Shifting blame: Buprenorphine prescribers, addiction treatment, and prescription monitoring in middle-class America

Sonia Mendoza, Allyssa S. Rivera-Cabrero, Helena Hansen

    Research output: Contribution to journalArticlepeer-review


    Growing nonmedical prescription opioid analgesic use among suburban and rural Whites has changed the public's perception of the nature of opioid addiction, and of appropriate interventions. Opioid addiction has been recast as a biological disorder in which patients are victims of their neurotransmitters and opioid prescribers are irresponsible purveyors of dangerous substances requiring controls. This framing has led to a different set of policy responses than the "War on Drugs" that has focused on heroin trade in poor urban communities; in response to prescription opioid addiction, prescription drug monitoring programs and tamper-resistant opioid formulations have arisen as primary interventions in place of law enforcement. Through the analysis of preliminary findings from interviews with physicians who are certified to manage opioid addiction with the opioid pharmaceutical buprenorphine, we argue that an increase in prescriber monitoring has shifted the focus from addicted people to prescribers as a threat, paradoxically driving users to illicit markets and constricting their access to pharmaceutical treatment for opioid addiction. Prescriber monitoring is also altering clinical cultures of care, as general physicians respond to heightened surveillance and the psychosocial complexities of treating addiction with either rejection of opioid dependent patients, or with resourceful attempts to create support systems for their treatment where none exists.

    Original languageEnglish (US)
    Pages (from-to)465-487
    Number of pages23
    Journaltranscultural psychiatry
    Issue number4
    StatePublished - Aug 1 2016


    • buprenorphine
    • opioid maintenance treatment
    • prescription monitoring programs

    ASJC Scopus subject areas

    • Health(social science)
    • Psychiatry and Mental health


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