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The War on Drugs Comes to the Pharmacy Counter: Frontline Work in the Shadow of Discrepant Institutional Logics

Published online by Cambridge University Press:  27 December 2018

Elizabeth Chiarello
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Abstract

Increasingly punitive attempts to curb prescription drug misuse constitute an expansion of the “War on Drugs” into mainstream medicine, leaving frontline health care providers caught between competing institutional logics of treatment and punishment. This study brings an institutional approach to frontline work by empirically examining how pharmacists manage discrepant logics while deciding whether to provide abusable medications and devices. Analyses of semistructured interviews with seventy‐one retail pharmacists in the United States reveal that pharmacists manage discrepant logics by engaging in two gatekeeping processes—medical and legal—that lend themselves to different identities, epistemologies, field foci, patterns of action, and interpersonal orientations. Pharmacists' decisions have implications for patients' access to care and exposure to the criminal justice system. Findings advance theories of frontline work by systematically examining the interplay between elements of institutional environments and decision making and yield policy considerations as states increasingly monitor patients and providers through prescription monitoring programs.

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Articles
Information
Law & Social Inquiry , Volume 40 , Issue 1 , Winter 2015 , pp. 86 - 122
Copyright
Copyright © American Bar Foundation, 2015 

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References

References

Abbott, Andrew 1988. The System of Professions: An Essay on the Division of Expert Labor. Chicago, IL: University of Chicago Press.Google Scholar
Abood, Richard R. 2011. Pharmacy Practice and the Law. Sudbury, MA: Jones and Bartlett.Google Scholar
Acker, Caroline J. 2002. Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control. Baltimore, MD: Johns Hopkins University Press.Google Scholar
Albiston, Catherine R. 2005. Bargaining in the Shadow of Social Institutions: Competing Discourses and Social Change in Workplace Mobilization of Civil Rights. Law & Society Review 39 (1): 11–50.Google Scholar
American Medical Association. 2013. AMA Response to Drug Store Chain Intrusion into Medical Practice. Chicago, IL: American Medical Association.Google Scholar
Baker, Kimberly M. 2012. Decision Making in a Hybrid Organization: A Case Study of a Southwestern Drug Court Treatment Program. Law & Social Inquiry 38 (1): 27–54.Google Scholar
Barley, Stephen R. 1986. Technology as an Occasion for Structuring: Evidence from Observations of CT Scanners and the Social Order of Radiology Departments. Administrative Science Quarterly 31 (1): 78–108.Google Scholar
Baumgartner, Mary Pat 1993. The Myth of Discretion. In The Uses of Discretion, ed. Hawkins, Keith, 129–162. New York: Oxford University Press.Google Scholar
Binder, Amy 2007. For Love and Money: Organizations' Creative Responses to Multiple Environmental Logics. Theory and Society 36 (6): 547–571.Google Scholar
Brown, Michael K. 1981. Working the Street: Police Discretion and the Dilemmas of Reform. New York: Russell Sage Foundation.Google Scholar
Castellano, Ursula 2011. Courting Compliance: Case Managers as “Double Agents” in the Mental Health Court. Law & Social Inquiry 36 (2): 484–514.Google Scholar
Catan, Thomas, and Perez, Evan 2012. A Pain‐Drug Champion Has Second Thoughts. Wall Street Journal. http://online.wsj.com/news/articles/SB10001424127887324478304578173342657044604 (accessed May 7, 2014).Google Scholar
