Paper short abstract:

In my ethnographic study of Pike and Wayne Counties, participants view users, especially Whites addicted to prescription drugs, as both actors in and victims of their addiction. They refuse harm-reduction strategies in fear of attracting more use, removing users’ agency over their own health.

Paper long abstract:

This paper exposes results of my ethnographic study of Pike and Wayne Counties to demonstrate how residents conceptualize the responsibility of people with addiction, of the medical field, and of the government in responding to increased drug-related mortality rates. Participants confirmed findings by Campbell (1995, 2000, 2007) which suggested that users are considered untrustworthy and unreliable actors deprived of agency, rendering harm-reduction strategies incoherent as they rely on personal responsibility.

Participants sympathized with users—especially, if not uniquely, those addicted to prescription opioids, mirroring Becker (1963) and Lindesmith (1947)’s canonical studies demonstrating differential understandings of “criminals” and “patients” suffering from an illness depending on whether the drug used was illicit or pharmaceutical—but reaffirmed their stigmatization, given participants’ beliefs about drug use’s dirtiness and criminality. Residents have refused locally-proposed drug-exchange and rehabilitation centers in fear of attracting more users. State and federal Naloxone-distribution programs were suspected of leading to increased use, mirroring the 1988 Drug Abuse Act’s logic that forbid federal funding for needle-exchange programs.

While participants did not immediately associate drug use with Blackness—perhaps due to the counties’ demographics (89.3% and 94.3% White) and overdose statistics (80.7% and 90.8% White)—and they admitted that addiction can affect any socioeconomic category, intersections of race and class altered participants’ perspectives. Participants often imagined users as Whites in situations of poverty, associating them with poor decision-making, low will-power, and other characteristics linked to the “poor, White trash” stereotype, ripe itself with connotations of dirtiness, criminality, and immorality since the mid-19th century.