How We Hurt: The Politics of Pain in the

Opioid Epidemic Melina Sherman

Visit to download the full and correct content document:
https://ebookmass.com/product/how-we-hurt-the-politics-of-pain-in-the-opioid-epidemi
c-melina-sherman/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

The Right to Pain Relief and Other Deep Roots of the

Opioid Epidemic Mark D. Sullivan

https://ebookmass.com/product/the-right-to-pain-relief-and-other-
deep-roots-of-the-opioid-epidemic-mark-d-sullivan/

The Opioid Epidemic: What Everyone Needs to Know 1st

Edition Yngvild Olsen

https://ebookmass.com/product/the-opioid-epidemic-what-everyone-
needs-to-know-1st-edition-yngvild-olsen/

A Public Health Guide to Ending the Opioid Epidemic Jay

C. Butler (Editor)

https://ebookmass.com/product/a-public-health-guide-to-ending-
the-opioid-epidemic-jay-c-butler-editor/

Fighting the Opioid Epidemic: The Role of Providers and

the Clinical Laboratory in Understanding Who is
Vulnerable 1st Edition Amitava Dasgupta

https://ebookmass.com/product/fighting-the-opioid-epidemic-the-
role-of-providers-and-the-clinical-laboratory-in-understanding-
who-is-vulnerable-1st-edition-amitava-dasgupta/
Pain-Induced Negative Affect Is Mediated via
Recruitment of The Nucleus Accumbens Kappa Opioid
System

https://ebookmass.com/product/pain-induced-negative-affect-is-
mediated-via-recruitment-of-the-nucleus-accumbens-kappa-opioid-
system/

Coercion: The Power to Hurt in International Politics

1st Edition Kelly M. Greenhill

https://ebookmass.com/product/coercion-the-power-to-hurt-in-
international-politics-1st-edition-kelly-m-greenhill/

We're Still Here: Pain and Politics in the Heart of

America Jennifer M. Silva

https://ebookmass.com/product/were-still-here-pain-and-politics-
in-the-heart-of-america-jennifer-m-silva/

Who We Are and How We Got Here: Ancient DNA and the new
science of the human past David Reich

https://ebookmass.com/product/who-we-are-and-how-we-got-here-
ancient-dna-and-the-new-science-of-the-human-past-david-reich/

Energy, Entropy, and the Flow of Nature Thomas F.

Sherman

https://ebookmass.com/product/energy-entropy-and-the-flow-of-
nature-thomas-f-sherman/
How We Hurt
 How We Hurt
The Politics of Pain in the Opioid Epidemic
MELINA SHERMAN
 Oxford University Press is a department of the University of Oxford. It furthers the
University’s objective of excellence in research, scholarship, and education by publishing
worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and
certain other countries.
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.
© Oxford University Press 2024
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, without the prior permission in
writing of Oxford University Press, or as expressly permitted by law, by license, or under
terms agreed with the appropriate reproduction rights organization. Inquiries concerning
reproduction outside the scope of the above should be sent to the Rights Department,
Oxford University Press, at the address above.

You must not circulate this work in any other form and you must impose this same
condition on any acquirer.
Library of Congress Cataloging-in-Publication Data
Names: Sherman, Melina, author.
Title: How we hurt : the politics of pain in the opioid epidemic / Melina Sherman.
Description: New York, NY : Oxford University Press, [2024] |
Includes bibliographical references and index. |
Identifiers: LCCN 2023011323 (print) | LCCN 2023011324 (ebook) |
ISBN 9780197698235 (paperback) | ISBN 9780197698228 (hardback) |
ISBN 9780197698259 (epub) | ISBN 9780197698266
Subjects: LCSH: Opioid abuse—United States. | Chronic
pain—Treatment—United States.
Classification: LCC HV5825 .S4499 2024 (print) | LCC HV5825 (ebook) |
DDC 362.29/3—dc23/eng/20230322
LC record available at https://lccn.loc.gov/2023011323
LC ebook record available at https://lccn.loc.gov/2023011324
DOI: 10.1093/oso/9780197698228.001.0001
To all of those who live in pain.
 Contents

