Remaking The Meaning of Dependence: The Case of a Supervised Injection Site
Bibliographic record
Abstract
What role can the state play in fostering autonomy in citizens who are dependent on drugs, but also deeply stigmatized, marginalized, and disenfranchised? In this paper I draw on interviews conducted with people associated with Insite, North America’s first and only supervised injection facility located in Vancouver, Canada, as well as philosophical accounts of autonomy to consider this question. At Insite, a government funded facility, injection drug users can consume pre-obtained illegal drugs under medical supervision. Fostering autonomy entails on the one hand, putting in place the relational, embodied, and material support necessary to facilitate the capacity for autonomy, the capacity to determine one’s ends or meaningfully shape one’s life plans, and on the other hand, creating the conditions wherein people are ascribed the status of an autonomous individual. In order for the state to achieve both goals where drug users and other marginalized people who are classified as dependent are concerned, it must generate institutional and social conditions that reshape the meaning of stigmatized forms of dependence. I argue that through services delivered at Insite the state is relatively successful in creating some of the institutional and material conditions for recreating the meaning of dependence on drugs (addiction) and therefore fostering autonomy. However, because of the political context in which the struggle to keep the doors of Insite open has taken place and, in turn, the ensuing public health discourse adopted by its advocates, there are limitations to the state’s ability to use Insite as a means for reconceiving dependence in such a away that it fosters the recognition-elements of autonomy. Though political expedient, the public health discourse limits recognition of autonomy in favor of recognition of “humanity,” which has different implications. This speaks more broadly to some of the limitations the state may face in attempting to foster autonomy. Nonetheless, the expanded opportunity for capacity-based autonomy that Insite offers may also provide the tools for other means of generating recognition.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.032 | 0.067 |
| Scholarly communication | 0.009 | 0.010 |
| Open science | 0.002 | 0.014 |
| Research integrity | 0.008 | 0.015 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".