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International Journal of Drug Policy 20 (2009) 450–452

Contents lists available at ScienceDirect

International Journal of Drug Policy

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Review essay

Foucault on methadone: Beyond biopower

Helen Keane ∗

School of Humanities, Australian National University, Canberra, ACT 0200, Australia

a r t i c l e i n f o

Article history:

Received 1 October 2008

Accepted 18 October 2008

Keywords:

Methadone

Treatment

Foucault

Biopower

a b s t r a c t

This essay reviews four texts which critically analyse methadone maintenance therapy using Foucault as

a key theoretical framework: [Friedman, J., & Alicea, M. (2001). Surviving heroin: Interviews with women in

methadone clinics. Florida: University Press of Florida], [Bourgois, P. (2000). Disciplining addictions: The

bio-politics of methadone and heroin in the United States. Culture Medicine and Psychiatry, 24, 165–195],

[Bull, M. (2008). Governing the heroin trade: From treaties to treatment. Ashgate: Aldershot], and [Fraser, S.,

& valentine, k. (2008). Substance & substitution: Methadone subjects in liberal societies. New York: Palgrave

Macmillan]. Taken together these works demonstrate one trajectory in the development of critical drug

studies over the past decade. While all four view MMT as a regulatory technology which aims to create

productive and obedient subjects, their understandings of the power relations of the clinic are quite dis-

tinct. The first two texts emphasise the social control of drug users, the third, issues of governmentality

and liberal political practice, while the fourth engages with ontological questions about substances them-

selves. Thus while Foucauldian analysis has become familiar in social studies of drugs and alcohol, new

uses for its conceptual tools continue to emerge.

© 2008 Elsevier B.V. All rights reserved.

From his early reputation as a very French anti-humanist who

threatened the foundations of social research, Foucault has become

a familiar presence in Anglophone health studies. In critical analy-

ses of drug and alcohol policy, research and treatment, the concepts

of disciplinary power, biopower and governmentality have proved

enormously productive. These conceptual tools have enabled cri-

tique to expand from a consideration of problem drugs to the

construction of drugs as a problem, from how to treat addicts and

users to the constitution of ‘the addict’ and ‘the user’ as medico-

legal subjects (Duff, 2004; Keane, 2002; Miller, 2001; Valverde,

1998).

As Foucauldian modes of thought have become well-established

in the drug field, significant differences within the genre have

become apparent. This essay reviews four texts which examine

methadone maintenance therapy (MMT) and thereby highlights

one trajectory in the development of critical scholarship on drugs.

The first text discussed is an article from Culture, Health and Psy-

chiatry, ‘Disciplining addiction: The biopolitics of methadone and

heroin in the United States’ (Bourgois, 2000) and the second is a

book specifically on MMT, Surviving heroin: Interviews with women

in methadone clinics (Friedman & Alicea, 2001). These earlier texts

use the notion of disciplinary biopower to present MMT as an

oppressive attempt to produce docile bodies. The two more recent

∗ Tel.: +61 2 6125 2734; fax: +61 2 6125 4490.

E-mail address: Helen.keane@anu.edu.au.

texts are Governing the heroin trade: From treaties to treatment (Bull,

2008) and Substance and substitution: Methadone subjects in liberal

societies (Fraser & valentine, 2008), a book which I first read and

discussed with the authors as an unpublished manuscript. These

works employ more complex understandings of power, focusing in

the first case on the governmentality of drug prohibition, and in

the second, on an analysis of methadone as a material and socio-

cultural phenomenon.

Disciplinary power and social control

‘Disciplining addiction’ and Surviving heroin both construct

MMT as a pernicious and intense exercise of disciplinary biopower,

an attempt by a hostile state to control ‘unruly misuses of pleasure’

and reform ‘unproductive bodies’ (Bourgois, 2000, p. 165). In his

characteristic take-no-prisoners style, Bourgois contrasts the med-

ical discourse of methadone as an effective treatment for addiction

with the debilitating effects of methadone addiction experienced

by his informants. Primo, a former crack house manager who had

sniffed heroin and cocaine for years without becoming addicted,

is incapacitated by methadone. His self-respect is destroyed by his

dependency on the clinic and his relationships collapse because

of the drug’s effects. The ‘byzantine’ rules and invasive surveil-

lance practices of the clinic foster alienation and mistrust (p. 175).