Acknowledgments

Opening
1. Tracing the Painkiller Revolution
2. Strategic Ignorance in Opioid Regulation
3. Branding Pain Relief
4. Self-Help and the Rise of the Pain Patient-Expert
5. Pain’s New Faces
Closing

References
Index
 Acknowledgments

I did not write this book alone. Many people, in many different
places around the world, helped me do it.
The first to acknowledge are the following members of my
dissertation committee in Los Angeles, who read and reread this text
in its earliest form and told me that it was, in fact, a book.
Patti Riley, thank you for helping me figure out how to write a
dissertation as a book from the get-go. You told me that I needed to
tell a compelling story, and that’s what I’ve worked hardest to try to
do.
Chris Smith, we’ve had many a productive conversation in your
office. There, you pushed me to think more deeply about the cultural
dynamics that color the landscape of opioids and pain. I hope I did
our conversations justice.
Henry Jenkins, who took me on last minute as his advisee, also
shared with me that, sometimes, it’s better to ask for forgiveness
rather than permission. Well, that’s what we did, and it worked!
Sarah Banet-Weiser, my advisor and friend, thank you for letting
me choose this as my dissertation topic. I know it was a drastic
departure from what I had initially planned to write, but you
supported me, nonetheless. And even though I still don’t always
believe that the rules apply to me, I won’t forget that it was you who
let me spread my scholarly wings. Chapter 3 is for you, sister.
And Andy Lakoff, who was (and continues to be) a brilliant
advisor and one of the smartest people I know. Your intellectual
contributions are spread out all over these pages. Thank you for so
many an office hour discussing Foucault’s biopolitics. I still have the
notes I wrote then, and I refer to them often.
Outside of my committee, several other scholars provided me
with advice and inspiration. I drew heavily on their experience and
work when developing this project. They are Marcia Meldrum, Kelly
Ray Knight, Eugene Raikhel, Helena Hansen, and Emily Martin.
Aside from researching, teaching, and writing a dissertation, I
was lucky enough to form many friendships in the doctoral program
at the University of Southern California. From each of these friends,
I collected advice and drew inspiration. Thanks for that, Andrea
Wenzel, Shabnam Shalizi, Dan O’Reilly-Rowe, Anna Loup, Nathalie
Maréchal, Lik Sam Chan, Katie Elder, MC Forelle, Perry Johnson,
Courtney Cox, and Kristen Steves.
After graduate school (and a stint in Brazil), I moved to
Manhattan to work at New York University with Eric Klinenberg, who,
during my postdoctoral appointment, graciously gave me both the
time and encouragement I needed to revise the manuscript. The
method of social autopsy is one of several of your ideas that
animates these pages, and which I believe improved the book.
I’d be remiss not to also thank my colleagues at Knology in New
York City, especially Rebecca, Jena, and John. Your friendship and
solidarity give me excellent reasons to get to work, and you’ve
cheered me on, on the many occasions when I’ve referenced this
project.
Then, I must also thank the anonymous reviewers who read and
reread this text, and who made insights and suggestions that greatly
improved it. And a big thank you to my editors at Oxford University
Press in the United Kingdom and New York, who brought this idea to
fruition.
Outside of work, Mom and Dad, my sister Marisa, and my
grandparents were crucial in providing me with limitless love and
support. Without them, all of this would have been but a dream.
Somewhere between Barcelona and California is my dear friend
Manuel Castells, who always believed in this project and urged me to
keep going, even when I had decided I would never write or think
again. Te lo agradezco, mucho.
Here in Brazil, where I currently live, I am motivated by my two
fierce stepchildren, Luiza and Rafael. Your unbridled enthusiasm for
politics, history, and human rights inspires me more than you will
ever know.
 And finally, I owe this book to my husband, Marcelo. How many
hours have you spent listening to my digressions on the politics of
pain, the many meanings of health, and my hopes for the future of
drug policy? You pushed me even when I was unwilling to be pushed
and have been the best sounding board I could have ever asked for.
Obrigada, meu companheiro, meu lar, e meu amor.
 Opening

