Dr Fay Dennis: CDP Early Career Researcher Keynote
‘Mobilising stasis: A critical orientation to change’
Change is not necessarily progressive, productive or good. In drug treatment, change is often constructed in rigid ways, involving a devaluing or ‘giving up’ of the current self – as one of my research informants recently put it, to declare oneself a ‘piece of shit’ – in order to be re-formed anew, away from drugs. Indeed, much of the new recovery movement, at least in the UK, has been galvanised around the figure of the ‘stuck’ drug user.
Tracing this politics of change through my research with people who consume opioids, I will pay attention to ways of being-with drugs that resist change, and indeed value a certain stasis in ‘holding together’, ‘becoming normal’ or simply ‘living well with drugs’. Rather than rejecting these modes of being as constraining forces that draw their power from elsewhere (e.g., neoliberal functionality), delimiting what a person can or should be, I will explore how they derive their meaning and power from inside the drug-using event. In doing so, I consider the benefits of understanding this ethico-politics from within these events, so that we can start to take seriously how a demand for stasis may also be a generative act of empowerment.
Staying with these events, I aim not only to build a conception of change that can incorporate stasis, but one that does so because it comes from situated and relational ways of knowing and being. As a rebuttal to a world that necessitates speed and a treatment system that requires new ways of being, mostly without drugs, and increasingly as a prerequisite for payment (by results), I’ll ask what a slowing down might do (Latimer, 2019; Stengers, 2018). In other words, I will ask, what can we learn from becoming a little bit more stuck? How can we make sense of, and pay attention to, participants’ wishes to continue using drugs even though it is not always socially, legally or even physically desirable? By decentring the persistent focus on the future, I ask how we might engage with people’s current modes of acting, feeling and thinking to develop more responsive treatment, policy and scholarship.
Dr Fay Dennis is a Wellcome Trust Research Fellow in Social Science and Bioethics in the Department of Sociology at Goldsmiths, University of London. Her work explores the socio-material constitution of drug use and drug-related effects through ethnographic and inventive methods. Her latest project investigates the rise in deaths involving opioids in the UK. Dr Dennis has published in Critical Public Health, Contemporary Drug Problems, International Journal of Drug Policy and Journal of Media and Culture, and recently co-edited a themed collection on ‘Drugged pleasures’ for the International Journal of Drug Policy. Her forthcoming book, entitled Injecting Bodies in More-Than-Human Worlds, will be published in 2019 in Routledge’s Sociology of Health and Illness Series.
Associate Professor Natasha Martin
‘Rethinking hepatitis C treatment and prevention: How modelling is informing the change required to achieve elimination among people who inject drugs’
The advent of highly-effective direct-acting antiviral therapies for the hepatitis C virus (HCV), coupled with theoretical modelling of the potential population impact of these therapies, sparked a dramatic shift in approach towards people who inject drugs (PWID). Reluctance among some providers and governments to treat PWID was replaced with optimism that HCV treatment for those with ongoing risk could prevent transmission and achieve dramatic reductions in disease burden and incidence. For example, modelling indicated that the World Health Organization elimination target of 90% reduction in incidence could likely be achieved among PWID across a variety of settings through modest levels of treatment, particularly in combination with harm reduction. This work has and continues to catalyse policymakers to commit to scaling-up treatment and harm reduction interventions among PWID in several settings worldwide. Despite this global commitment, challenges remain which hamper effective treatment and prevention responses among PWID. Indeed, major health system and policy changes are likely to be required if countries are to reach their elimination goals.
This presentation will discuss several key areas in which modelling has played or is playing a role in advocating or galvanizing change in the arena of HCV elimination, and in advancing the primacy of PWID in related policy and clinical and other service models. It will highlight how modelling has informed much-needed change in: harm reduction policy and coverage, enhanced strategies for HCV diagnosis and linkage to care, broad access to treatment and retreatment for PWID, new models of HCV care and treatment delivery, and policy around drug use and decriminalization. The presentation will provide examples where modelling has been used to advocate for change in policy/service provision/health systems organization, increase funding for HCV prevention and treatment interventions, and inform changes in attitudes surrounding PWID with the eventual goal of HCV elimination. The presentation will also consider how modelling might have changed as a result of this work, and how modelling constraints might affect the knowledge being sought and generated, and in turn the treatment goals being set and pursued.
