The Opioid Epidemic 

Harvard Summer School 

Summer 2020 
Mondays, Wednesdays, 6:30-9:30 pm, or on demand. 
  
Instructor Information 
Faculty 
Jason Silverstein, Ph.D., Lecturer and Writer-in-Residence, Department of Global Health and Social 
Medicine, Harvard Medical School 
Office: 641 Huntington Avenue (HMS Campus) 
Email: jason_silverstein@hms.harvard.edu 
  
Teaching Assistant 
Brian Michael Foote, MTS 
Email: bmf703@mail.harvard.edu 
  
Credits 
4.0 
 
Course Description 
 
More people die every year from opioid overdoses than gunshot wounds and car accidents, and the 
crisis only appears to be worsening and rapidly changing. Understanding the crisis in real-time is 
notoriously difficult, however, especially since most who overdose do not go to hospitals and death 
certificates are often unreliable. And while everyone agrees something must be done, what that 
something is leads to heated debates over health care spending and harm reduction. While most 
medical research focuses on the biology of disease, this course takes a biosocial approach to unmask 
how social factors, economic insecurity, and the availability of massive amounts of pharmaceuticals 
have become an overdose crisis. We will read social scientists, journalists, public health scholars, and 
ethnographic accounts in order to understand the chronic emergencies (such as deindustrialization 
and despair) behind this acute crisis. By investigating the opioid epidemic in this way, students will 
be encouraged to think boldly and creatively beyond the traditional boundaries of medicine: perhaps 
someone’s best “medicine” is a housing voucher, or a testing strip to detect fentanyl. By the end of 
the class, students will understand the social roots of the opioid epidemic, and how solutions may be 
implemented. 
 
Course Readings 
 
Required: 
 —Bourgois, Philippe and Jeffrey Schonberg. Righteous Dopefiend. Berkeley: University of 
California Press, 2009. 
—Garcia, Angela. The Pastoral Clinic: Addiction and Dispossession along the Rio Grande. 
Berkeley: University of California Press, 2010. 
—Macy, Beth. Dopesick: Dealers, Doctors, and the Drug Company that Addicted America. 
New York: Little, Brown & Company, 2018. 
—Simon, David, and Edward Burns. The Corner: A year in the Life of an Inner-City 
Neighborhood. Broadway, 1998. 
—Wilson, William Julius. When Work Disappears: The World of the New Urban Poor. 
Chicago: University of Chicago Press, 1996. 
 
Grading, Progress, and Performance 
  
Undergraduate Course Requirements: 
1.  Reading of course materials 
2.  Participation in class discussion and exercises (10%) 
3.  Discussion question posts (20%) 
4.  Community learning responses (30%) 
5. Final project (written component 30%, presentation 10%)  
 
​Graduate Course Requirements: 
1.  Reading of course materials 
2.  Participation in class discussion and exercises (10%) 
3.  Book review (20%) 
4. Community learning responses (30%) 
5. Final project (written component 30%, presentation 10%)  
 
Please note:​ this course has a community learning component. This component is designed to 
allow students to learn directly from community members affected by and responding to the opioid 
epidemic. Three written responses will reflect on these in-class conversations with course concepts 
and theories on addiction, labor, poverty, and treatment. 
 
Students taking the course asynchronously​ will earn participation by posting a quote from the 
assigned readings, and a question about the quote for class discussion. This should be completed 
every week by 5pm on the day before class to earn credit.  
 
Late Work Policy: 
The order and timing of assignments is important for this class. Failure to turn in assignments on 
time may seriously affect your ability to meaningfully participate in this course and receive timely 
feedback from the teaching staff. Late work will be penalized half a letter grade per day. Extensions 
will only be granted for documented medical and personal emergencies. 
 
 
Course Structure 
  
Classroom Participation: 
No matter how a student participates in the class, students are expected to be active and respectful 
participants in classroom discussions. This includes ​being prepared by having read and analyzed 
assignments, and being ready to offer analyses and insights during class discussions whether during 
the live session or on the class discussion board. We will have a class norm of sensitivity and 
generosity in discussion; please keep in mind that you might not know if someone is personally 
affected by this epidemic. 
  
Laptop Policy: 
Students are permitted to use laptops to take notes during class, but the instructor reserves the right 
to modify this policy if it appears that students are abusing this right. Students are expected to be 
respectful and generous to each other, which includes paying close attention to the comments of 
their peers. 
  
Canvas Course Website:  
The Canvas site is an important learning tool for this course where students will access required 
articles, post discussion questions, submit course assignments, and share other resources with the 
class. Course announcements will be posted on the site and students are advised to check the course 
website before each session. 
 
 
Harvard Summer School Policies and Expectations 
  
Accommodations for Students with Disabilities 
The Summer School is committed to providing an accessible academic community. The Accessibility 
Office offers a variety of accommodations and services to students with documented disabilities. 
Please visit http://www.summer.harvard.edu/resources-policies/accessibility-services for more 
information. 
 