Centers for Disease Control and Prevention. 2011. Prescription Drug Overdoses: An American Epidemic. http://www.cdc.gov/cdcgrandrounds/archives/2011/01‐february.htm.Google Scholar
Charmaz, Kathy 2006. Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Thousand Oaks, CA: Sage.Google Scholar
Chiarello, Elizabeth 2011. Pharmacists of Conscience: Ethical Decision‐Making and Consistency of Care. 3472822. Irvine, CA: University of California.Google Scholar
Chiarello, Elizabeth 2013. How Organizational Context Affects Bioethical Decision‐Making: Pharmacists' Management of Gatekeeping Processes in Retail and Hospital Settings. Social Science & Medicine 98:319–329.Google Scholar
Conrad, Peter, and Schneider, Joseph W. 1992. Deviance and Medicalization: From Badness to Sickness, expanded ed. Philadelphia, PA: Temple University Press.Google Scholar
Corbin, Juliet, and Strauss, Anselm 2008. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Los Angeles, CA: Sage.Google Scholar
Courtwright, David T. 1982. Dark Paradise: Opiate Addiction in America before 1940. Cambridge, MA: Harvard University Press.Google Scholar
Cowen, David L. 1992. Changing Relationship Between Pharmacists and Physicians. American Journal of Health‐System Pharmacy 49 (11): 2715–2721.Google Scholar
Denzin, Norman K., and Mettlin, Curtis J. 1968. Incomplete Professionalization: The Case of Pharmacy. Social Forces 46 (3): 375–381.Google Scholar
Drug Abuse Warning Network. 2010. Highlights of the 2009 Drug Abuse Warning Network (DAWN) Findings on Drug‐Related Emergency Department Visits. Rockville, MD: Center of Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.Google Scholar
Drug Enforcement Administration. 2012. DEA Suspends for Two Years Pharmaceutical Wholesale Distributor's Ability to Sell Controlled Substances from Lakeland, Florida Facility. http://www.justice.gov/dea/pubs/pressrel/pr051512.html (accessed April 19, 2013).Google Scholar
Dunn, Mary B., and Jones, Candace 2010. Institutional Logics and Institutional Pluralism: The Contestation of Care and Science Logics in Medical Education, 1967–2005. Administrative Science Quarterly 55 (1): 114–149.Google Scholar
Elias, Paul 2012. FedEx, UPS Investigated for Online Drug Shipments. Seattle Times. http://seattletimes.com/html/health/2019692133_apusonlinepharmaciesshippersinvestigated.html (accessed November 15, 2013).Google Scholar
Executive Office of the President of the United States. 2011. Epidemic: Responding to America's Prescription Drug Abuse Crisis. Washington, DC: Government Printing Office.Google Scholar
Feldman, Martha S. 1992. Social Limits to Discretion: An Organizational Perspective. In The Uses of Discretion, ed. Hawkins, Keith, 163–183. New York: Oxford University Press.Google Scholar
Feldman, Martha S., and Pentland, Brian T. 2003. Reconceptualizing Organizational Routines as a Source of Flexibility and Change. Administrative Science Quarterly 48 (1): 94–118.Google Scholar
Fine, Gary Alan 1984. Negotiated Orders and Organizational Cultures. Annual Review of Sociology 10:239–262.Google Scholar
Freidson, Eliot 1970. Professional Dominance: The Social Structure of Medical Care. New York: Atherton Press.Google Scholar
Freidson, Eliot 1986. Professional Powers: A Study of the Institutionalization of Formal Knowledge. Chicago, IL: University of Chicago Press.Google Scholar
Friedland, Roger, and Alford, Robert R. 1991. Bringing Society Back In: Symbols, Practices, and Institutional Contradictions. In The New Institutionalism in Organizational Analysis, ed. Powell, Walter W. and DiMaggio, Paul J., 232–263. Chicago, IL: University of Chicago Press.Google Scholar
