Happy New Year! Last September, I promised my editor that I would submit my revised manuscript by the end of 2022. Well, I just did and towards the end, I was so enjoying my time with the manuscript that I didn’t really want it to end. So I am starting off 2023 with some reflections on my book's message.
Boundaries of Addiction, Treatment, and Disease: Global Drugs Governance from Post-war to AIDS looks at the international drug control system through the eyes of the World Health Organization. It began during my PhD on the Indian AIDS response. I noticed that the public health response to HIV dealt with sexual transmission and with injecting drugs separately – my question was why. I interviewed doctors at the All India Institute of Medical Sciences and project leaders at the UN Office on Drugs and Crime Regional Office for South Asia. Through their accounts, supplemented by NACO Director Sujatha Rao’s 2017 Do We Care? and publications in medical journals, I learned how opioid substitution therapy (a harm reduction treatment for managing withdrawal) came to be included under India’s AIDS programme in the mid-2000s.
The book deals with the way substances have been treated differently depending on whether they are classified as narcotics or as medicines. As one might expect, laws and systems governing drugs were developed in response to certain crises, which then shapes the categorization of how useful or how harmful a certain substance is for the general public. But as historians of drugs who are also proficient in histories of medicine have been pointing out, like Nancy Campbell, Virginia Berridge, and Caroline Jean Acker, drugs are just chemical compounds. They have been developed in certain social contexts, they are used in certain social contexts, and they become problematic or helpful in certain social contexts. My book's core message is to show how substances are governed awkwardly between drug control and public health. Heroin or diacetylmorphine was made in a lab as a non-addictive alternative to replace morphine, but it became so widely abused that by 1953, WHO (at the UN’s request) requested member states whether they would be willing to prohibit it in medical use. The reason given was that there were plenty of synthetic analgesics pushed out by pharmaceutical industries to substitute heroin. At that time, most countries didn’t have well-developed safety and quality testing for pharmaceuticals, until the 1961 thalidomide disaster, wherein a tranquilizer marketed at pregnant women led to birth deformities.
At the same time, like all global developmental issues, international drug control deals with the same vagaries of international relations when it comes to agenda-setting through the treaties. Much of recent drug policy scholarship focuses on this, however, and so one of the key arguments of the book is that, to understand drug control in its entirety, we need to look at the spheres of international diplomacy (HQ, the treaties, the meetings of heads of state in Vienna) and the field interventions (the projects wherein IO field officers collaborate with national governments and local doctors) in tandem. Just as WHO and World Bank struggled to define their roles in AIDS prevention during the 1980s global economic recession, the UN drug control system has to strike the right balance between international and national controls. Moreover, ideology (war on drugs, harm reduction, and everything in between) is still quite important to drug policy discussions, due to how risky drugs are. Modern drug control began as an effort to control the commodity trade in opium between British India and Qing China but it soon evolved into something much bigger with the UN’s peace and development mandate after the Second World War. As a UN official noted in 1971, the law of supply and demand operated in full force in the narcotics field. I don’t think it’s a stretch to argue that narcotics control is one of the most important case studies of post-war international cooperation.
To celebrate submitting the revised manuscript, I’ll be uploading a mini-workshop series I hosted on 7, 14, and 21 April 2021 while I was in Edinburgh onto my personal YouTube channel. One of the speakers, Ray Brettle, was a doctor who encountered and mapped the outbreak HIV among injecting drug users in the early 1980s. I also interviewed him for the book and his account will be in chapter six on the HIV through injecting drug use response. Hopefully, I will have a final paper related to this project out soon, as an accompaniment to “Governing Drugs Globally” published in 2022 in the Social History of Alcohol and Drugs. This special issue paper “Addiction Consultants and Pharmacology Experts” looks at science diplomacy in two WHO and UN supported drug-related field projects in Thailand and India during the Cold War.
Making sure chapter subsections are smooth and read well
A very happy 2023 to all. I have a feeling it’s going to be a year I’ll be telling my grandkids about. I don’t know why I like writing about things that are difficult to trace: viruses, chemical compounds, and soon, international development financing – but I am very excited to get started. I hope everyone is getting sometime to rest and reflect :)