Academic Integrity 
You are responsible for understanding Harvard Summer School policies on academic integrity 
(http://www.summer.harvard.edu/policies/student-responsibilities) and how to use sources  
responsibly. Not knowing the rules, misunderstanding the rules, running out of time, submitting the 
wrong draft, or being overwhelmed with multiple demands are not acceptable excuses. 
To support your learning about academic citation rules, please visit the Resources to Support 
Academic Integrity 
(http://www.summer.harvard.edu/resources-policies/resources-supportacademic-integrity) where 
you will find links to the Harvard Guide to Using Sources and two free online 15-minute tutorials to 
test your knowledge of academic citation policy. The tutorials are anonymous open-learning tools. 
 
Course Schedule (Note: Dates will be updated) 
 
June 22 Introduction/Many Missing Pieces 

June 24 From the War on Poverty to the War on Drugs 

June 29 and July 1 The Ancient Business of Survival: The Drug Trade in Baltimore 

July 6 and 8 The Deaths of Despair Hypothesis 

July 6: Community Learning Response 1 

July 13 Life in the Grey Zone: Loss and Inheritance in New Mexico 

July 15 Life in the Grey Zone: The Moral Economy of Homeless Drug Users in San Francisco 

July 20 A Market for Pain: Pharma’s Pain Hustlers 

July 20: Community Learning Response 2 

July 22 A Market for Pain: The Recovery Racket 

July 27 A Gentler Drug War? 

July 27: Community Learning Response 3 

July 29 To Treat or Not to Treat? Methadone, Narcan, and Supervised Injection Facilities 

August 3 Research Presentations 

August 5 ​Final Paper Due 

 
 
Reading Schedule Draft 
 
June 22, Introduction: Many Missing Pieces 
—Bebinger, Martha. “Black Drug Users Grapple With Surging Opioid Overdose Death Rates.” 
New England Public Radio. May 24, 2018. 
http://nepr.net/post/black-drug-users-grapple-surgingopioid- 
overdose-death-rates#stream/ 
—Cassidy, John. “Why Did the Death Rate Rise Among Middle-Aged Americans?” The New 
Yorker. November 9, 2015. https://www.newyorker.com/news/john-cassidy/why-is-the-death-rate 
Rising-among-middle-aged-white-americans. 
—Jason Silverstein, "When an Overdose Doesn't Kill You," VICE (July 3, 2017) 
 
June 24, From the War on Poverty to the War on Drugs 
—Jacques Derrida, "The Rhetoric of Drugs," in Points (Stanford UP 1995). 
—Hart CL (2014) How the Myth of the ‘Negro Cocaine Fiend’ Helped Shape American Drug 
Policy. The Nation (Op-Ed) January 29, 2014: 
http://www.thenation.com/article/how-myth-negro-cocaine-fiend-helped-shape-american-drug-pol
icy/ 
—​Kuziemko, Ilyana, and Steven D. Levitt. "An empirical analysis of imprisoning drug offenders." 
Journal of Public Economics​88, no. 9 (2004): 2043-2066. 
—​Mauer and King, 2007 report for The Sentencing Project, “A 25-Year Quagmire: The War on 
Drugs and Its Impact on American Society” 
—​Schmoke, Kurt L. 2008. “Drug Sanity.” The New Republic, April 14 
—​Wacquant, Loic. "Deadly symbiosis: When ghetto and prison meet and mesh." ​Punishment & 
Society​ 3, no. 1 (2001): 95-133. 
 
June 29 and July 1, The Ancient Business of Survival: The Drug Trade in Baltimore 
—Simon, David, and Edward Burns. The Corner: A Year in the Life of an Inner-City 
Neighborhood. Broadway, 1998. 
—Bourgois, Phillipe. In Search of Respect: Selling Crack in the Barrio. Cambridge, U.K.: Cambridge 
University Press, 2003. [Excerpts] 
—Silverstein, Jason. "Trump Thinks Executing Drug Dealers Will Stop the Opioid Epidemic." 
VICE (March 14, 2018). 
 
July 6 and 8: The Deaths of Despair Hypothesis 
—Wilson, William Julius. When Work Disappears: The World of the New Urban Poor. Chicago: 
University of Chicago Press, 1996. 
—Deaton, Angus. 2017. “Economic Aspects of the Opioid Crisis: Testimony before the Joint 
Economic Committee of the United States Congress.” 
—Hollingsworth, Alex, Christopher J. Ruhm, and Kosali Simon. "Macroeconomic conditions and 
opioid abuse." ​Journal of health economics​ 56 (2017): 222-233. 
—Marx and Engels, “The Working Day.” 
—McLean, Katherine. "“There's nothing here”: Deindustrialization as risk environment for 
overdose." ​International Journal of Drug Policy​ 29 (2016): 19-26. 
—Ruhm, Christopher J. ​Deaths of despair or drug problems?​ No. w24188. National Bureau of Economic 
Research, 2018. 
 
