Essay by Grace Payne
Art by Karen Zhang
According to data gathered by the Government of Canada, 3,002 deaths occurred in British Columbia from April 12, 2020 through April 4, 2022, as a result of the COVID-19 virus (bc.thrive.health stats). Meanwhile data released by the BC Coroners Service indicates that at least 2,224 individuals died in 2021 alone, as a result of BC’s toxic illicit drug (opioid) crisis (Farnworth). Data pertaining to BC’s opioid epidemic is, however, likely an underrepresentation of overdose deaths. As the COVID-19 pandemic and the opioid epidemic converged in BC, creating a syndemic, both individuals who use drugs, and first responders, have suffered the effects of the co-occurring health crises. Furthermore, interruptions to treatment, mental health, and harm reduction services, as well as increased isolation, have exacerbated resources and the government’s ability to distinguish between deaths related to COVID-19 and those caused by opioid overdose. As the effects of the opioid epidemic extend beyond families and first responders, the associated rhetoric progresses from detachment—dismissed as personal responsibility—to increased awareness and sympathy for those most impacted. A similar pattern occurred in the rhetoric of COVID-19, as the widespread contagion of the Omicron variant inadvertently destigmatized contraction of the disease. While such destigmatizations may appear positive, the causes for this rhetorical change are not necessarily so. Through analysis of addiction studies, outbreak narratives, and racism in the healthcare system, I will describe the development of rhetorics of risk and responsibility in both the COVID-19 pandemic and the Opioid Epidemic, with a particular focus on British Columbia.
In her article “What a Difference a Body Makes: Addiction Studies and the Authority of Experience,” Karen Kopelson chronicles a brief history of addiction studies, applying this discourse to multiple first-hand accounts of addiction, including her own. Kopelson demonstrates that due to “addiction’s lack of material, objective reality,” scholars have historically attempted to “critique it out of existence” (351). She supports her argument with an analysis of sociologist Craig Reinarman’s 2005 article on “Addiction as Accomplishment,” which undermines the complexity of addiction by first claiming it was “invented” and later by attaching it solely to its “discursive practices,” such as participation in a recovery group (351). Such “social-constructionist” and “materialist” discourses date from the 1990s, and appear as recently as 2013, such as in a similar article by sociologist Darin Weinburg (352). Essentially, Kopelson calls for scholarship studying addiction in “embodied, experiential, and existential” terms, in place of those which overemphasize its social and material forms (352). Such avenues include the neurological study of habit, for example, but most notably, Kopelson suggests a rhetorical study of addiction to understand the co-constitutive nature of discourse and matter, and to conceive of “agency(ies) as multiple and dispersed” (354). With support from Kopelson’s article, I will begin by analyzing the opioid epidemic within rhetorical frameworks of character and narrative.
Kopelson’s article reviews three autobiographical accounts of addiction. While such accounts are not exclusive to every individual’s experience of addiction, they offer a sense of the neurological processes associated with addiction, and correspondingly, the dominant rhetoric of personal responsibility. Kopelson, citing her first author, emphasizes that “addiction is, first and foremost, a relationship between a person and a substance” (Szalavitz qtd. in Kopelson 367). This reconfiguration—-though helpful for navigating personal experience – is often misused by theorists, applied unwittingly to discourses which classify human desires as either “healthy [or] pathological” (Kopelson 367). Under the binary of health and pathology, individuals who use substances are stigmatized for a lack of rationality, that is, non-users struggle to accept the idea of “someone so unreasonable that they would choose ‘to keep doing what they do despite… serious negative consequences and very little reward’” (Keane qtd. in Kopelson 356). From such discourses emerges a narrative which classifies substance users as individuals who choose to partake in behaviours with known personal risk and consequences. It is the emphasis on agency, or lack thereof in the characterization of addiction, which renders substance users comparable to the scapegoats of outbreak narratives.