Gast, Scott 2002. Who Defines “Legitimate Medical Practice?” Lessons Learned from the Controlled Substances Act, Physician‐Assisted Suicide, & Oregon v. Ashcroft . Virginia Journal of Social Policy and the Law 10:1–27.Google Scholar
Glaser, Barney G., and Strauss, Anselm L. 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago, IL: Aldine.Google Scholar
Goffman, Erving 1963. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice‐Hall.Google Scholar
Goode, Erich 2008. Drugs in American Society, 8th ed. New York: McGraw‐Hill.Google Scholar
Gostin, Lawrence O., Lazzarini, Zita, Jones, T. Stephen, and Flaherty, Kathleen 1997. Prevention of HIV/AIDS and Other Blood‐Borne Diseases Among Injection Drug Users: A National Survey on the Regulation of Syringes and Needles. Journal of the American Medical Association 277 (1): 53–62.Google Scholar
Grant, Don, Morales, Alfonso, and Sallaz, Jeffrey J. 2009. Pathways to Meaning: A New Approach to Studying Emotions at Work. American Journal of Sociology 115 (2): 327–364.Google Scholar
Harris, Elizabeth A. 2011. Robber Kills 4 in L.I. Pharmacy; One Victim Is a 17‐Year‐Old Girl. New York Times. http://www.nytimes.com/2011/06/20/nyregion/gunman‐kills‐4‐in‐a‐long‐island‐pharmacy.html?_r=0 (accessed June 19, 2013).Google Scholar
Harrits, Gitte Sommer, and M⊘ller, Marie Østergaard 2013. Prevention at the Front Line: How Home Nurses, Pedagogues, and Teachers Transform Public Worry into Decisions on Special Efforts. Public Management Review 16 (4): 1–34. doi: 10.1080/14719037.2013.841980.Google Scholar
Heimer, Carol 1999. Competing Institutions: Law, Medicine, and Family in Neonatal Intensive Care. Law & Society Review 33 (1): 17–66.Google Scholar
Hellman, Deborah 2008. Prosecuting Doctors for Trusting Patients. George Mason Law Review 16:701–745.Google Scholar
Herbert, Steve 1996. Morality in Law Enforcement: Chasing “Bad Guys” with the Los Angeles Police Department. Law & Society Review 30 (4): 799–818.Google Scholar
Johnston, Jocelyn M., and Romzek, Barbara S. 2010. The Promises, Performance, and Pitfalls of Government Contracting. In The Oxford Handbook of American Bureaucracy, ed. Durant, Robert F., 396–420. New York: Oxford University Press.Google Scholar
Johnston, Lloyd D., O'Malley, Patrick M., Miech, Richard A., Bachman, Jerald G., and Schulenberg, John E. 2013. Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2011. Ann Arbor, MI: Institute for Social Research, University of Michigan.Google Scholar
Kelly, Brian C. 2013. Considering the Gray Pharmaceutical Market: The Use of Prescription Drugs from Non‐Medical Sources for Medicalized Problems Among Young Adults. Paper presented at the Law and Society Association, Boston, MA, May 30.Google Scholar
Larson, Magali Sarfatti 1977. The Rise of Professionalism: A Sociological Analysis. Berkeley, CA: University of California Press.Google Scholar
Libby, Ronald T. 2008. The Criminalization of Medicine: America's War on Doctors. Westport, CT: Praeger.Google Scholar
Lipsky, Michael 1980. Street‐Level Bureaucracy: Dilemmas of the Individual in Public Services. New York: Russell Sage Foundation.Google Scholar
Locke, Karen 2001. Grounded Theory in Management Research. Thousand Oaks, CA: Sage.Google Scholar
Locke, Karen, and Golden‐Biddle, Karen 2002. An Introduction to Qualitative Research: Its Potential for Industrial and Organizational Psychology. In Handbook of Research Methods in Industrial and Organizational Psychology, ed. Rogelberg, Steven G., 99–118. Malden, MA: Blackwell.Google Scholar
Lofland, John 2006. Analyzing Social Settings: A Guide to Qualitative Observation and Analysis. Belmont, CA: Wadsworth/Thomson Learning.Google Scholar
