At the Expense of a Life: Race, Class, and the Meaning of Buprenorphine in Pharmaceuticalized “Care”

ABSTRACT

Background/Objective: Office-based buprenorphine maintenance has been legalized and promoted as a treatment approach that not only expands access to care, but also reduces the stigma of addiction treatment by placing it in a mainstream clinical setting. At the same time, there are differences in buprenorphine treatment utilization by race, ethnicity, and socioeconomic status. Methods: This article draws on qualitative data from interviews with 77 diverse patients receiving buprenorphine in a primary care clinic and two outpatient substance dependence clinics to examine differences in patients' experiences of stigma in relation their need for psychosocial supports and services. Results: Management of stigma and perception of social needs varied significantly by ethnicity, race and SES, with white educated patients best able to capitalize on the medical focus and confidentiality of office-based buprenorphine, given that they have other sources of support outside of the clinic, and Black or Latino/a low income patients experiencing office-based buprenorphine treatment as isolating. Conclusion: Drawing on Agamben's theory of “bare life,” and on the theory of intersectionality, the article argues that without attention to the multiple oppressions and survival needs of addiction patients who are further stigmatized by race and class, buprenorphine treatment can become a form of clinical abandonment.

KEYWORDS:

• Medication assisted treatment
• addiction
• race
• socioeconomic status
• intersectionality
• multiple oppressions
• structural violence
• stigma

Acknowledgments

We would like to acknowledge the contribution of Bruce Link in conceptualizing the work and for his guidance with data analysis. We would also like to thank Erica Gibble and Parth Patel for their instrumental help with data analysis. Support for this work was provided by a National Institutes of Health (NIH) grant DA 032674032674 (Awarded to Hansen).

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.