In Contagious: Cultures, Carriers, and the Outbreak Narrative, Priscilla Wald discusses the outbreak narrative as a rhetorical agent in the stigmatization of certain groups, populations, and individuals (3). Specifically, she discusses the characterization of the “superspreader” in outbreak narratives. This description, though scientifically disputed, is usually attributed to an individual who seemingly infects “large numbers of people” (Wald 4). The superspreader of the pandemic is akin to the substance user of the epidemic, in that they are also characterized with intentionality in their infection of others. Oftentimes, this scapegoating is connected to stigma beyond illness. For instance, during the 1980s’ AIDS epidemic, flight attendant Gaetan Dugas was classified as patient zero and became the subject of intense scrutiny and hate by the media (Wald 4). While not overtly stated during the time period, his stigmatization was not solely for his infection, but rather, for his sexuality as a gay man. A similar process has occurred throughout the COVID-19 pandemic, as Asian individuals are continually scapegoated and made victim to hate crimes in BC, Canada, and the United States. Based on data published by Statistics Canada, there were 198 police-reported hate crimes in BC in 2020, an increase of 60 per cent from 2019 (“BC had highest rate of hate crimes in the country during the first year of COVID-19 pandemic”). The COVID-19 scapegoating against Asian populations was motivated by prejudice, and enabled by the virus’ initial discovery in Wuhan, China (“when Xenophobia Spreads like a Virus”). In the context of COVID-19, scapegoating unproductively obscures the poverty faced by those physically inhabiting the space where the virus originated, while equally dismissing the exacerbating influence of global modernity on poverty (Wald 8). This scapegoating process, as emphasized in Wald’s article, similarly occurred during the 2003 SARS outbreak which originated in the Guangdong Province of China (8). Contagion scapegoating, exemplified by hostility towards the already stigmatized individual, increases suffering in an attempt to justify fears of interdependence in a globalized world.
While scapegoating still occurred through the later stages of the COVID-19 pandemic, it lessened relative to the first year of the pandemic, a development which may be interpreted through Priscilla Wald’s analysis of the co-constitutive nature of contagion and community. The outbreak of a virus causes suffering on both an individual and community level. In terms of the scientific study of bacteriology and narratives of transmission, contagion developed as a system for classifying the “rationale of social organization” (Durkheim qtd. in Wald 14). Based on theorist Emilé Durkheim’s research, Wald argues that contagion “bound[s] people to the relationships that [constitute] the terms of their existence” (14). In the article “Constituting good health citizenship through British Columbia’s COVID-19 public updates,” Spoel et al. work with data from BC Provincial Health Officer Dr. Bonnie Henry’s public communication to analyze her rhetoric. Their findings emphasize Henry’s focus on evoking “pro-social behaviour and civic values” in citizen response to the pandemic. An individual who engages in such pro-social behaviour, is what Spoel et al. refer to as “the good covid citizen” (5). A key theme that Spoel et al. extract from Henry’s rhetoric is that “the good covid citizen is part of a unified community” (6). This finding demonstrates Dr. Henry’s focus on understanding the public health crisis through the lens of community, a tendency exemplified by phrases such as “we all” and “all of us” (Spoel et al. 7). While instances of individualistic language did appear in Dr. Henry’s public communication, they were often connected to the community by way of moral obligation. Phrases like “the actions we are taking as individuals and as communities” combine collective and individualistic language, reflecting Wald’s aforementioned discussion of contagion as connection (Henry qtd. in Spoel et al. 10). In British Columbia, though most individuals initially favoured infection rhetorics of personal risk and responsibility over community connectivity, such individualistic thinking faltered under the social bond of contagion.
Indeed, it is perhaps what Wald would call “the social bond of contagion” which has produced the most productive response to the co-occuring health crises in British Columbia. The rhetoric surrounding the Opioid Epidemic has shifted away from blame as the public has learned about the manufactured nature of the epidemic, with overdose deaths attributable to “excessive levels of medical opioid prescribing” (Fischer et al. 112). Though the entity of the medical system is to be held accountable for over-prescribing opioids in place of other forms of treatment, responsibility for “wrong doing [and] negligence” must be claimed by once trusted pharmaceutical companies, who placed pressure on physicians to prescribe their opioids (Fischer et al. 110). Systemic issues intersecting with the Opioid Epidemic, however, reach further than the dominance of pharmaceutical companies, especially in British Columbia. Indigenous peoples are continually subjected to racism in Canadian healthcare systems and can be dangerously mistreated on the basis of prejudice and racial stereotypes (Goldman and Leibowitz-Lord). The devastation of the Opioid Epidemic across Indigenous communities is an extension of settler-colonial damage and Canada’s history of cultural genocide. The newfound knowledge of the Opioid Epidemic’s manufacturing, and equally, the crisis’ presence beyond Indigenous communities, in upper-middle class, and white communities, has served to catalyze rhetorical changes in discourses and media surrounding the epidemic. Such changes work to replace blame with sympathy, similarly to the destigmatization of contracting COVID-19.