Bourgois reports that methadone addicts are at the bottom of drug

user hierarchies, looked down on by ‘institutionally autonomous’

street-based addicts (p. 180).

0955-3959/$ – see front matter © 2008 Elsevier B.V. All rights reserved.

doi:10.1016/j.drugpo.2008.10.005

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H. Keane / International Journal of Drug Policy 20 (2009) 450–452 451

The account of Primo’s transformed subjectivity produces a

binary structure in which life on the street represents freedom

while enrolment in the clinic represents capitulation and control.

While this narrative provides a dramatic and damning account of

drug treatment, it presents biopower as much like the unified, uni-

directional, and repressive force that Foucault’s work resolutely

problematised. While Bourgois makes powerful use of the con-

cept of biopower to reveal the disciplining of bodies which takes

place in the methadone clinic, he does not extend his analysis to

the technologies of self that are also produced by its regimes.

A similar social control paradigm frames the account of MMT in

Surviving heroin, in this case combined with a commitment to nor-

mative feminist politics. This text is based on ethnographic research

carried out in the early 1990s in three US methadone clinics. The

authors emphasise the historical context of their subjects’ experi-

ences. Most of the women began using drugs during the 1960s and

1970s, influenced by the ideals and style of the hippie movement.

The historical narrative supports the construction of the women’s

heroin use as a form of resistance to patriarchal values and the lim-

itations of femininity. While heroin ultimately fails to deliver the

freedom and pleasure the women are seeking, Friedman and Alicea

interpret illicit drug use as a proto-feminist enactment of agency.

However, while the authors use a feminist model of oppression

and resistance to understand the lives of their informants, they turn

to the concepts of disciplinary power and governmentality in their

analysis of ‘Life on the clinic’. Like Bourgois, they constitute MMT

as a disciplinary apparatus which aims to create ‘safe deviants and

docile bodies’ (2001, p. 130). They argue that the clinic, with its

multitude of rules about space, time and conduct, aims not only to

reform the women’s drug use, but also to instil conformity to tradi-

tional gender roles (p. 152). But in contrast to Bourgois, Friedman

and Alicea do not produce the illicit drug subculture as a space of

relative autonomy, rather they observe that ‘its social world mir-

rors [the women’s] experiences in conventional society of being

devalued and regulated to a low status’ (p. 118). The women are

oppressed by male partners and pimps just as much as they are by

state agencies and services. The outside of power in this analysis is

inside the self, it is a proto-feminist core which enables the women

to negotiate individual life stories despite the powerful discourses

which classify them as worthless (p. 170). In an examination of

critical pedagogy, Ian Hunter describes Foucault being ‘effortlessly

absorbed into the progressive emancipatory project’, his account

of the prison and the classroom serving simply to enhance cri-

tiques of hegemonic ideologies (1996, p. 144). In a similar way,

Foucault has been used by Friedman and Alicea to add a ‘microana-

lytics’ of bodies and conduct to their indictment of the institutional

and medical power of the clinic, without disrupting their vision of

female resistance.

Drugs, government and phenomena

As a genealogy of the international drug control system, Melissa

Bull’s Governing the heroin trade has a more sustained Foucauldian

framework. Its measured style contrasts with the frank political

engagement of Disciplining addiction and Surviving heroin, as does

its focus on national and international strategies rather than the

experiences of individuals. With meticulous care it examines the

‘conditions of possibility’ for drug control, highlighting the contin-

gency of the relationships that have produced the current system

and its range of techniques (p. 11). Unlike Bourgois and Friedman

and Alicea, Bull locates her research firmly within the field of neo-

Foucauldian governance studies, citing scholars such as Mitchell

Dean, Nikolas Rose, Barry Hindess and Pat O’Malley. She addresses

MMT as a case study of demand reduction, analysing the network

of legal governance which enables and regulates the prescription of

methadone. The governmentality framework produces a less bifur-

cated vision of biopower: prescribers and dispensers as well as

clients appear as regulated subjects within the bureaucratic system

of MMT.

Bull’s analysis also highlights the contradictory nature of MMT.

