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Opiate Users: Deserving and Undeserving?

Updated: Aug 30, 2023

In her second day as a Guest Blogger, Helen Keane of Australian National University examines how “niceness” and the lack thereof shape our understandings of heavy drug use.

In the previous post I discussed the distinction between dependence and addiction. Here I’d like to raise a few issues about the psychological/behavioural model of addiction developed in pain medicine. I’ve written about this topic with Kelly Hamill in this paper.[i]

In the context of pain treatment, opiates are not dangerous illicit substances but effective and safe analgesics appropriate for long-term use in selected patients.

The At-Risk & Predisposed Individual

Because the prescription of opiate drugs is central to its clinical practice, pain medicine has developed a definition of addiction which does not implicate drugs as the primary agents of addictive disorder.Instead it constructs addiction as a psychological disorder recognisable by the addict’s out of control behaviour, her drug-focused lifestyle and her destructive patterns of drug use. The prevention of addiction in the pain clinic therefore centres on the identification of certain “at risk” and predisposed individuals, including those with a past history of substance abuse. These risky patients require extra-vigilant monitoring and surveillance if they are to be prescribed opiate drugs. Clinicians must be alert to any aberrant or suspicious behaviour such as noncompliance, aggression, erratic appointments, doctor-shopping and stories of lost and stolen medication which may indicate the development of addiction. In contrast to the improvements in functioning seen in the compliant pain patient, the life of the addicted patient deteriorates. Therapeutic medical drug use has become harmful illicit drug use.

The concern is that this account of addiction easily becomes a reiteration of the common sense view of addicts as inherently devious, deceptive and prone to criminality.  By challenging the assumption that addiction is located in the properties of certain kinds of problem drugs, the behavioural model of addiction reinforces the belief that addicts are certain kinds of problem people.

The Deserving Pain Patient

Kirsten Bell and Amy Salmon have pointed out that the legal and regulatory sanctions surrounding opiates have created an environment in which pain clinics are “virtually required” to construct oppositional categories of “deserving pain patients” and “undeserving addicts.” [ii]  In order to protect the rights of pain patients to medical treatment, do addicts have to be demonised and marginalised (yet again) as the abnormal and aberrant– those dependent drug users who are outside the realm of medical compassion? I don’t think so. One of the noteworthy features of Siobhan Reynolds’ post was her depiction of the commonality and common interests of pain patients and addicted patients. Reynolds points out that both groups are denied proper treatment by the criminalisation of opiates and both suffer from the stigma of addiction which is “wholly man made.”

Up Next– Addiction and Pseudoaddiction


[i] ‘ Keane, H. & Hamill, K. Variations in addiction: The molecular and the molar in neuroscience and pain medicine’,  BioSocieties 2010, 5: 52-69.

[ii] Bell, K. & Salmon, A. (2009) Pain, physical dependence and pseudoaddiction: Redefining addiction for nice people? International Journal of Drug Policy, 20.


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