Opioids and fentanyl are a drug ‘power category’

Opioids and fentanyl are a drug ‘power category’

Fentanyl for saleThe EMCCDA and others (Duke, 2019; European Monitoring Centre for Drugs and Drug Addiction, 2019) have highlighted the rise of novel psychoactive substances (NPS) and one dimension of this upsurge in new drugs, previously little known drugs, and drugs previously largely restricted to medicinal use, is the rise of artificial opioids, fentanyl and its derivatives and benzodiazepines (‘benzos’). These drugs are frequently highly potent, and though sometimes are claimed and marketed as mimicking the effects of established drugs are often not analogous to them. Many are initially unknown in drug using cultures and must be adapted to shared cultural norms and understandings. That process puts them on a trajectory which can begin with initial interest and novelty, and later recognising the drug’s harms and side effects, redefining it as a dangerous drug of abuse (Bilgrei, 2016).

NPSs are defined as a public health threat in various ways, as a regulatory problem (Duke, 2019), and a contaminant in existing drug use cultures (Measham, 2020).  We should not automatically accept that it does it exist as a coherent category (Potter and Chatwin, 2017) and in fact consist of several distinct types which combine into different effects. There are performance and image enhancing drugs, recreational NPSs, and opioids and their derivatives. I separate these out as ‘power categories’ because they involve different demographics of users, different forms and pharmacokinetics of the drugs, and different modes of distribution and consumption contexts. Opioids and fentanyl are similarly new and not new. What is novel is the way they exist as a new power category, which locks down the multivarious ways opium functions into a narrow set of effects (Breger Bush, 2020). Ultimately the impact of opioids and fentanyl is to separate this new category from its supposed origin, the opium poppy. Though opioids mimic some of the analgesic qualities of opium, and operate on the same brain receptors, they have become a distinct ontological category marked by concerns about potency and addiction. Historically we can see the category come into being with the emergence of pain medicine during the 1970s. This was a concerted shift in the focus of medicine and of medical science which came to treat pain as an object which could be worked on and managed as part of medical practice (Bonica, 1991). New journals were founded, new directions for medical science and education were proposed, and new ideas of what pain was were proposed. A whole system of pain management emerged as medical practice and system of governance (Sherman, 2017).

Part of that history was the rise of pharmacological solutions, promoted fiercely by drug companies like Purdue (Quinones, 2016). Oxycontin came to be a default solution to pain – both physical and psychic – and the trigger for a new wave of addiction and drug related death that swept through North America (Hansen and Skinner, 2012). The drug came to be a part of white working class life and trauma, and once again changed its status as a political object. It was bound up with a number of existential threats – economic, social, and racial – which fundamentally altered the meaning and trajectory of white working class life in North America. As with other drug related panics this new regime misses out or diminishes the experiences of users who do not fit this discourse, who belong to other ethnic groups and/or are suburban or urban based (King, 2014).

In a literal sense they are a power category, as in, one which is especially potent in the mind and body of the user, and one which emphasises potency in discourse and use (Kennedy and Coelho, 2020). Potency has a double meaning: both positively powerful and because of that risky and dangerous. The ability of a drug to inscribe its history on the users’ body is a signal of its long term potency (Dennis, 2019). I argue that as opioids have come into the illicit drug market they have brought this meaning with them, and have shifted focus from users’ intoxicant experience with the drug to an emphasis on the drug as powerful and challenging. The drugs’ potency introduces new challenges: it becomes unstable, and is hard to titrate into a predictable dose (Broadhurst et al., 2020). The language around it reflects that: it is estimated to be orders of magnitude stronger that heroin or morphine, and has a high fatality risk.

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