Contagion elicits stigmatization of the individual and reflection on human interdependence (Wald 3). As emphasized in Wald’s Outbreak Narratives, such products of contagion have consequences (3). As exemplified in Dr. Henry’s public communications, the “good covid citizen” emerges from the COVID-19 pandemic as a symbol of community. This pretense of “good citizenship” exists in spite of violent prejudice towards Asian individuals and the harmful narratives of the “superspreader” as discussed in Wald’s Outbreak Narratives. Similarly, Kopelson studies individuals who suffer from complex relationships to substances, focusing particularly on the disparities between experience and popular perceptions of addiction, which differ in their attribution of the individual’s agency and responsibility. The ‘individualistic’ narratives of British Columbia’s COVID-19 pandemic and Opioid Epidemic have, however, elicited community-level responses. Increased awareness of the misguided practices occurring at the level of pharmaceutical companies, in addition to undeniable widespread addiction and death across both central cities and rural communities, have slowly helped bring about a public response. Similarly, the widespread infection of the Omicron variant has helped destigmatize contraction of the COVID-19 virus. Though each health crisis has put pressure on British Columbia’s health care workers, first responders, and resources, the intersection of the COVID-19 pandemic and the Opioid Epidemic has brought about critical rhetorical and social changes. Among the devastation of each crisis is hope for meaningful changes in our perception of addiction, sickness and suffering. These experiences are never confined to just the individual.
Works Cited
“B.C. had the highest rate of hate crimes in the country during the first year of COVID-19 pandemic.” CBC News, 17 Mar. 2022, https://www.cbc.ca/news/canada/british-columbia/bc-hate-crime-statistics-1.6388519. Accessed 15 Nov. 2022.
Escobar, Natalie. “When Xenophobia Spreads like a Virus.” Code Switch, 4 Mar. 2020. https://www.npr.org/2020/03/02/811363404/when-xenophobia-spreads-like-a-virus. Accessed 4 Apr. 2022.
Farnworth, Mike. More than 2,200 British Columbians lost to illicit drugs in 2021. BC Gov News, 2022, https://news.gov.bc.ca/releases/2022PSSG0010-000188. Accessed 4 Apr. 2022.
Fischer, Benedikt; Vojtila, Lenka; Rhem, Jürgen. “The ‘fentanyl epidemic’ in Canada – some cautionary observations focusing on opioid-related mortality.” Preventative Medicine, vol. 107, pp. 109-113.
Goldman, Brian. “SafeSpace App – How ‘scary’ ER visit led to an app that allows Indigenous patients to share stories of racism in health care.” White Coat, Black Art, from CBC Radio, 18 June 2020, https://www.cbc.ca/radio/whitecoat/how-scary-er-visit-led-to-an-app-that-allows-indigenous-patients-to-share-stories-of-racism-in-health-care-1.6065355.
Kopelson, Karen. “What a Difference a Body Makes: Addiction Studies and the Authority of Experience.” Rhetoric of Health & Medicine, vol. 3, no. 3, 2020, pp. 350-370.
Leibowitz-Lord, Sam. “The COR Syndemic: The Overlap of COVID-19, Opioids, and Systemic Racism in Healthcare.” Rutgers Center of Alcohol & Substance Use Studies. https://alcoholstudies.rutgers.edu/the-cor-syndemic-the-overlap-of-covid-19-opioids-and systemic-racism-in-healthcare/. Accessed 4 Apr. 2022.
Spoel, Philippa; Lacelle, Naomi; Millar, Alexandra. “Constituting good health citizenship through British Columbia’s COVID-19 public updates.” Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 2021, pp. 1-19.
Stats, BC COVID-19 Support App. bc.thrive.health. 2022, https://bc.thrive.health/covid19app/stats. Accessed 4 April 2022.
Wald, Priscilla. Introduction. Contagious: Cultures, Carriers, and the Outbreak Narrative, by Wald, Duke University Press, 2008, pp. 1-28.