Treating Heroin Addiction in Norway Focusing on the world of Norwegian Opioid Substitution Treatment (OST) in the aftermath of significant reforms, this book casts a critical light on the intersections between medicine and law, and the ideologies infusing the notions of “individual choice” and “patient involvement” in the field of addiction globally. With ethnographic attention to the encounters between patients, clinicians, and bureaucrats, the volume shows that OST sustains the realities it is meant to address. The chapters follow one particular patient through complex clinical and legal battles as they fight to achieve a better quality of life. The study provides ethnographic insight that captures the individual, experiential aspects of addiction treatment, and how these experiences find a register within different domains of treatment and policy, including the familial, social, legal, and clinical. Offering a rare view of addiction treatment in a Scandinavian welfare state, this book will be of interest to scholars of medical and legal anthropology and sociology, and others with an interest in drug policy and addiction treatment. Aleksandra Bartoszko is a social anthropologist and Associate Professor at VID Specialized University in Oslo, Norway. Routledge Studies in Health and Medical Anthropology Depression in Kerala Ayurveda and Mental Health Care in 21st Century India Claudia Lang Diagnosis Narratives and the Healing Ritual in Western Medicine James Peter Meza Medical Materialities Toward a Material Culture of Medical Anthropology Edited By Aaron Parkhurst, Timothy Carroll Haemophilia in Aotearoa New Zealand More Than A Bleeding Nuisance Julie Park, Kathryn Scott, Deon York, Michael Carnahan The Anthropology of Epidemics Edited By Ann H. Kelly, Frédéric Keck, Christos Lynteris Locating Zika Social Change and Governance in an Age of Mosquito Pandemics Edited By Kevin Bardosh Affective Health and Masculinities in South Africa An Ethnography of (In)vulnerability Hans Reihling Wandering the Wards An Ethnography of Hospital Care and its Consequences for People Living with Dementia Katie Featherstone, Andy Northcott Actively Dying The Creation of Muslim Identities through End-of-Life Care in the United States Cortney Hughes Rinker Treating Heroin Addiction in Norway The Pharmaceutical Other Aleksandra Bartoszko Treating Heroin Addiction in Norway The Pharmaceutical Other Aleksandra Bartoszko First published 2021 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 605 Third Avenue, New York, NY 10158 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2021 Aleksandra Bartoszko The right of Aleksandra Bartoszko to be identified as author of this work has been asserted by her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record has been requested for this book ISBN: 9780367655549 (hbk) ISBN: 9780367655556 (pbk) ISBN: 9781003130079 (ebk) Typeset in Sabon by Deanta Global Publishing Services, Chennai, India To Aja, Hugo, and Bartosz Contents Foreword: This happened while x Acknowledgments xii Introduction xiv 1 Through the opioid landscape 1 “Heroin users” 1 Opioid deaths 2 Opioid Substitution Treatment 3 OST medications 6 The reform and patient rights 9 The beautiful duckling 11 Train, plane, and Internet 11 Notes 14 2 Pharmaceutical polyphony 16 The pharmacotopic promise 16 Whole human being 22 Never healthy on buprenorphine 27 Socio-pharmacological uncertainties 29 “These physical things” 31 At the margins of Gaussian curve 34 Misreading addiction and addicted patients 36 Pharmaceutical self 39 Pharmaceutical othering 41 Notes 42 3 Pharmaceutical atmospheres 43 Buprenorphine settling in 44 Buprenorphine is buprenorphine is buprenorphine 46 viii Contents Polluting pharmaceutical atmosphere 49 Placebos, nocebos, and compulsion 51 Suboxone as metonymy 54 Morphine—a missing link 56 Medicine as anti-pleasure culture 56 The immoral pill 61 The good, the bad, and the in-between 63 Pharmacology is social 65 Notes 66 4 Waiting for evidence 67 Narrating the best drug in the world 67 Pure math and reality 71 Undiscovered knowledge 74 The system 77 The guidelines 79 The suspicion 84 The risk 89 Moral economies of treatment in the uncertain field 93 Notes 94 5 Living longer than life 95 “More bloody days” 95 The proximity of death and bonus life 96 Gift of life 98 Will to live 99 Social aging and the biographical clock 102 Living the good life 105 Living longer 106 The lethal burden of survival and new subjects at risks 107 Note 110 6 From hope to §3-1 111 Siv’s walk to Canossa 111 Treatment capital 113 Fight mode 115 The linguistic turn 118 Legal fetishism 119 Legal self 120 Legal patientization and real patients 122 Contents ix From medifare to lawfare 125 Not only good to think with 128 Notes 129 Conclusions 130 The reform and the narratives 130 Against treatmentality 131 Liberating narratives of patienthood 133 Negotiating in an inconsistent field 134 Law and medicine 135 Addicted citizens 136 Glossary 139 Bibliography 141 Index 159