In early 2018, TIME magazine published an online photojournalism

series on what has become known as the U.S. “opioid epidemic.”
“The Opioid Diaries” requires visitors to scroll down through a series
of black-and-white photographs, each of which is accompanied by
captions and quotes. In the first image, situated at the very top of
the page, a man and woman are photographed crouching in the
back of a van, which the caption says is parked in San Francisco.
Inside it, the couple balances on their shins as they aim needles full
of clear liquid at the veins they’ve found in each other’s arms.
Further down the page is a pick-up truck with a man named Chad
reclining in the driver’s seat. His body is lax and, although his eyes
are open, his head is cocked backward so far that it nearly escapes
the frame. He overdosed shortly before the picture was taken and
now lies in a state of semiconsciousness as a trio of paramedics
leans through the truck’s open door and try to revive him. Below
Chad’s image is a photograph of two people—a elderly woman and a
young man—embracing inside a funeral parlor in New Hampshire.
The woman’s 24-year-old granddaughter, Michaela, can be seen in
the background lying colorless and quiet inside her open casket.
Scrolling down, a quote appears in large block letters on the screen;
they belong to an Ohio sheriff who, commenting on what he’s seen
of the opioid epidemic in his own state, says simply, “It’s nonstop.
It’s every day.”
Continuing down the page, a woman in Boston squats on a
mound of dirty snow. Whether because of overuse or the dropping
temperature, she is struggling to find a vein. Below her, a homeless
grandmother injects heroin next to a shopping cart full of her
belongings. She is followed by a series of police officers. Each is
accompanied by overdose victims, whose limp bodies were found on
the side of the road in New Mexico, or stretched out on a bed in
Ohio, or crumpled in a heap on the kitchen floor. With every
movement of the mouse, more and more photos appear on the
screen, more and more people, though most of them are bodies—
depictions of death found in every corner of the nation, from
Massachusetts and New Hampshire to Florida, Ohio, Kentucky, and
New Mexico. But finally, at the bottom of the page is an image of life
—a tiny baby, born just seconds before the photo was a taken. On
first glance, the photograph is a hopeful one, though the quote
accompanying it tells a different story. For this little girl is but one of
the many children who, from the moment they enter the world, are
destined “to be born addicted.” She, and the others like her, are not
symbols of hope, nor of life, but of a bleak and provisional endpoint:
The first book in “The Opioid Diaries” may be full, but another one
sits on the shelf beside it—a stack of blank pages waiting to be filled
by the next generation of corpses-in-waiting and the stories they’ll
tell about a future where nothing is getting any better.
The story offered to us in the “The Opioid Diaries” not only
describes a desperate reality located in the present but also lays out
a nightmarish trajectory of the future—a story set in motion by the
descent of so many people into the labyrinth of addiction. This dark
space that, as all of the images described above suggest, is occupied
by ever-expanding networks of drugs, death, and, perhaps most
tellingly, of pain. The networks of pain that encompass people who
use opioids, their families, as well as social workers, counselors, and
police officers, among others, have been growing exponentially over
the past 20 years and yet show no signs of stagnating—at least not
anytime soon.
But while “The Opioid Diaries” and many other striking news
stories like it point to opioid use and addiction as the key problems
that define the current crisis, I disagree. I want to suggest, as this
book does, that understanding opioid epidemic—what it is, how it
evolved, and how it gained meaning and significance among the
American population—is a story that is better told through the lens
of pain. After all, it was pain and, specifically, the various moves that
rendered certain pain medications legible as safe and popular drugs
of choice that helped us get here in the first place. Borrowing a term
used in popular parlance, it often seems as if we’re being pushed
down to “rock bottom,” while growing pain networks continue to
encompass more and more of us and the people we love.
It is no stretch to say, as many already have, that the ongoing
opioid epidemic represents the worst overdose crisis in modern
history—one that, over the past two decades, crept slowly but surely
into the lives of millions of people living in North America. The rate
at which Americans and Canadians are now overdosing and dying
from the use of opioid drugs is astonishing: Since 1999, U.S.
overdose deaths involving opioids have quintupled, to the extent
that drug overdoses now constitute the leading cause of accidental
death in the United States (CDC, 2017a, 2017b, 2017c). According to
the most recent CDC estimates, in 2021 alone, overdoses killed
nearly 108,000 Americans—a tally that far surpasses the total
number of fatalities caused by car accidents and gun violence
combined (Ahmad et a., 2022). Opioids, which account for 75% of
all drug overdoses, are the principal force driving up this body count.
While opioid overdoses were climbing throughout the 2000s, so
too was the problem of pain. The number of pain diagnoses from
2000 to 2009 show a gradual, yet stable, increase of about 3.3%
and then suddenly shot upward, marking a threefold increase from
2009 to 2010, with an even greater wave seen in chronic pain
diagnoses, which escalated 4.4-fold during those same years
(Murphy et al., 2017). Today, according to the CDC, more than 50
million Americans suffer from chronic pain. That’s about one-fifth of
the adult population and includes 20 million people who suffer from
what’s referred to as “high-impact” chronic pain, that is, pain that
limits their life in such a way that they can’t perform even the most
basic daily functions (Dahlhamer et al., 2018).
But looking at these parallel trends in opioids and pain, key
questions remain: What kinds of social forces underpin these
numbers? How did it happen that so many people in pain began
seeking out, receiving, and consuming opioids? After all, opioids
represent just one of many classes of pain-relieving medications,
including many over-the-counter options, nonsteroidal anti-
inflammatory drugs (NSAIDs), nonopioid analgesics, antiepileptic
drugs (AEDs) tricyclic antidepressants (TCAs), local anesthetics
(LAs), and more. How did it come to pass that opioids—the class of
pain relieving drugs with the longest and perhaps most well-known
history of dangerous side effects, overdose, and death—suddenly
took their place in the medicine cabinets of so many people in pain?
This problem of pain, which cannot be separated from the waves of
opioid supply and demand, is precisely what this book seeks to
understand.

