Od: Naloxone and the Politics of Overdose

by Nancy D Campbell

The history of an unnatural disaster--drug overdose--and the emergence of naloxone as a social and technological solution.For years, drug overdose was unmentionable in polite society. OD was understood to be something that took place in dark alleys--an ugly death awaiting social deviants--neither scientifically nor clinically interesting. But over the last several years, overdose prevention has become the unlikely object of a social movement, powered by the miracle drug naloxone. In OD, Nancy Campbell charts the emergence of naloxone as a technological fix for overdose and describes the remaking of overdose into an experience recognized as common, predictable, patterned--and, above all, preventable. Naloxone, which made resuscitation, rescue, and "reversal" after an overdose possible, became a tool for shifting law, policy, clinical medicine, and science toward harm reduction. Liberated from emergency room protocols and distributed in take-home kits to non-medical professionals, it also became a tool of empowerment.

After recounting the prehistory of naloxone--the early treatment of OD as a problem of poisoning, the development of nalorphine (naloxone's predecessor), the idea of "reanimatology"--Campbell describes how naloxone emerged as a tool of harm reduction. She reports on naloxone use in far-flung locations that include post-Thatcherite Britain, rural New Mexico, and cities and towns in Massachusetts. Drawing on interviews with approximately sixty advocates, drug users, former users, friends, families, witnesses, clinicians, and scientists--whom she calls the "protagonists" of her story--Campbell tells a story of saving lives amid the complex, difficult conditions of an unfolding unnatural disaster.

Genres: Nonfiction

424 pages, Hardcover

Published March 3, 2020

Reviews

[Dominic Piacentini · Rating 4 out of 5]

An insightful, if laborious, history of naloxone and its position as a "technological artefact" bound up in politics, culture, and social relations. Campbell reiterates that naloxone is "more than medicine." She presents it as a unique technology of solidarity with a long history and spanning social words as divergent as the global harm reduction movement and the carceral, medico-legal surveillance state that necessitated its wider distribution in the first place.

Take-home naloxone offers those who use drugs a path toward skirting the violence of law enforcement, stigma-ridden EDs, and compassion fatigued first responders. But it also positions those who use drugs into a neoliberal, public health "responsibilization" that places the onus of preventing death on people who use drugs and harm reduction organizations. "Overdose is not a contagious, infectious, chronic disease. Nor is it a natural disaster. It is a human made disaster exacerbated by denial and disavowal of responsibility by those who structured and maintained distinctions between legal and illegal drugs, 'patients' and 'addicts,' and physiological and existential pain."

How naloxone survives as a technology of harm reduction and social solidarity going forward is the question at the heart of this book, as it is poised to become a new medical commodity with the approval for OTC availability and as naloxone distribution is increasingly incorporated into economical and audit-based State efforts to prevent death.

Personally worthwhile here, as an anthropologist engaged in such efforts, were the reflections on the "science of overdose" and the knowledge problems inherent to tracking and understanding drug-related deaths. The book is impressive, but Campbell's thesis came a little late and could have been improved by a more judicious editor and 75–100 fewer pages.

[Amber · Rating 4 out of 5]

Complex and meticulously research exploration of overdose and Naloxene within the US and UK contexts. In some ways this is a social history of the collective work it took to bring tools like Naloxene and Narcan into public use. It was surprising to learn that these tools have been available since at least the 70s and just how controversial they were - it speaks to the dominant perceptions of drug users and their seeming "worth" in society. It really did take the user groups coming together - yes, government was involved in ultimately normalizing Narcan, but it was drug users who approached the situation without judgment and with a more realistic view towards harm reduction.

I kept expecting Campbell to discuss the opiate epidemic experienced here in the US and she did lightly touch on it, but heroin was the primary focus. Just from my own experience, it seems public perception has come around to these harm reduction tools because of our collective awareness of opiates, so there was room for more of a discussion related to those specifically. I did appreciate her discussion regarding moral hazard and the provision of Narcan - though again, it came in the last chapter, when it was a common theme throughout the book.

Overall, super intense review of the politics and provision of Narcan and other lifesaving tools over the last 50 years. It's shocking how these tools have become so normalized as to be unseen, taken for granted. At my place of work supplies have been available for a couple years and no one sees them, no one understands what a seismic shift in public health and public consciousness it has taken to put these life saving tools in our hands. The democratization of life saving tools is something we are already taking for granted and that's infuriating to some extent.

Get trained, do a google search for the SCARE ME protocol, and be mindful of the tools available.

[Cherry · Rating 3 out of 5]

May-Dec. That’s how long it took me to slog through this book. But I was determined to finish. If you like reading textbooks- this ones for you! There’s a really fascinating US and Euro history presented here. I did indeed learn quite a bit, it was just rough for me to get through it. If you really like to think about data, data ethics, data quality you will like a few chapters. The first half of the book presents quite a bit of history of Naloxone, most of it I hadn’t known and most of it left me feeling grateful we are no longer in the same place with it’s use and application (For example, it’s historical, punitive use for “proof of use”). Good shout out to Dan Biggs. A really good shout out to many of the underground, grassroots, and zine loving community who truly have been unsung heroes for decades.

[C]

A great and current discussion of overdose, mostly focusing on naloxone. Quite academic, but useful for anyone working in this space. Much more than the history of a medication or of public health interventions-- deep and illuminating discussions about who we call addicts, use of science to explain addiction, racial politics in addiction, what "harm reduction" means, much more.

[Monica · Rating 3 out of 5]

3.5 stars for me. Would agree with others that, while this book is thoroughly researched and while the topic is so important, it was a bit of a slog to get through. Big props to the author, though, for tackling such an important subject and for presenting such a comprehensive history.

[Lindsey · Rating 5 out of 5]

Fascinating history of opioids and overdose in the US and the emergence of naloxone. Unfortunately for some, this is more of a textbook read so it is a slower more detailed read