One of America’s leading experts on addiction battles drugs, HIV, and racism in this absorbing memoir.
Primm, an anesthesiologist by training, helped found the Addiction Research and Treatment Corporation, a pioneering drug-treatment program in Brooklyn, and directed the Federal Office of Treatment Improvement under President George H. W. Bush. His reminiscences afford an insider’s view of policy shifts during the explosion of drug abuse in the 1960s and ’70s, when the earlier emphasis on punishment gave way to a medical approach focused on weaning users off dependency, including long-term methadone-maintenance therapy for heroin addiction. Primm recounts intense controversies surrounding drug-treatment innovations: he was initially skeptical of long-term methadone maintenance himself and endured criticism from other doctors for supplementing inpatient treatment with outpatient centers that could accommodate impoverished addicts while providing social services. There’s a guerilla-warfare feel to these anecdotes, with activists squatting in abandoned buildings they want for rehab centers, invading government offices to demand funding, and coping with NIMBY violence. (Primm’s early drug-treatment facilities were targeted by neighborhood vandals and arsonists, and he was confronted by machete-carrying black militants who considered methadone just another white man’s drug that would keep their community addicted.) He continues on to his experiences during the AIDS epidemic, when he founded the Brooklyn AIDS Task Force and lobbied for federal support for needle-exchange programs and greater attention to the intertwining of drug abuse and AIDS. Primm, who is African-American, discusses how disadvantages and discrimination exacerbate sociomedical crises in minority communities; his personal saga—the lack of openings for black students in the 1950s forced him to go to Europe for medical school—makes these observations more resonant. He and amanuensis Friedman tell the story in lucid, straightforward, rather subdued prose that conveys fraught incidents in a matter-of-fact style. One wishes that Primm had given more space to the science of addiction, but his narrative of policy implementation captures important aspects of crucial episodes in American health care.
An interesting, informative firsthand account of how medicine and government grappled with two plagues that reshaped society.