Lowry, Fran 2013. FDA Panel Calls for Greater Restrictions on Hydrocodone. Medscape Today News. http://www.medscape.com/viewarticle/778275 (accessed January 28, 2014).Google Scholar
Manchikanti, L. 2006. Prescription Drug Abuse: What Is Being Done to Address This New Drug Epidemic? Testimony Before the Subcommittee on Criminal Justice, Drug Policy and Human Resources. Pain Physician 9 (4): 287–321.Google Scholar
Manning, Peter K. 1992. “Big Bang” Decisions: Notes on a Naturalistic Approach. In The Uses of Discretion, ed. Hawkins, Keith, 249–285. New York: Oxford University Press.Google Scholar
Maynard‐Moody, Steven, and Musheno, Michael 2003. Cops, Teachers, Counselors: Stories from the Front Lines of Public Service. Ann Arbor, MI: University of Michigan Press.Google Scholar
Maynard‐Moody, Steven, and Musheno, Michael 2012. Social Equities and Inequities: Street‐Level Workers as Agents and Pragmatists. Public Administration Review 72 (s1): S16–S23.Google Scholar
Maynard‐Moody, Steven, and Portillo, Shannon 2010. Street‐Level Bureaucracy Theory. In The Oxford Handbook of American Bureaucracy, ed. Durant, Robert F., 252–277. New York: Oxford University Press.Google Scholar
Mayo Clinic. 2012. Prescription Drug Abuse. http://www.mayoclinic.com/health/prescription‐drug‐abuse/DS01079 (accessed May 7, 2014).Google Scholar
Meier, Barry 2003. Pain Killer: A “Wonder” Drug's Trail of Addiction and Death. Emmaus, PA: Rodale Books.Google Scholar
Meier, Barry 2012. A New Painkiller Crackdown Targets Drug Distributors. New York Times. http://www.nytimes.com/2012/10/18/business/to‐fight‐prescription‐painkiller‐abuse‐dea‐targets‐distributors.html (accessed October 17, 2014).Google Scholar
Mills, C. Wright 1940. Situated Actions and Vocabularies of Motive. American Sociological Review 5 (6): 904–913.Google Scholar
Musheno, Michael, and Maynard‐Moody, Steven Forthcoming. The End of Discretion: Choreographing the Normative Ordering and Pragmatic Improvisation of Front‐Line Work. In Understanding Street‐Level Bureaucrats: On How They Work and Are Being Managed, ed. Hupe, Peter, Hill, Michael, and Buffat, Aurélien Bristol: Policy Press.Google Scholar
Musto, David F. 1999. The American Disease: Origins of Narcotic Control, 3rd ed. New York: Oxford University Press.Google Scholar
Nelson, Robert L., and Nielsen, Laura Beth 2000. Cops, Counsel, and Entrepreneurs: Constructing the Role of Inside Counsel in Large Corporations. Law & Society Review 34 (2): 457–494.Google Scholar
Office of Diversion Control. 2013. Program Description. http://www.deadiversion.usdoj.gov/prog_dscrpt/index.html (accessed May 6, 2014).Google Scholar
Office of National Drug Control Policy. 2011. A Response to the Epidemic of Prescription Drug Abuse. Washington, DC: Government Printing Office.Google Scholar
Office of National Drug Control Policy. 2012. Prescription Drug Abuse. http://www.whitehouse.gov/ondcp/prescription‐drug‐abuse (accessed May 6, 2014).Google Scholar
Oppmann, Patrick 2011. Addicts Putting Pharmacies Under Seige. CNN Health. http://www.cnn.com/2011/HEALTH/06/03/drugstore.robberies/index.html (accessed April 15, 2013).Google Scholar
Paik, Leslie 2011. Discretionary Justice: Looking Inside a Juvenile Drug Court. New Brunswick, NJ: Rutgers University Press.Google Scholar
PMP Alliance. n.d. Available from http://www.pmpalliance.org/.Google Scholar
PMP Center of Excellence. n.d. Addressing the Problem. http://www.pmpexcellence.org/content/addressing‐problem (accessed April 14, 2014).Google Scholar
Prottas, Jeffrey Manditch 1979. People Processing: The Street‐Level Bureaucrat in Public Service Bureaucracies. Lexington, MA: Lexington Books.Google Scholar