On one hand it can be understood as a neo-liberal form of gover-

nance which enlists users as ‘responsible choice-makers’ capable of

risk management (p. 143). But on the other hand, as Bourgois and

Friedman and Alicea vividly highlight, MMT has decidedly unliberal

elements which constrain client choice. Bull argues convincingly

that MMT operates by differentiating between clients requiring

extended periods of discipline and those whose capacities for self-

regulation can be harnessed through more benign and supportive

strategies (p. 155). Drawing on Hindess, Bull points out that the

authoritarian control of subjects (such as addicts) judged lacking in

the capacities for self-government is not the result of a failed com-

mitment to liberty, but is in fact a consequence of that commitment

(p. 153). For subjects with impaired wills, compulsion is required

in order to produce the ability to be free.

The paradoxes and tensions of liberal government are also cen-

tral to Substance and substitution, although this text is more varied in

its methodology. It combines interviews (with clients, prescribers,

health workers and policy makers) with analyses of media repre-

sentations, medical literature and policy documents and is valuable

purely for the amount of data and information on MMT that it con-

tains. But most significantly, it marries a Foucauldian concern with

power with a materialist ontology drawn from feminist science

studies. A notable result is that the substance of methadone itself

is refigured as a phenomenon to be explained, rather than existing

as a stable entity upon which the politics of MMT is erected.

The concept of phenomenon used in Substance and substitution

comes from the work of physicist and feminist theorist Karen Barad.

It contrasts with the everyday notion of ‘things’ because phenom-

ena include objects, practices, subjects, humans and non-humans.

Moreover, unlike the notion of static, independent and pre-existing

entities, phenomena are the result of dynamic processes of co-

production (Fraser & valentine, 2008, p. 23). Fraser and valentine

set out to examine the heterogeneous range of phenomena which

are produced in MMT: the substance of methadone, representa-

tions of methadone, the liberal subject and its Others, technologies

of regulation, social identities, the dosing point and political values.

Typical of their approach is their account of the subject positions

produced by MMT. Moving beyond the oppositional alternatives

of chaotic addict or compliant patient they argue that the famil-

iar identity of ‘the dissatisfied customer’ describes many of their

informants’ actions and responses. This is especially apparent when

methadone is dispensed from retail pharmacies as is common in

parts of Australia (p. 120). However because MMT clients are not

viewed solely as customers, but also as inherently dishonest drug

users, their complaints are readily interpreted as suspicious ‘drug-

seeking behaviour’ (p. 123).

A key chapter of Substance and substitution focuses on regu-

lations and their impact on practitioners and clients. Fraser and

valentine explore the specific effects of the regulations when they

are interpreted and put into practice, rather than simply identify-

ing them as a tool of power. The guidelines about the supervision of

dosing, the provision of takeaways, client conduct and disciplinary

procedures are interpreted by some participants as ‘law’ requiring

strict adherence, by some as ‘suggestions’ open to selective and flex-

ible use, and by others as ‘surveillance’, a way of gaining knowledge

of clients (pp. 73–74). As well as having significant effects on the

experience of treatment, these different modes of interpretation

involve contests over doctors’ professional autonomy. Therefore

‘the outmoded, paternalistic relationship of compliance’ that the

regulations produce between doctors and clients is also marked by

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452 H. Keane / International Journal of Drug Policy 20 (2009) 450–452

the inconsistency and uncertainty which results from the interpre-

tive acts of individual health professionals (p. 86, 88).

The analysis of regulation is extended by examining MMT as

a temporal and spatial phenomenon that is co-produced with

‘methadone clients’. Fraser and valentine focus on waiting and

queuing as constitutive elements of life on MMT. The queue is

produced by particular conditions and arrangements in place at

the clinic: opening times are restricted, staff are limited, dos-

ing involves observation, testing of urine or blood is sometimes

required and security concerns limit the number of clients at the

counter at one time (p. 107). The result is that clients often spend

a great deal of time waiting, sometimes outside in unsupervised

and bleak spaces. This is not just another case of the demean-

ing treatment of drug users. Fraser and valentine argue that the

queue does more than organise pre-existing clients, it actively pro-

duces certain kinds of clients: those that disrupt public order (for

example by lighting fires to keep warm while queuing outside),

those that use the opportunity afforded by the queue to buy or sell

methadone or other drugs and those that fail to achieve the goal of

independence through paid employment (p. 109). The unruliness,

unreliability, dishonesty and aggression often viewed as inherent

qualities of methadone clients are refigured as phenomena at least

partly produced by MMT itself: ‘there is no decisive way in which to

separate the attributes that belong to clients and those that belong

to the process of program delivery’ (p. 112). In fact, the demands of

the clinic reproduce rather than depart from the model of waiting,

uncertainty and dependence seen as characteristic of heroin use.

