Technologies of Expertise: Opioids and Pain Management’s Credibility Crisis

Journalistic accounts of the opioid crisis often paint prescription opioids as the instrument of profit-minded pharmaceutical companies who enlisted pain specialists to overprescribe addictive drugs. Broadening beyond a focus on pharmaceutical power, this article offers a comparative-historical explanation, rooted in inter- and intra-professional dynamics, of the global increase in rates of opioid prescribing. Through archival analysis and in-depth interviews with pain specialists and public-health officials in the United States and France, I explain how and why opioids emerged as the “right tool for the job” of pain relief in the 1980s and 1990s, affecting how pain science is produced, pain management is administered, and a right to pain relief is promised in different national contexts. I argue that opioids, selected and destigmatized as the technology for pain relief, helped establish a global network of pain expertise, linking a fledgling field of pain specialists to the resources of global-health governance, public-health administration, humanitarian organizations, and pharmaceutical companies. I then compare how U.S. and French pain specialists leveraged opioids to strengthen the boundaries of their emergent fields. Pain specialists’ differing degrees of autonomy in each country’s network of pain expertise shaped the extent to which opioids could dominate pain management and lead to crisis. Tracing the relationship between opioids and pain expertise, I show how technologies can drive crises of expert credibility if and when they escape the control of the networked fields that selected them.