Natasha Martin is an Associate Professor in the Division of Infectious Diseases and Global Public Health at the University of California San Diego, and an Honorary Senior Lecturer in the School of Population Health Sciences at the University of Bristol. She is an infectious disease and economic modeller, with a particular focus on epidemic modelling of blood-borne virus transmission among high risk populations such as people who inject drugs, men who have sex with men and female sex workers. A/Prof Martin is a leading modeller of hepatitis C prevention and elimination, and her modelling work has informed several national and global technical guidelines and strategies (e.g. World Health Organization). She has a particular focus on modelling the impact of structural determinants of HIV, HCV and overdose risk such as drug criminalization and incarceration. She is currently working on HCV elimination trials and studies locally (San Diego) as well as in a number of countries abroad such as Myanmar, Australia, India and the United Kingdom.
Associate Professor Kate Seear
‘On law’s fragility, onto-advocacy and the possibility of change’
Achieving major changes in approach to drugs and the people who consume them sometimes feel elusive, partly because of the persistence of punitive drug laws. Apart from a few well-known examples, such as reforms to laws in Portugal and Canada, most countries continue to criminalise drug consumption and/or persist with the ‘war on drugs’. Advocates who are inspired by countries that have reformed their laws often highlight the importance of the political process in bringing about changes in the lives of people who use drugs.
Emphasising legislation and the political process has costs, however, potentially distracting attention from the multiple ways legal content is made and sustained, including through practices of lawyering. Lawyers play a vital and hitherto underappreciated role in constituting ‘legal truths’ about drugs and ‘addiction’, including links between addiction, gendered violence and poverty. They do this through practices including legal advocacy in lower courts and tribunals and negotiations with other lawyers. Latourian scholar Kyle McGee (2015) has emphasised the centrality of legal practices to legal content, noting that legal truth is ‘fragile and constantly renegotiated’. Bruno Latour has similarly underscored law’s fragility, noting that ‘its span is just as striking as its emptiness’ (2015: 343).
This presentation explores these issues, drawing upon data collected for a major international study on addiction in the law, including interviews with lawyers and judges, analyses of case law and legislation. I shed light on how law is made, highlighting the importance of articulations and connections in producing legal content. I argue that legal content can be made anew if different connections are articulated. In this sense, the law is more fragile than we might assume. This presents opportunities for remaking law, and the subjects and objects shaped by it.
On this final point, I introduce the concept of ‘onto-advocacy’ – an approach that combines ideas from the ‘ontological turn’ in alcohol and other drug studies with critical approaches to legal ethics. I argue that lawyers might consider deliberately leveraging law’s ontological fragility, and rethinking their advocacy practices in light of the power they hold to constitute objects, subjects and outcomes.
Kate Seear is a practising lawyer and Associate Professor in the Faculty of Law at Monash University. She previously held a prestigious Australian Research Council DECRA Fellowship (2016-2019), and is the author of numerous books, articles and reports on alcohol and other drug policy and law, family violence, human rights and stigma. Her books include Law, Drugs and the Making of Addiction: Just Habits (2019, Routledge) and Making Disease, Making Citizens: The Politics of Hepatitis C (2011, Ashgate, with Suzanne Fraser). Her research is socio-legal and empirical in nature and draws upon a diverse range of theoretical tools, including ideas from science and technology studies, feminist theory, queer theory and critical legal ethics scholarship. A/Prof Seear’s research has led to major law reforms across Australia, including changes to laws that will improve the lives of victims of crime who also use alcohol and other drugs, and laws that shape the transmission and prevention of hepatitis C. She was previously a Research Fellow in the Social Studies of Addiction Concepts program at the National Drug Research Institute, where she retains an adjunct role.