Reay, Trish, and Hinings, C. R. 2009. Managing the Rivalry of Competing Institutional Logics. Organization Studies 30 (6): 629–652.Google Scholar
RxPatrol. 2013. Available from http://www.rxpatrol.com/newsroom.aspx.Google Scholar
Scott, Marvin B., and Lyman, Stanford M. 1968. Accounts. American Sociological Review 33 (1): 46–62.Google Scholar
Soss, Joe, Fording, Richard C., and Schram, Sanford 2011. Disciplining the Poor: Neoliberal Paternalism and the Persistent Power of Race. Chicago, IL: University of Chicago Press.Google Scholar
Spillane, Joseph F. 2000. Cocaine: From Medical Marvel to Modern Menace in the United States, 1884–1920, Studies in Industry and Society. Baltimore, MD: Johns Hopkins University Press.Google Scholar
Spillane, Joseph F., and McAllister, William B. 2003. Keeping the Lid On: A Century of Drug Regulation and Control. Drug and Alcohol Dependence 70 (3): S5–S12.Google Scholar
Stablein, Timothy, and Anthony, Denise 2012. Privacy, Information Exchanges, and the Stigmatizing Role of the Electronic Health Record. Paper presented at the Eastern Sociological Society, New York, February 23.Google Scholar
Strauss, Anselm, Schatzman, Leonard, Ehrlich, Danuta, Bucher, Rue, and Sabshin, Melvin 1963. The Hospital and Its Negotiated Order. In The Hospital in Modern Society, ed. Freidson, Eliot, 147–169. New York: Free Press of Glencoe.Google Scholar
Substance Abuse and Mental Health Services Administration. 2011. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
Suchman, Mark C., and Swider, Sarah 2012. A Time of Confidences: Public Perceptions of Medical Privacy in the Wake of HIPAA. Paper presented at the International Conference on Law and Society, Honolulu, HI, June 8.Google Scholar
Swidler, Ann 1986. Culture in Action: Symbols and Strategies. American Sociological Review 51 (2): 273–286.Google Scholar
The Project on Harm Reduction in the Health Care System. 2008. Non‐Prescription Access to Sterile Syringes. http://www.temple.edu/lawschool/phrhcs/otc.htm (accessed April 15, 2012).Google Scholar
Thornton, Patricia H., and Ocasio, William 2008. Institutional Logics. In The Sage Handbook of Organizational Institutionalism, ed. Greenwood, Royston, Oliver, Christine, Sahlin, Kerstin, and Suddaby, Roy, 99–129. Thousand Oaks, CA: Sage.Google Scholar
Thornton, Patricia H., Ocasio, William, and Lounsbury, Michael 2012. The Institutional Logics Perspective: A New Approach to Culture, Structure, and Process. New York: Oxford University Press.Google Scholar
US Department of Justice Drug Enforcement Administration. 2014. A Pharmacist's Guide to Prescription Fraud. http://www.deadiversion.usdoj.gov/pubs/brochures/pharmguide.htm (accessed January 14, 2014).Google Scholar
Wang, Jing, and Christo, Paul J. 2009. The Influence of Prescription Monitoring Programs on Chronic Pain Management. Pain Physician 12 (3): 507–515.Google Scholar
Yngvesson, Barbara 1993. Virtuous Citizens, Disruptive Subjects: Order and Complaint in a New England Court, After the Law. New York: Routledge.Google Scholar

Cases Cited

Gordon v. Frost, 388 S.E.2d 362 (1989 GA).Google Scholar
Ryan v. Dan's Food Stores, Inc., 972 P.2d 395 (UT 1998).Google Scholar
United States v. Hayes, 595 F.2d 258 (5th Cir. 1979).Google Scholar
United States v. Lawson, 682 F.2d 480 (4th Cir. 1982).Google Scholar
Webb v. United States, 249 U.S. 96, 99 (1919).Google Scholar

Statutes Cited

Federal Comprehensive Drug Abuse Prevention and Control Act of 1970, 21 U.S.C. §§ 801–970.Google Scholar
Harrison Narcotics Tax Act, 38 Stat. 85 (1914).Google Scholar
Methamphetamine Production Prevention Act of 2008, P.L. 110–415.Google Scholar
21 C.F.R. § 1306.04(a).Google Scholar