This insight has important policy implications, as it suggests that

location, layout, staffing, opening hours and availability of take-

aways are constitutive of clients’ ability to achieve the autonomous

and rational conduct of the liberal subject.

As well as the development of a more complex picture of power

and subjectivity in the clinic, Substance and substitution reflects the

increasing willingness of critical health studies to engage with the

biological. Socio-cultural work in the drug field has traditionally

bracketed pharmacology and biology in order to highlight the social

settings, relations and meanings of drug use that medical research

overlooks (Kushner, 2006). ‘Disciplining addiction’, Surviving heroin

and Governing the heroin trade continue this tradition in as far as

they view the properties of drugs as inherent to the substances

themselves. Bourgois certainly inverts the accepted categories of

poison and cure when he states that heroin is a less harmful and

more socially useful drug than methadone (p. 188). However, he

bases his (admittedly ambivalent and strategic) advocacy of med-

ical heroin on quantifiable data such as that produced by a Swiss

heroin prescription pilot. Methadone is a bad drug because of its

‘painfully physiologically addictive properties’ while heroin is more

useful because of its ‘unambiguously euphoric effects’ and its ‘rel-

ative lack of negative side effects’ (p. 183, 188). Thus the capacities

of these drugs exist independently of their use.

In contrast, the approach of Fraser and valentine questions

whether the heroin prescribed as a treatment would be the same as

the illicit drug. In Substance and substitution, there is no methadone

apart from that which is represented (Fraser & valentine, 2008, p.

56; Gomart, 2002). Its status as a replacement for a demonised drug

is crucial to the effects it produces in MMT. As a replacement for

heroin, methadone is both inauthentic (a substitute rather than a

real solution) and dangerous (an analogue of heroin) (p. 55). In

another context, outside the logic of replacement, the effects of

methadone could be quite different. In fact Substance and substitu-

tion argues for the abandonment of replacement as the conceptual

frame for MMT because of its harmful effects on the reputation of

the treatment and the status of its users (p. 56).

While investigation of the materiality of substances and their

differential performance is some distance from the discursive

approaches commonly inspired by Foucault, what these critical

impulses share is scepticism about the pre-given. Just as the drug-

using subject after Foucault does not exist outside of the clinics,

programs and other disciplinary regimes which produce it, the drug

as a phenomenon does not exist outside its sites of production.

Making drugs matter (while continuing to highlight the social and

political) is one of the key challenges set out by the latest iteration

of Foucault on drugs.

References

Bourgois, P. (2000). Disciplining addictions: The bio-politics of methadone andheroin in the United States. Culture Medicine and Psychiatry, 24, 165–195.

Bull, M. (2008). Governing the heroin trade: From treaties to treatment. Aldershot:Ashgate.

Duff, C. (2004). Drug use as a ‘practice of the self’: Is there any place for an ‘ethics ofmoderation’ in contemporary drug policy? International Journal of Drug Policy,15, 385–393.

Fraser, S., & valentine, k. (2008). Substance & substitution: Methadone subjects in liberalsocieties. New York: Palgrave Macmillan.

Friedman, J., & Alicea, M. (2001). Surviving heroin: Interviews with women inmethadone clinics. Florida: University Press of Florida.

Gomart, E. (2002). Methadone: Six effects in search of a substance. Social Studies ofScience, 32(1), 93–135.

Hunter, I. (1996). Assembling the school. In A. Barry, T. Osborne, & N. Rose (Eds.), Fou-cault and political reason: Liberalism neo-liberalism and rationalities of government(pp. 143–166). Chicago: University of Chicago Press.

Keane, H. (2002). What’s wrong with addiction? Carton South: Melbourne UniversityPress.

Kushner, H. (2006). Taking biology seriously: The next task for historians of addic-tion? Bulletin of the History of Medicine, 80(1), 115–143.

Miller, P. (2001). A critical review of the harm minimization ideology in Australia.Critical Public Health, 11(2), 167–178.

Valverde, M. (1998). Diseases of the will: Alcohol and the dilemmas of freedom. Cam-bridge: Cambridge University Press.