By Daniel Wolfe and Roxanne Saucier / ScienceDirect
The future of addiction treatment is biotechnological. A nearly forty-year drought in addiction treatment approaches has been followed in the past decade by a flood of technologies proffering new options for the opioid dependent. Study is underway on percutaneous nerve stimulation devices now approved to mitigate withdrawal symptoms, hapten conjugate vaccines being developed to block opioid receptors in one part of the body while allowing normal function in others, and neurosurgical implantation of electrodes to stimulate those areas of the brain associated with impulse control. We focus here on long-acting implants and injections because these are the first of the new treatment technologies to be prescribed in the U.S., offering insights into the range of issues associated with their use. Formulations now on the U.S. market include monthly naltrexone injections (Vivitrol); sustained release buprenorphine implants (Probuphine); and buprenorphine injections delivered monthly (Sublocade).
Madeline Akrich notes that new technologies come to be understood through social “scripts” about their use, determined through a complex dynamic between inventor, imagined users, actual user, and the qualities of technologies themselves. Rhodes and Lancaster argue for the study of new treatments not as fixed or stable, but rather as interventions in a process of “becoming” and shaped by the interplay between doctors, patients, and a range of other nonhuman factors such as diagnostic tools, clinical guidelines, intervention devices, and surveillance measures. While use and understanding of long-acting addiction treatment is still evolving, it is clear that scripts for these subcutaneous and subdermal technologies—or what Rhodes and Lancaster would term the “evidence making” process created through use of the new medicines—turn on old tensions between patient benefit and health system control.