Thinking beyond 'outbreak': The contentious politics of the science of early warning and overdose epidemic.

This Commentary on the article, "Early warnings and slow deaths: A sociology of outbreak and overdose" by Tim Rhodes and Kari Lancaster, reflects upon rapid response reflexes invoked in societal responses to 'emergency,' 'epidemic,' 'crisis,' and disasters, all of  which require immediate action with no time to think. Epidemiology has given us machines for producing 'fact' about the 'opioid overdose epidemic' that promote the forgetting of the ways in which apparatuses of social control enact the production of facticity. While facts are supposed to be epistemologically reliable and worthy, the work of Rhodes and Lancaster invites us to de-subscribe to these beliefs and re-member our way towards developing slower, more thorough, and more thoughtful ways of seeing a wider array of "indicators, signals, evidence, and narratives of an ecological kind" (Rhodes and Lancaster 2023; this issue). This Commentary focuses on the practices of 'early warning' in social, political, and economic context.

When Should Screening and Surveillance Be Used during Pregnancy?

Using the ethical and legal concept of shared responsibility for healthy births, this article considers social, cultural, and historical contexts in which medicalization and criminalization have worked in tandem to widen surveillance in ways that intensify scrutiny of women's lives under the guise of child protection, bringing women who are pregnant, postpartum, or parenting under criminal justice control. Although pregnant and postpartum women are prime candidates for medication-assisted treatment (MAT), the expanding carceral system has not prioritized drug treatment or reproductive justice. This article investigates ethical and historical dimensions of the question, According to which principles and practices should screening and surveillance be carried out to reduce harm, safeguard civil and human rights-including reproductive autonomy-and ensure that treatment, when necessary, occurs in the least coercive settings possible?

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids-Conception and maturation.

BACKGROUND: Opioid overdose is a major cause of mortality, but injury and fatal outcomes can be prevented by timely administration of the opioid antagonist naloxone. Pre-provision of naloxone to opioid users and family members (take-home naloxone, THN) was first proposed in 1996, and WHO Guidelines were issued in 2014. While widespread in some countries, THN is minimally available or absent elsewhere. This review traces the development of THN over twenty years, from speculative harm reduction proposal to public health strategy. METHOD: Medline and PsycINFO were searched for peer-reviewed literature (1990-2016) using Boolean queries: 1) "naloxone OR Narcan"; 2) "(opioid OR opiate) AND overdose AND prevention". Grey literature and specialist websites were also searched. Data were extracted and synthesized as narrative review, with key events presented as chronological timeline. RESULTS: Results are presented in 5-year intervals, starting with the original proposal and THN pilots from 1996 to 2001. Lack of familiarity with THN challenged early distribution schemes (2001-2006), leading to further testing, evaluation, and assessment of challenges and perceived medicolegal barriers. From 2006-2011, response to social and legal concerns led to the expansion of THN programs; followed by high-impact research and efforts to widen THN availability from 2011 to 2016. CONCLUSIONS: Framed as a public health tool for harm reduction, THN has overcome social, clinical, and legal barriers in many jurisdictions. Nonetheless, the rising death toll of opioid overdose illustrates that current THN coverage is insufficient, and greater public investment in overdose prevention will be required if THN is to achieve its full potential impact.

Behavior within fortuitous environments: The entwined history of Division 28 and the fields of behavioral pharmacology and toxicology.

Behavioral pharmacology emerged in the early to mid-20th century as an experimental and observational science, helping to consolidate an empirically based psychological science of behavior. Behavioral psychologists came to play significant roles in toxicology, neuropharmacology, and psychopharmacology. This article traces the first 3 decades of American Psychological Association Division 28. Sources include the Division 28 Oral History Project; formal interviews conducted by the author in the early 2000s with behavioral, experimental, and clinical pharmacologists; and the archived newsletters of Division 28. (PsycINFO Database Record

Stowaways in the history of science: the case of simian virus 40 and clinical research on federal prisoners at the US National Institutes of Health, 1960.

