Addiction and Disease Problematisation

Reiko Kanazawa, Beyond Global Postdoc

Image

If concepts of disease and health are fluid, how arbitrary are their responses? In light of recent debates on punitive responses to opioid over-prescription and addiction, my project on the intersection of international drug control and global health investigates this very question. From a global health governance perspective, when does addiction start being considered a disease: in other words, an actionable point of intervention for international and national bureaucracies? My work so far has found that for a multilateral health agency like WHO, conceptualising and responding to addiction as a disease is often limited by external factors, particularly institutional politics and bureaucratic boundaries. 

For instance, WHO was aware quite early in the post-war drug control regime that medicines could simultaneously be official prescription pain relief, sources of addiction and treatments for narcotic addiction. Indeed, as Figure 1 shows, WHO would test synthetic substances for evidence both of producing dependence behaviours and providing withdrawal relief. However, despite its health mandate, the agency was limited because it had to bridge member countries with very different attitudes and approaches to addiction.

Manufacturing nations ensured domestic pharmaceutical operations were not governed by any international authority. Even so, only some had achieved significant levels of bureaucratic interconnectivity between health bureaucracies, law enforcement and pharmaceutical companies, for instance Japan which requested WHO regulate ‘Spa’ in 1960 (Figure 1). In this case, WHO’s only role was to consider whether the substance required scheduling in international drug conventions.

In other cases, countries requested WHO’s support to document the scale of addiction problems: in other words, WHO became the first agency to ‘discover’ addiction in that context. Thus, in its field investigations, WHO would have to interview health officials and practitioners directly to get a general statistical grasp, rather than narcotics branches or other bureaucracies insisting there was no significant problem.

What does this mean for conceptualising ‘disease’ and ‘health’ from a global health governance perspective? I tentatively argue that international agencies frame a phenomenon as ‘disease’ only when it becomes overwhelmingly evident that a healing action is more efficient and productive: a kind of debt cancellation or collective social catharsis. ‘Disease’ and ‘health’ also provide a language with which to conceptualise the point and mode of an actionable intervention. At the same time, framing addiction as a disease must be a last resort, because it requires an international agency acknowledging the failures of country governments.