Convenors’ Preface to Special Issue: ‘Drug Regimes in Southern Africa’

Over the last century and a half, the term ‘drug’ has been assigned an insupportable burden of classificatory and moral labour, defining – in public, legal and health discourses – certain substances and products in relation to the intended purposes and effects of their consumption. As pharmacologist and medicines policy consultant Andy Gray has observed, formal attempts to establish binary categories of classification have been ongoing. For example, identifying one pivotal date:

Since 1985, the World Health Organisation has steadily moved away from the term ‘drug’ (still widely used, and particularly in the US) and tried, whenever possible, to substitute the term ‘medicine’. A complementary effort sought to characterize ‘drugs’ as being those subject to misuse and abuse, and consequentially prohibition or strict control. By contrast, ‘medicines’ were those perceived to have legitimate therapeutic and ‘medicinal’ value and uses [ … ] That dichotomy – between pharmacologically-active substances considered legitimate (and therefore worthy of regulation as medicines, and also as public goods) and those considered problematic (and therefore deserving of moral and legal opprobrium, prohibition and sanction) – has informed global regulatory regimes for decades.¹

Even so, this has been keenly contested terrain, and fixed boundaries of meaning have long been inherently elusive. Although, in the nineteenth and twentieth centuries, normative thinking about drugs attempted to assert and to police neat divisions between lawful and deviant uses, consumers and commerce, these dichotomies have been continually unsettled in social and individual practice.

Historical perspectives bring to light the social processes through which bioactive plants, manufactured pharmaceuticals and techniques of treatment come to figure in diverse and changing human experiences, through experimentation and discovery, manipulation and use, and regimes of knowledge, circulation and regulation. They show how these processes are entangled with, and productive of, broader human relations of power and inequality, as well as relations involving non-human animals and the natural world. In the South African context, as in others, historical perspectives indicate some of the ways that colonialism, political economy, science and technology, expanding literacy and global connections (between a variety of differentially located actors) have transformed the conditions in which regimes of use and regulation have emerged and have been challenged.

Critical historical perspectives on drugs and treatments are especially urgent today, a period of expanding pharmaceutical invention, consumption and controversy. Substances are being subjected to renewed ontological scrutiny and debates about policy reform. Both nationally and worldwide, they are being disaggregated from the largely political category ‘drugs’ – through civic, medical and commercial initiatives. What is at stake in the intersecting phenomena of drug regimes today is supercharged by revolutionary new capacities of technology and global capitalism which, over the last two or three decades especially, have radically transformed the market conditions where molecule meets metabolism.²

This Special Issue of the South African Historical Journal presents six varied yet related articles which collectively deepen and broaden the southern African social, political and economic meanings of drugs, broadly defined. In this part of the world, scholarly research on drugs has largely focused on recent decades, responding to delays, stigma and scandals in provisioning of HIV treatment and to problems related to antibiotic-resistant tuberculosis. This collection of papers, however, considers cases of other socially significant medicaments, substances and practices across a broader swathe of time, drawing upon both established and innovative historical research methodologies. Taken together, these papers open up a chronology of changing relationships between chemicals and bioactive and/or psychoactive substances, on the one hand, and, on the other, the beings – human and animal – who consume them or to whom they are administered. Each article marks moments of key change in these relationships, and the public and private politics mediating their flows and consumption. All authors focus on local realities, actors and constellations of power, while also emphasising global connections and trends.

Articles may be productively read singularly and sequentially or, alternatively, according to historical period. Roughly, they fall into two broad tranches of time: the first three (by Andreas, Chattopadhyaya and Waetjen) reference the mid-1800s to, roughly, the 1920s; the final three (by Beinart & Beinart, Parle and Hodes) consider middle twentieth-century and even more recent histories of pharmaceutical compounds. While ranging widely in their focus and framing, they commonly reveal the uncertainties, struggles and circulations of drug knowledge, and competing claims of expertise to define a preparation or treatment as therapeutic or hazardous.

Early drafts were aired at the Wellcome Trust-supported workshop – entitled ‘Drug Regimes in Southern Africa: Regulation and Consumption in Twentieth Century Contexts’ – hosted by the History Department at the University of Johannesburg, 9–11 November 2017.³ We are deeply and ongoingly indebted to the University of KwaZulu-Natal School of Pharmacy’s Andy Gray, our keynote speaker and generous expert discussant, who made a major contribution to all discussion sessions on topics as varied as inoculating cattle and the hazards of bio-waste and pharma-trash; from thalidomide and cannabis to unregulated Nigerian herbal commodities. Thanks also to the workshop participants whose work does not appear in this issue but whose insights and discussion greatly enriched it: Kabir Abdulkareem, Chikosa Banda, Catherine Burns, Kyle Harmse, Ivo Mhike, Wendell Moore, Nonhlanhla Ndlovu, Musa Sadock, Jonathan Stadler and Samuel Umoh. We are grateful to Raymond Pogir of the Pharmaceutical Society of South Africa (PSSA), who hosted a visit by workshop participants to the PSSA Pharmacy Museum and Library in Johannesburg. Finally, our most heart-felt thanks to Arianna Lissoni for her patience and exceptional care in editing this special issue.

ORCID

Thembisa Waetjen http://orcid.org/0000-0001-8635-0949

Rebecca Hodes http://orcid.org/0000-0002-2502-803X

Notes

1 A. Gray, ‘Opening Remarks: Drug Regimes in Southern Africa: Regulation and Consumption in Twentieth Century Contexts’, unpublished Keynote Address at Drug Regimes Workshop, University of Johannesburg, 9 November 2017, 2.

2 D. Courtwright, The Age of Addiction: How Bad Habits became Big Business (Cambridge, MA: Harvard University Press, 2019).

3 Funded by Wellcome Trust Small Grant: UNS48138, 2017.