Problematising the 'evidence-based' drug policy paradigm

Abstract

'Evidence-based policy' has become the catch-cry of the drug policy field. A growing literature has been dedicated to realising the goal of ‘evidence-based’ drug policy: to maximise the use of quality research to inform decision-making and help answer the question of 'what works.' The aim of this thesis was to problematise the premise of the 'evidence-based policy' paradigm and, by interrogating underlying taken-for-granted assumptions, consider the implications and effects of this dominant mode of governance for drug policy. This research was informed by a range of critical perspectives, particularly the work of Carol Bacchi (whose Foucauldian-influenced approach is underpinned by social construction theory, poststructuralism, feminist body theory and governmentality studies). A qualitative multiple-case study design was employed, comparing three drug policy issues in Australia: (i) discussion of 'recovery' approaches to drug treatment; (ii) the development of approaches to extend distribution of injecting equipment through peers in Sydney; and (iii) processes leading to the establishment of programs to make naloxone available to opioid overdose witnesses in Canberra and Sydney. The case studies drew on documentary sources and semi-structured interviews (n=41) with policy makers, advocates, researchers and clinicians closely involved in these processes. By examining the productive techniques and constitutive effects of both drug policies and 'evidence-based policy' discourse, this research revealed how policies constitute the 'problems' they purport to address (Paper 1) and the discursive, subjectification and lived effects that flow from particular problem representations (Paper 2); how knowledge ('evidence') is legitimised (Paper 3) and constituted by specific performances (Paper 5); and how political subjects (such as 'consumers') are enacted in the material-discursive practices of 'evidence-based policy' (Paper 4). A reflexive account of the research is also given (Paper 6). By scrutinising the premise and effects of 'evidence-based policy,' and highlighting the contingent nature of 'problems,' 'subjects' and the object of 'evidence' itself, this research contributes to a body of poststructuralist scholarship which has used the 'problematisation' framework to examine the political implications of the taken-for-granted status of 'evidence-based policy' discourse, leading to considerations for how drug policy and 'evidence' may be otherwise enacted.