In 1960, J. Anthony Morris, a molecular biologist at the US National Institutes of Health conducted one of the only non-therapeutic clinical studies of the cancer virus SV40. Morris and his research team aimed to determine whether SV40 was a serious harm to human health, since many scientists at the time suspected that SV40 caused cancer in humans based on evidence from in vivo animal studies and experiments with human tissue. Morris found that SV40 had no significant effect but his claim has remained controversial among scientists and policymakers through the present day--both on scientific and ethical grounds. Why did Morris only conduct one clinical study on the cancer-causing potential of SV40 in healthy humans? We use the case to explain how empirical evidence and ethical imperatives are, paradoxically, often dependent on each other and mutually exclusive in clinical research, which leaves answers to scientific and ethical questions unsettled. This paper serves two goals: first, it documents a unique--and uniquely important--study of clinical research on SV40. Second, it introduces the concept of "the stowaway," which is a special type of contaminant that changes the past in the present moment. In the history of science, stowaways are misfortunes that nonetheless afford research that otherwise would have been impossible specifically by creating new pasts. This case (Morris' study) and concept (the stowaway) bring together history of science and philosophy of history for productive dialog.

The spirit of St Louis: the contributions of Lee N. Robins to North American psychiatric epidemiology.

This article takes up the history of North American psychiatric epidemiology with reference to production of knowledge concerning sociopathic or antisocial personality disorder and drug dependence, abuse, and/or addiction. These overlapping arenas provide a microcosm within which to explore the larger shift of postwar psychiatric epidemiology from community studies based on psychological scales to studies based on specific diagnostic criteria. This paper places the figure of sociologist Lee Nelken Robins within the context of the Department of Psychiatry in the School of Medicine at Washington University in St Louis, Missouri. The St Louis research group--to which Robins was both marginal and central--developed the basis for specific diagnostic criteria and was joined by Robert Spitzer, Jean Endicott and other architects of DSM-III in reorienting American psychiatry towards medical, biological and epidemiological models. Robins was a key linchpin working at the nexus of the psychiatric epidemiological and sociological drug addiction research networks. This article situates her work within the broader set of societal and governmental transformations leading to the technologically sophisticated turn in American psychiatric epidemiology and research on the aetiology of drug abuse and mental health and illness.

The history of the development of buprenorphine as an addiction therapeutic.

This paper traces the early 21st century success of the agonist-antagonist buprenorphine and the combination drug buprenorphine with naloxone within the broader quest to develop addiction therapeutics that began in the 1920s as the search for a nonaddictive analgesic. Drawing on archival research, document analysis, and interviews with contemporary actors, this paper situates the social organization of laboratory-based and clinical research within the domestic and international confluence of several issues, including research ethics, drug regulation, public attitudes, tensions around definitions of drug addiction, and the evolving roles of the pharmaceutical industry. The fervor that drove the champions of buprenorphine must be understood in relation to (1) the material work of research and pharmaceutical manufacturing; (2) the symbolic role of buprenorphine as a solution to numerous problems with addiction treatment evident by the mid-1970s; the destigmatization and individualization of addicts as patients; and (3) the complex configurations of public and private partnerships.

"A new deal for the drug addict": the Addiction Research Center, Lexington, Kentucky.

This article describes the social organization of knowledge production in the formative moments of the substance abuse research enterprise. It describes the institutional arrangements and material conditions of a U.S. Public Health Service laboratory that was housed in a facility run jointly with the federal Bureau of Prisons. The Addiction Research Center (ARC) in Lexington, Kentucky, was dedicated to elucidating the basic underlying mechanisms of drug addiction. The ARC was housed on the rural campus of a prison-hospital called "Narco," one of two "narcotics farms" in Lexington, Kentucky, and Fort Worth, Texas. For its studies on drug effects, the ARC had access to a pool of drug-experienced human subjects drawn from the ranks of convicted felons. Given their unparalleled access to human subjects, the scientists who worked at the ARC made conceptual contributions still acknowledged today. Based on archival work as well as dozens of oral history interviews with individuals who began their research careers at Lexington, the article presents an analytic, intellectual history of the early work of Abraham Wikler, whose lifelong pursuit of the underlying mechanisms of opiate addiction led him to hypothesize the role of conditioning in relapse, as an exemplar of the kind of scientific research that depended on closely listening to and observing "post-addicts," as subject participants were called.