City University of New York (CUNY) CUNY Academic Works All Dissertations, Theses, and Capstone Projects Dissertations, Theses, and Capstone Projects 9-2019 Illicit Psychoactive Medication Use: Experiences of Medicalization and Normalization Mark Pawson The Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/3320 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] ILLICIT PSYCHOACTIVE MEDICATION USE: EXPERIENCES OF MEDICALIZATION AND NORMALIZATION By MARK PAWSON A dissertation submitted to the Graduate Faculty in Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy, The City University of New York 2019 i © 2019 MARK PAWSON All Rights Reserved ii Illicit Psychoactive Medication Use: Experiences of Medicalization and Normalization by Mark Pawson This manuscript has been read and accepted for the Graduate Faculty in Sociology in satisfaction of the dissertation requirement for the degree of Doctor of Philosophy. Date Barbara Katz Rothman Chair of Examining Committee Date Lynn Chancer Executive Officer Supervisory Committee: Lynn Chancer Thomas DeGloma Brian Kelly THE CITY UNIVERSITY OF NEW YORK iii Abstract Illicit Psychoactive Medication Use: Experiences of Medicalization and Normalization By Mark Pawson Advisor: Barbara Katz Rothman This dissertation explores illicit psychoactive medication use among young adults. Overwhelmingly, the literature on this drug trend, particularly among this population, is grounded in a study of pathology. However, my research demonstrates that this obscures a significant portion of how youth practice and make meaning of their consumption of these controversial medications. The following phenomenologically based dissertation presents and unpacks the experiences, practices, and perspectives of young adults who illicitly consume psychoactive medications. Through analyzing 162 interviews of 18-29 year olds who report recent misuse of a prescription stimulant, tranquilizer, sedative, and/or opioid, I present the ways youth medicalize and normalize particular consumption practices and context. By taking seriously the ways youth experience these drugs in day to day life this phenomenological study highlights how youth construct socially responsible practices of illicit drug use. The focus and timing of this research is significant as it relates to gaining a more comprehensive social and cultural understanding of a well-known drug trend ubiquitously framed as one of today’s major social problems in U.S. society. iv TABLE OF CONTENTS 1. Introduction- p.1 2. Literature Background- p.9 3. Theoretical Background- p.34 4. Methodology- p.51 5. Constructing Problems and Solutions- p.56 6. Medicalization and Challenging Medical Authority- p.91 7. Drug Normalization- p.121 8. Conclusion- p.155 Appendixes 1. References- p.168 v Chapter 1- Introduction Much has been written about the history of mind altering drugs here in the United States. A great majority of this work has focused on studying drug addiction as well as various aspects of the war on drugs. Significantly less attention has been paid to analyzing some of the licit roles psychoactive substances play in American society. Medicines containing chemicals that affect the central nervous system rank among some of the most successful selling pharmaceuticals in U.S. history. However, the market for psychoactive pharmaceuticals has been notably volatile and the labelling of many of these medications as social problems has at times led to steep declines in production, popularity, and sales. Institutions like the American Medical Association (AMA), the Centers for Disease Control and Prevention (CDC), the National Institute of Health (NIH), as well as the President of the United States, and the U.S. congress have all at one time or another made claims that pharmaceuticals containing substances like cocaine, cannabis, alcohol, opioids, amphetamines, barbiturates, or benzodiazepines are socially problematic. Many federal laws have been passed in hopes of controlling these substances and limiting the social problems they may cause. For instance, the Harrison Narcotics Tax Act, the Volstead Act, and the Controlled Substances Act have all sought to limit the availability of these drugs. Furthermore, institutions like the Federal Drug Administration (FDA), the National Institute on Drug Abuse (NIDA), the Office of National Drug Control Policy (ONDCP), and the Drug Enforcement Administration (DEA) have been created to monitor and control the production and consumption of many of these substances. 1 Despite these laws and those agencies tasked with enforcing them, psychoactive medications remain among the most popular and top selling medications on the U.S. market. Sales for prescription stimulants and sedatives have more than doubled and the sale of prescription opiates has more than tripled since the 1990’s (SAMHSA, 2015). As with past booms in psycho-pharmaceutical sales, these medications popularity has been met with controversy as the illicit use of these medications has come to be labelled by health organizations and government institutions as a social problem. Concerns regarding the increasing availability of these psycho-pharmaceuticals are primarily not problematized in and of themselves, but only in their relation to corresponding rates of their “misuse”. The misuse of these medications has been defined by NIDA as using them in ways other than those specifically prescribed to you by your doctor for a medical condition (NIDA 2016). This may include using psychoactive medications obtained from a non-medical source, using more than the prescribed dose, as well as using them for a recreational purpose. Important to medical definitions of misuse is the distinction that misuse can occur whether or not one has a prescription for a particular psycho- pharmaceutical. According to this definition, the most recent National Survey on Drug Use and Health claims that 15 million Americans age 12 and up reported misusing a psychoactive prescription drug at least once in the past year with an estimated 6.5 million having done so as recently as the past 30 days (SAMHSA 2015). Placed in the larger context of illicit drug use in the U.S., more people report the illicit use of a psychoactive pharmaceutical than use cocaine, heroin and methamphetamine combined (DEA 2017). In fact, psychoactive medication misuse is second only to marijuana when it comes to illicit drug use. As all practices of psychoactive misuse are in fact illicit drug behaviors, these two terms “misuse” and “illicit use” will be used interchangeably throughout much of the dissertation. 2 Similar to rates of drug use overall, rates of illicit psychoactive medication use have consistently been found to be highest among young adults. The most recent national data continues to report that they are twice as likely to engage in this behavior when compared to their counterparts in other age cohorts (SAMHSA 2015). Subsequently, youth also experience high rates of negative consequences associated with the illicit consumption of psychoactive medications. In 2014, nearly five young adults died each day from prescription drug overdoses, outnumbering those for both heroin and cocaine combined (SAMHSA, 2015). Deaths from psychoactive pharmaceutical overdose now also outnumber those killed in auto accidents (CDC 2017). For every death due to overdose 119 youth were sent to the emergency room and 22 entered some form of addiction treatment (SAMHSA DAWN 2014). While these rates dwarf the numbers of older adults overdosing and seeking addiction treatment for prescription drug misuse, their numbers are increasing (Scholl et al. 2018). As youth represent a high risk group for illicitly consuming psychoactive medications, they also represent a group whose involvement in this drug trend commands a lot of attention from media, law enforcement, politics, and public health. In fact, most all forms of substance use have been commonly framed as a social problem when engaged in by youth (Ferrell et al. 2004; Ferrell and Websdale 1999; Young 1972). However, drug scholars increasingly note the significance of recreational drug use among young adults as a common and unremarkable feature of their leisure time activities (Duff 2005; Measham and Shiner 2009; Parker, Aldridge and Measham 1998; Pennay and Moore 2010). These drug normalization scholars note that the transitional life cycle of young adulthood in late modern societies results in the deferment of many adult milestones for many youth. As such, they claim that time spent within leisure spaces become important sites within which youth accumulate different valued forms of social and 3 cultural capital (Measham, Aldridge and Parker 2001; Parker, Aldridge and Measham 1998). It is within this context of leisure, recreation, and pleasurable consumption that drug use emerges as a normalized aspects of young adult’s lives. While studies have yet to specifically analyze the normalization of psychoactive medication misuse among young adults, the concentration of prescriptions and corresponding high rates of illicit use among this particular generational cohort reveal a need to better understand how youth make meaning of these medications within their day to day lives. The vast amount of academic research studying