Heroin Assisted Treatment (HAT)
HAT is ‘Heroin Assisted Treatment’, setting up supervised clinics where addicts can self inject Heroin that is prescribed. A recent BMJ article (ref 1) explains the evidence in favour of this ‘treatment’ benefiting those that have been ‘refractory’ to help with oral substitutes such as Methadone and accompanying psycho-social supports (e.g. Counselling for anxiety, stress, PTSD; and help with housing, debt management; and access to group work with people who have overcome a substance addiction – called Mutual Aid).
Implementation of HAT will be politically unacceptable under Capitalism
This account explores the problems of implementing such treatments within the culture of capitalism and a neoliberal de-regulated free market where ‘anything goes’. From a psychoanalytic perspective such de-regulation has caused a structure of the social-economy to emerge that is one of perversion, where the individual is now de-humanised ‘human capital’ that self consumes through consuming objects ”of pleasure’. (Ref 2) Such objects include the ‘medical test or treatment’. The administrators of such a culture – governing or sham-governing act like sadistic torturers – cycling between a) promising relief and b) blackmailing with pain. These elements are applied to the problem of HAT and its implementation.
Implementation is unlikely in a failed market based healthcare system.
Whilst the trial evidence in terms of societal costs and health benefits seems fairly solid in favour of Heroin Assisted Treatments for the ‘refractory and suffering addict’ the possibility of implementation faces a huge political barrier. The influential think tank ‘The Centre for Social Justice’ headed up by government minister Ian Duncan-Smith published ‘No Quick Fix’ in 2013 – this prepared the ground for Conservative policies to impose benefit sanctions on addicts (Heroin, Alcohol, even the Obese) who ‘refuse’ to access treatment. The report likens Methadone to providing vodka to an alcoholic instead of his preferred gin and tonic, and suggests sanctions and withdrawal of Methadone may, through the break up of families, homelessness and emotional breakdown, actually encourage engagement with treatment and ultimately, abstinence.
“Much of the system’s response to addiction remains to supply methadone to heroin addicts, a policy akin to supplying an alcoholic with vodka in place of his preferred gin. Methadone is an opioid (artificial opiate) invented in Germany which mimics some of the effects of heroin but without the ‘highs’. However, many abuse it, with some addicts selling their prescription to other addicts. It is a legal class A drug supplied to addicts through the public purse.” (p27)
“The CSJ has heard, however, that current reforms to the welfare system may be drawing a previously hard-to-reach group of addicts into treatment. For some addicts, a ‘nudge’ is required before they seek treatment. This can be the negative effects upon their own health, getting arrested, or the prospect of losing their children. The CSJ has also heard that for some who had refused treatment before, reforms to the welfare system under the current Government have led them to come forward for help with their addiction.” (p53)
This rhetoric of ‘abstinence’ or refusal of treatment is filtering into clinical work as substance use services are competing for tenders and cutting costs drastically. The likelihood of implementation of Heroin Assisted Treatment seems light years away.
The political move to the right and repressive attitudes to addicts is fuelled by the financial crisis and austerity. The market economic system has failed and leads to health inequalities. The addict is just one example of a subject compulsively ‘enjoyed’ by a market system based upon a discourse of self-sacrifice and the always failing satisfaction of chasing profit for profit’s sake. There is no longer any pretence of achieving social security for all. The chances of HAT being implemented may require a revolution in our political- economic system first.
Childhood Vaccinations in Australia
Another example of bio-politics in action is the recent announcement that the Australian government is planning to withhold welfare payments from families that do not have their children vaccinated.
The prime minister said that his government was “extremely concerned” about the risks posed to the rest of the population by families who chose not to immunise their children.
“The choice… is not supported by public policy or medical research nor should such action be supported by taxpayers in the form of child care payments,” Mr Abbott said in a joint statement with Social Services Minister Scott Morrison.
Again we have a ‘threat’ demonising a section of the population, ‘people who choose not to vaccinate their children’, and a sanction to protect ‘the taxpayer’. This is a bio-political act as with the intended plan in the UK to sanction addicts who fail to complete or access ‘treatments’ (and become abstinent). People are positioned as those who ‘must’ comply. A condition for being valued as a citizen opens you to blackmail, and this is justified in terms of the vague universal ‘threat’ you may pose, and in times of imposed austerity is framed as being especially justifiable in terms of being fair to the ‘taxpayer’. A parent’s choice for their child is now being managed by the state and The Law. Does the State feel free to do this because it is no longer restrained – the permanent crisis of capitalism, with the resultant evaporation of any prohibitions on State actions, leads to a need or drive for the state to ‘enjoy’ its citizens through mechanisms of promised ‘protection’ alongside sadistic punishments in the name of ‘necessary austerity. This becomes medical fascism.
It is possible to argue that medical interventions ….. are part of a structure like a see-saw – and always susceptible to the drives of a capitalist system that is always in crisis and is currently reacting to the 2008 financial crash with a rhetoric of austerity. See sawing between a rhetoric of credit and debt. Two opposing activities are taking place concurrently : and both act upon this object’s ‘access to medical investigations and treatment’: the drive is structured like a Lacanian structure of perversion wherein the subject has become ‘free’ as the master has evaporated into thin air, as the failure of capitalism has become apparent – especially given the Troika’s intransigence in relation to Greece’s permanent indebtedness. Thus access to medical investigations and treatment has become the object of enjoyment for its own sake, any ‘test’ will do. The pleasure (beyond that which will provide for physical survival) is the jouissance obtainable through providing the other with access to (and controlling) their access to jouissance. Thus, as with the sadist, of perversion, the subject the medical-technician has the Other, the ‘patient embodying the flesh to be tested, treated, (and sacrificed) has the patient at the mercy of his whims – jouissance is obtainable (for the medical-technician) by offering access to medical care: suggestive of a) offering ‘prevention of pain’, even at the same time as b) blackmailing the patient as a way of limiting access and causing pain.
This is line with the perverse structure of capitalism where ‘anything’ can be interchangeably needed enjoyed and used for the ‘flesh’ or ‘flash’ of jouissance it provides but nothing is desired for its own sake, for the promise of its desire for the subject. A horrible example might be the man ‘with everything’ who no longer desires love through the love of the other, but instead transgresses, and having lost his master and castration, is now driven by the need to ‘use’ or ‘enjoy’ prostitutes, or voyeurism or sadism and so on.
It is imaginable that such a man – too close to the object of enjoyment – becomes so free of any law that he makes his own law, as a banker selling high risk debts to the vulnerable, a pharmaceutical dealer hiding unfavourable trial results, or even a surgeon such as Ian Paterson assaulting healthy women with unnecessary breast excisions and perfecting inadequate excisions on women with breast cancer.
Drug users should be able to get heroin from the health system
2. Lacan and Debt, by Andrea Mura