Ill and against the Law: The Social and Medical Control of Heroin Users

Abstract

This discussion focuses on the criminalization and medicalization of heroin users in the United States in two historical periods: the late teens to early twenties, and the late sixties to early seventies. Comparative analysis reveals that while different social circumstances have stimulated specific state responses, class and ethnic patterns of drug use have played a leading role in shaping overall policy. Continuous clashes and adjustments between licit and illicit markets have reflected deeper economic and ideological conflicts. The essence of official policy, whether under a public health or a criminal justice rubric, has been the attempt to effect a real and symbolic order. Claims to the contrary notwithstanding, the advocates of reform and of the medical approach to addiction have accommodated more than they have challenged law enforcement. Doctors' professional interests and the uses of medical rhetoric to justify state policy have changed, but the control aspects within the medical model stand out sharply. This analysis of the limits of conflict and structures of resolution between specific heroin policymakers draws on an appreciation of more general political, economic, and social forces which shape the interplay of “deviance” and the official reaction to it. This theoretical orientation departs from the leading paradigms in the sociology of drug control developed within labelling and interest-group frameworks.