July 13 and July 15: Life in the Grey Zone 
—Garcia, Angela. The Pastoral Clinic: Addiction and Dispossession along the Rio Grande. Berkeley: 
University of California Press, 2010. 
—Bourgois, Philippe and Jeffrey Schonberg. Righteous Dopefiend. Berkeley: University of 
California Press, 2009. 
 
July 20, A Market for Pain: Pharma’s Pain Hustlers 
—Macy, Beth. Dopesick: Dealers, Doctors, and the Drug Company that Addicted America. New 
York: Little, Brown & Company, 2018. 
—Jackson, Jean E. Camp Pain: Talking with Chronic Pain Patients. Philadelphia: University of 
Pennsylvania Press, 1999. [Excerpts] 
—​Declan Barry et al., “Opioids, chronic pain, and addiction in primary care,” The Journal of Pain 
2010; 11: 1442-1450. 
—Keefe, Patrick Radden. "The Family That Built an Empire of Pain.” The New Yorker. October 
2017. 
—Lopez, German. “The growing number of lawsuits against opioid companies, explained.” Vox. 
May 15, 2018. 
https://www.vox.com/policy-and-politics/2017/6/7/15724054/opioid-epidemiclawsuits- 
purdue-oxycontin. 
—Meldrum, Marcia. “ ‘The Long Walk to the Counter’: Opioid Pain-Relievers and the Prescription 
as Stigma.” In Prescribed: Writing, Filling, Using and Abusing the Prescription in Modern America, 
eds. Elizabeth Watkins and Jeremy Greene. Baltimore: Johns Hopkins Press, 2012. 
 
July 22, A Market for Pain: The Recovery Racket 
—Alvarez, Lizette. “Haven for Recovering Addicts Now Profits From Their Relapses.” STAT. June 
20, 2017. https://www.nytimes.com/2017/06/20/us/delray-beach-addiction.html. 
—Moore, Lela. “Clean, Sober, and $41,000 Deep in Out-of-Pocket Addiction Recovery Costs.” The 
New York Times. July 26, 2018. 
https://www.nytimes.com/2018/07/26/reader-center/costs-of-drugrehab.html. 
—Segal, David. “City of Addict Entrepreneurs.” The New York Times. December 27, 2017. 
https://www.nytimes.com/interactive/2017/12/27/business/new-drug-rehabs.html. 
—Segal, David. “In Pursuit of Liquid Gold.” The New York Times. December 27, 2017. 
https://www.nytimes.com/interactive/2017/12/27/business/urine-test-cost.html​. 
 
July 27, A Gentler Drug War? 
—Blendon, Robert J. and John M. Benson. “The Public and the Opioid-Abuse Epidemic.” The 
New England Journal of Medicine 378, no. 5 (February 1, 2018): 407-411. 
—Del Real, Jose A. “Needle by Needle, a Heroin Crisis Grips California’s Rural North.” The New 
York Times. May 8, 2018. https://www.nytimes.com/2018/05/08/us/california-heroin-opioid.html 
—Netherland, Julie and Helena Hansen. “White opioids: Pharmaceutical race and the war on drugs 
that wasn’t.” Biosocieties 12, no. 2 (June 2017): 217–238. 
 
July 29, To Treat or Not to Treat? Methadone, Narcan, and Supervised Injection Facilities 
—Adams, Jerome M. “Increasing Naloxone Awareness and Use.” The Journal of the American 
Medical Association 319, no. 20 (2018): 2073-2074. 
—Davidson, Peter et al. "Using drugs in un/safe spaces: Impact of perceived illegality on an 
underground supervised injecting facility in the United States." International Journal of Drug Policy 
53 (2018): 37-44. 
—Frazier, Ian. “The Antidote.” The New Yorker. September 8, 2014. 
https://www.newyorker.com/magazine/2014/09/08/antidote​. 
—Hatcher, Alexandrea E., Sonia Mendoza, and Helena Hansen. “At the Expense of a Life: Race, 
Class, and the Meaning of Buprenorphine in Pharmaceuticalized ‘Care.’” Substance Use & Misuse 
53, no.2 (Jan 2018): 301-310. 
—​Nickerson, Jason W., and Amir Attaran. "The inadequate treatment of pain: collateral damage 
from the war on drugs." ​PLoS medicine​ 9, no. 1 (2012): e1001153. 
—Jason Silverstein, "People with Addiction Are Running Out of Places to Finish Their Recovery," 
VICE (December 12, 2016). 
 
August 3, Research Presentations 
 
August 5, Final Paper Due