and recovery.

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.”

The purpose of this paper is to estimate the demand and supply of opiates in the USA during the period 1870–1914 when the market was virtually unregulated.

The price and quantity of opiates is econometrically estimated using a data set constructed primarily from pharmaceutical trade journals.

Per capita opiate consumption varies in inverse proportion to its price, a price elasticity of demand of unity. The supply of opiates to the USA is perfectly elastic, a horizontal line, implying the USA was a “price-taker” in the world market for opium. The number of medical schools, a proxy for the state of medical science, significantly effects opiate consumption, as does the import tariff on opium.

Opiate use, both medicinal and addictive, is highly responsive to purely the economic forces of price and income. The influential role of the medical profession in shaping the pattern of consumption is confirmed. Data limitations prevent making substantive statements about usage of the various sub-categories of opium, requiring all opium to be treated as equivalent units of morphine sulfate.

Decriminalized access to opiates and other addictive substances is likely to result in a significant increase in usage, which could be controlled by taxation.

Prior studies of unregulated opiate demand and supply have covered Indonesia and Taiwan under colonial government monopoly, not a major western country user like the USA. Also, this paper uses a newly created consistent set of inflation-adjusted opiate prices covering a long period (1870–1914).

Buprenorphine (Subutex) was piloted in two Scottish prisons between 2004 and 2006 and consequently used within other penal establishments in Scotland. This 2007 qualitative study aimed to explore the use of Subutex and its associated effects on 14 participants on detoxification programmes.

All participants were male, aged from 21 to 44 years with prison sentences ranging from a few months to life imprisonment. Buprenorphine was unavailable to female prisoners at the time of this study. Participants were recruited from seven Scottish prisons. All 14 participants were on detoxification programmes, each was prescribed Subutex, and each was selected from a larger investigation that included both those undergoing detoxification and maintenance (n=21). All participants had previously also used methadone on previous detoxification programmes.

It can be concluded that the majority of detoxification participants within this study indicated that Subutex was a more effective treatment than methadone as it helped reduce craving, eased the process of withdrawal and improved sleeping patterns. In addition, the majority of participants noted higher levels of motivation and the ability to set goals towards obtaining an improved quality of life.

This study provides an alternative perspective to the use of Subutex within prison settings, when compared with results from previous quantitative studies reported. The study also highlights inconsistencies drawn from studies in this area, which may be an artefact of study design. It is recommended that further qualitative studies be conducted to explore further this alternative perspective. Finally, the issue of methodological approach taken should be addressed within the context of a related, but independent, research forum.