Making the Licit Illicit: Transforming Legal Medicines into Illegal Drugs through Categorical Discourse

Concern that licit medicines were being used illicitly

became prominent in 2007 when leading authorities in the federal government

announced that pharmaceuticals were the second “most abused illegal drug” among

young people in the US, behind only cannabis (ONDCP, 2007). Roy Bostock,

The Chairman of the Partnership for a Drug-Free America echoed these concerns when

commenting on a survey of prescription drug use among American youth:

For the first time, our national study finds that today’s

teens are more likely to have abused a prescription painkiller to get high than

they are to have experimented with various illegal drugs. In other words,

Generation Rx has arrived (Partnership for a Drug-Free America, 2005).

The advent of “Generation Rx” presents an opportunity to

examine how an emerging trend in drug use is framed as a problem. In part, the

artistic work of transforming licit medicines into illicit drugs is carried out

through categorical discourses and images created and circulated by several

stakeholders, including public health authorities, government drug control

agencies, and the news media. These discourses and images operate in the

following ways: they categorize all forms of nonmedical pharmaceutical use as

abuse; they equate nonmedical pharmaceutical use with the use of hard drugs,

and focus on one motivation for help: getting high.

Constructing All Forms of Nonmedical Pharmaceutical Use as “Abuse”

Recreational use of pharmaceuticals, along with other nonmedical forms of use, is labeled “abuse” through a categorical drug control discourse. Consider, for instance, the following characterization of illicit pharmaceutical use provided by the Office of National Drug Control Policy (ONDCP, 2007):

Nonmedical use, misuse, and abuse of prescription drugs are…defined … as the use of prescription medications without medical supervision for the intended purpose of getting high or for some reason other than what the medicine was intended.

Note the conflation in this definition: all forms of nonmedical use, misuse, and abuse become indistinguishable by being reduced to two essential features – all services that are not explicitly medically sanctioned and consciously directed at achieving pleasure. This conflation is operationalized in a manner that is familiar to any student of critical analyses of drug representations in the media (see Orcutt & Turner, [1983] for instance).

Conflating of nonmedical use, misuse, and abuse also occurs in US survey research. For example, drug surveillance systems, such as Monitoring the Future (MTF) and the National Survey on Drug Use and Health (NSDUH), typically provide raw data on behaviors that are labeled “use and misuse.” Thus, recent results from the MTF survey note that “the use of sedatives (barbiturates) fell steadily among 12th graders from the mid-1970s through the early 1990s” (Johnston, O’Malley, Bachman & Schulenberg, 2011:32), while the NSDUH reports that “in 2007, there were 2.5 million persons aged 12 or older who used psychotherapeutics nonmedically for the first time within the past year” (Substance Abuse and Mental Health Services Administration [MHSA], 2008:55). Note that neither source uses the word “abuse.” Data such as these, however, are then incorporated into various reports and media accounts where the same behaviors that were labeled “use/misuse” in original analyses are transformed into episodes of “abuse”. In this way, individual self-reports of nonmedical pharmaceutical use from surveys are aggregated into annual prevalence rates that, on the face of it, indicate alarming increases in the proportion of a population (usually young people) who entered the ranks of drug “abuse” over the last year. But by defining all nonmedical use in this way, even the once-in-a-lifetime experimenter is labeled a drug “abuser.”