Producing the 'problem' of drugs: A critical analysis of the effects of drug policy since 2010 with a particular focus on people who inject drugs

Over the past two decades, UK drug policy has shifted from being characterised by the public health imperatives of infection control and health maintenance, through various crime reduction initiatives, to a recovery orientated abstinence-based system of drug treatment underpinned by neoliberal notions of resilience, individual responsibility and self-regulating practices. Policy proposals and responses have been developed as solutions to self-evident drug problems with so-called evidence-based practices emerging as those that best address the particular problems of the day. With drug related deaths at an all-time-high and blood borne viruses and other injecting related infections remaining a public health concern, this research asks the question, in what ways have particular problematisations of drugs and their effects since 2010 affected people who use them, with particular reference to people who inject drugs (PWID). This thesis refers to the sociological literature on poststructural policy analysis and the processes of subjectification to illuminate the real-world effects of discursive practices, and shows how the subject positions available within particular policy discourses serve to regulate and govern the conduct of PWID. The research adopts a poststructural perspective drawing on Foucauldian influenced governmentality studies and is situated within an emerging body of literature and critical research that understands realities as being constituted through policy discourses and practices. Using Bacchi’s (2009) approach to policy analysis, What’s the problem represented to be? The research scrutinises policy and strategy documents over the past two decades and challenges the assumption that drug problems exist independently of societal or governmental forces (Bacchi and Goodwin 2016). Research objectives include exploring the operation of drug policy discourses as they are interpreted and negotiated by drug treatment professionals and drug treatment commissioners and how the effects of policy discourses impact on PWID. Interviews were conducted with 28 individuals (6 commissioners of alcohol and other drug (AOD) treatment services, 12 AOD treatment professionals and 10 PWID) and analysed using Bacchi and Bonham’s (2016) Poststructural Interview Analysis (PIA) approach. Purposive sampling was used to select participants and semi-structured interviews were conducted either face-to-face or using online/telephone communication platforms. Interviews typically lasted between 60 and 120 minutes. Interviews were transcribed verbatim and analysed alongside policy and theory as a means of plugging data into a poststructural analysis. This research shows that contrary to claims from successive governments for a radical departure and unprecedented change, drug policies have been consistently characterised by the same problem representations that produce and reproduce discourses of criminality, pathology and compulsive behaviour. It shows how drug problems are constructed in power-knowledge relations (discourses) as ‘truths’ and reproduced through practices as technologies for governing and regulating the behaviour of people who use drugs (PWUD) and in particular, PWID. It highlights how taken for granted assumptions, that attribute notions of risk and harms as the inevitable outcome of using drugs, are constituted in socially constructed discourses as realities, while individually targeted interventions and the responsibilising practices of drug treatment contribute to harm producing policies and the reproduction of stigma experienced by PWID.