No Hope for Relief : Using Opioids for Pain in an Age of Drug-Related Panic (Institutional Ethnography)

People living with chronic pain have experienced troubling shifts in their ability to access opioids for pain management in the context of panic around the “opioid crisis.” No Hope for Relief delves into their everyday lives while issuing a crucial call to action. Through an institutional ethnographic approach that combines text analysis and interviews with patients, doctors, pharmacists, other health care providers, policymakers, and guideline developers, the book traces how attempts to curb opioid prescribing have introduced new forms of surveillance and discipline. Critical health sociologist Leigha Comer demonstrates how this has prompted doctors to refuse to prescribe opioids, force patients to rapidly taper, and even remove people with chronic pain from their patient rosters altogether. These changes in practice have had devastating impacts on many people with chronic pain, who struggle to manage unrelenting pain and face a dwindling quality of life. By focusing on Ontario, Canada as a site where tensions around opioid prescribing have erupted, the ruling relations organizing these shifts in policy and practice are explored, including clinical practice, policymaking, guideline development, and professional regulation. In mapping these ruling relations, the book also identifies points for intervention, calling for a new ethics of care in which the aim is not to determine who “deserves” opioids but instead to complicate our understanding of risk, how opioids figure into public imaginaries of health and illness, and what constitutes a life worth living.