Opiate substitution treatment: Poisoned bodies and the history of substitution

摘要

The practice of substituting one drug for another has arguably become a taken-for-granted feature of contemporary responses to heroin dependency in Britain. Substitute prescribing has, however, recently come under attack from various commentators both inside and outside of the drug treatment system. The general tone of the argument is that problem drug users who are dependent upon heroin are entering the drug treatment system and are simply being "parked on methadone." In order to shed new light on this particular drug treatment intervention, this article will use the genealogical method to map out the historical conditions from which it became rational and necessary for medical experts to govern the heroin-dependent body through the practice of substitute prescribing. The principal thesis of this article is that substitute prescribing can be understood as an outcome of a convergence between the discursive fields of poisoning and addiction during the latter half of the 19th Century. This way of thinking and acting upon the heroin-dependent body as a poisoned object has had a lasting and significant impact upon the way we think about and respond to heroin withdrawal through the practice of substitute prescribing.