The drug effect: Health, crime and society

The Drug Effect is set within a particular moment in the theoretical trajectory of the sociology of drugs, drug use and harm reduction. The introduction offers a clear exploration of this theoretical journey: from an objectivist approach, favoured by proponents of ‘evidence-based policy’, which considers drug use and addiction as real phenomena to be defined and measured through objective study; to a social constructionist framework, which challenges the idea that addiction, drug use and effects have any real foundations, instead arguing that they are ‘collectively defined’ and constituted; to, and the position taken in this book, a kind of third way – a form of constructionism which also, most fervently, takes materiality seriously.

Following this line of enquiry, Fraser draws on Karen Barad's (2003) theory of agential realism in arguing that drugs and drug effects are made and remade in their ‘intra-actions’ with other entities. Fraser suggests that this theorization has wide implications for drug studies as it challenges ‘blanket assumptions about the properties of drugs, their actions, their effects (even their physical properties and physiological effects)’ (p. 6) whilst still maintaining their material reality – not independent from, but in constant relation to the world (known as relational ontology). Therefore, this book brings to light how the material and discursive, social and scientific, human and nonhuman and natural and cultural are intimately linked in producing drug effects. The chapters in this collection map out these intra-actions in three areas: cultural and social practices (Part 1); health and medicalization (Part 2); and law and criminalization (Part 3).

Part 1 can be seen to combine authors from different epistemological and ontological positions, which does not perhaps represent the ‘onto-epistemological’ position proposed in the introductory chapter, but nonetheless presents an interesting collection. For example, Race draws our attention to the role of drugs in the production of gay identities, and suggests that there are lessons to be learnt from Sydney's Mardi Gras, for informing more productive harm reduction which can embrace both care and pleasure. Boyd looks at the cultural representations of drugs and drug use, and how popular culture can produce different and more helpful understandings. And Moore, informed by Annemarie Mol and John Law, considers the ‘ontological politics’ of knowledge technologies, namely, agent-based modelling, and how it produces the drug user and his/her decisions in rationalized and singular ways. All chapters offer a critique of how drug effects are being produced in social and cultural practices, but more helpfully, they also offer solutions, through the production of different ways of knowing and policy implications.

Part 2 considers the processual nature of addiction, drug use and effects produced by health and medical knowledge and practice in particular spatial and temporal moments. Fraser argues that ‘values and social practices such as health policy and stigma make [hepatitis C] as much as microbes do’, while Campbell gives a historical overview of how American addiction technologies, namely opiate substitution treatments, have created different subjectivities – patients, criminals and consumers – and asks what sort of subjectivities may be produced by the new agonist/antagonist formulations.

The final part considers the production of certain drug users, suppliers and effects in the law and criminal justice system. Seddon draws on a Foucauldian approach in highlighting the construction of the ‘rational’ subject through two new UK judiciary orders based on drug treatment and testing, while Reinarman suggests that the cannabis reform movements in the USA have produced ‘non-medical cannabis use as either deviant or implicitly pathologized’ (p. 178). Bringing the section and book to a close, Manderson draws on the similarities between twenty-first century drug laws and sixteenth century witchcraft laws in which they are both seen to ‘bring to life a metaphorical representation of deep-seated anxieties and give them formal recognition’ (p. 231).

With this in mind, it can be concluded that it is up to us to question the forms that we are given and seek out alternative and more productive understandings of drug use and its effects. This book successfully starts us on this path, towards a critique of current ways of knowing in society, medicine and law, and furthermore, points us in the direction of a more nuanced, complex and multiple understanding which can ultimately produce more caring and less harmful drug effects. Therefore, the main contribution this book makes is at once theoretical and practical. Its theoretical foundation, although not shared to the same extent by all the contributors, means that the discipline can now engage not only with description and critique, but also with producing new and more helpful realities.

Fay Dennis

The Centre for Research on Drugs and Health Behaviour, London School of Hygiene & Tropical Medicine, London, UK E-mail: [email protected]