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International Journal of Drug Policy 20 (2009) 450452

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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, 165195],
[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 distinct. 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 themselves. 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 analyses 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 critique 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 medicolegal 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 Psychiatry, 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.
0955-3959/$ see front matter 2008 Elsevier B.V. All rights reserved.
doi:10.1016/j.drugpo.2008.10.005

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 sociocultural 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 medical 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 drugs effects. The byzantine rules and invasive surveillance 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).

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H. Keane / International Journal of Drug Policy 20 (2009) 450452

The account of Primos 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, unidirectional, and repressive force that Foucaults work resolutely
problematised. While Bourgois makes powerful use of the concept 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 normative 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 experiences. 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 womens
heroin use as a form of resistance to patriarchal values and the limitations 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 womens drug use, but also to instil conformity to traditional 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 mirrors [the womens] 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 critiques of hegemonic ideologies (1996, p. 144). In a similar way,
Foucault has been used by Friedman and Alicea to add a microanalytics 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
Bulls 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 contingency 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 neoFoucauldian governance studies, citing scholars such as Mitchell
Dean, Nikolas Rose, Barry Hindess and Pat OMalley. She addresses
MMT as a case study of demand reduction, analysing the network
of legal governance which enables and regulates the prescription of

451

methadone. The governmentality framework produces a less bifurcated vision of biopower: prescribers and dispensers as well as
clients appear as regulated subjects within the bureaucratic system
of MMT.
Bulls analysis also highlights the contradictory nature of MMT.
On one hand it can be understood as a neo-liberal form of governance 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 selfregulation 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 commitment 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 central 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 representations, medical literature and policy documents and is valuable
purely for the amount of data and information on MMT that it contains. 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 phenomena 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 coproduction (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, representations 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 familiar 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 drugseeking behaviour (p. 123).
A key chapter of Substance and substitution focuses on regulations 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 identifying 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 flexible use, and by others as surveillance, a way of gaining knowledge
of clients (pp. 7374). 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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H. Keane / International Journal of Drug Policy 20 (2009) 450452

the inconsistency and uncertainty which results from the interpretive 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, dosing 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 demeaning treatment of drug users. Fraser and valentine argue that the
queue does more than organise pre-existing clients, it actively produces 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 takeaways 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 medical 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 relative 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 substitution 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 drugusing 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 and
heroin in the United States. Culture Medicine and Psychiatry, 24, 165195.
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 of
moderation in contemporary drug policy? International Journal of Drug Policy,
15, 385393.
Fraser, S., & valentine, k. (2008). Substance & substitution: Methadone subjects in liberal
societies. New York: Palgrave Macmillan.
Friedman, J., & Alicea, M. (2001). Surviving heroin: Interviews with women in
methadone clinics. Florida: University Press of Florida.
Gomart, E. (2002). Methadone: Six effects in search of a substance. Social Studies of
Science, 32(1), 93135.
Hunter, I. (1996). Assembling the school. In A. Barry, T. Osborne, & N. Rose (Eds.), Foucault and political reason: Liberalism neo-liberalism and rationalities of government
(pp. 143166). Chicago: University of Chicago Press.
Keane, H. (2002). Whats wrong with addiction? Carton South: Melbourne University
Press.
Kushner, H. (2006). Taking biology seriously: The next task for historians of addiction? Bulletin of the History of Medicine, 80(1), 115143.
Miller, P. (2001). A critical review of the harm minimization ideology in Australia.
Critical Public Health, 11(2), 167178.
Valverde, M. (1998). Diseases of the will: Alcohol and the dilemmas of freedom. Cambridge: Cambridge University Press.