No Single Path: Review of Amy Sullivan's Opioid Reckoning

Abstract

No Single Path:Review of Amy Sullivan's Opioid Reckoning Jaeyoon Park (bio) Amy Sullivan. Opioid Reckoning: Love, Loss, and Redemption in the Rehab State. Minneapolis: University of Minnesota Press, 2021. 266 pp. $25.95 (hc). ISBN: 9781517908638. "Science can find a cure for our diseases, but not for our societal ills," one reads in a recent opinion column on the pandemic featured in the New York Times.1 Here we have, in aphoristic form, a now-familiar framework that reconciles the brilliant technological success of medical science in the last year with the relentlessness, still, of the COVID-19 pandemic. According to this framework, the pandemic is a two-part problem: one part virus, one part social resistance to the cure for the disease. The framing itself does not show us how to quell the resistance, and yet it charts the path forward. What we need to do in order to halt the pandemic is make the world more ready to be healed by science; what we need is a campaign against public skepticism about the health care system, against scientific illiteracy, and against vicious misinformation about the relative risks of COVID-19 and mRNA injections. This same framework has been circulating for years as an explanation for another health crisis also far from an end in this country: the epidemic of opioid addiction and overdose. In relation to that crisis, too, we hear that science has done its work, but there is resistance to the outcomes of science––hence, the crisis rages on. More precisely, we hear that medical scientists have developed "gold standard" treatments for addiction, but that for reasons of bureaucratic lethargy, public skepticism, or sheer hopelessness among those suffering from addiction, the treatments are not adequately made available and sought out. (The name for this problem, in media and state discourse, is "the treatment gap.") Again, we have the two-part, divided-labor frame: the opioid crisis is part biological illness, part social resistance, and the solution is, first, to develop the technical means to tame the disease; and second, to distribute that technical means among the affected public. Whether or not this framework is adequate for making sense of the COVID-19 pandemic, it certainly fails to capture the realities of the opioid crisis. Of course, the treatment gap is a problem, and the various forms of misunderstanding, ignorance, and misanthropy that render addiction treatment [End Page 225] unavailable for those who want and need it must be defeated. But we mislead ourselves when we think that science has solved the disease problem, and that an end to the crisis will come if we can just disseminate the science, and close down the gap between what medicine already offers and what patients clearly need. For addiction is, in essential respects, not like COVID-19. And there is likely no technical solution for the opioid crisis, here now or waiting in the wings. I cannot, of course, make a full argument for these claims in the space of a book review. But I can show how they are powerfully suggested by what goes on in the actually existing world of opioid addiction treatment, which we may glimpse through the recent work of the historian Amy Sullivan. Amy Sullivan's Opioid Reckoning centers on an often-overlooked set of experiences relating to opioid addiction treatment. We know from the ethnographic work of medical anthropologists such as Philippe Bourgois, Angela Garcia, and Helena Hansen something of the first-person experience of undergoing addiction treatment. And we know, from the many profiles of individuals suffering from opioid addiction featured in newspapers and magazines, something of the life stories into which treatment regimens fit, and of the complex personal circumstances into which treatments aim to intervene. Less often do we learn about the lives and experiences of those who are witness to an addiction and its treatment—as parents, physicians, activists, and community leaders. What is the kind of grief felt by parents who, long prior to the actual death of a child with a severe addiction, sense that the possibility of a long and open future for the child has perhaps already been lost, is unlikely to be...