The Problem of Pain

As I dug deeper into the opioid epidemic—its images, narratives, and
the stories of people who take opioids as well as those who
manufacture, prescribe, regulate, and police them—I realized that I
couldn’t answer any of the questions I had about opioids without
running into some kind of question or issue concerning pain. And in
the years I spent trying to learn everything I could about these
drugs—which meant sifting through decades of medical journal
articles, opioid advertisements, U.S. Food and Drug Administration
(FDA) meeting transcripts, court cases, congressional hearings, and
drug forum threads, among other things—I kept running into
institutional discussions and debates around opioids that either
revolved around, questioned, or were somehow stalled in the
process of trying to understand how pain works and how best to
deal with it.
In medicine, for example, arguments regarding the possibilities
and pitfalls of using opioids as a pain treatment were waged among
those with differing approaches to the problem of how to adequately
measure and treat the problem of patients’ pain. Those who saw
pain as a “vital sign,” an objectively measurable object equal in
importance to one’s heart rate, breathing rate, and temperature,
tended to advocate on behalf of opioid-based pain interventions,
while those who approached pain as a behavioral symptom of a
more complex social problem were often opposed to the uptake of
opioids in treating pain.
 Outside of the medical domain, the problem of pain has also been
a powerful tool in the cultivation of consumer demand for opioid
products. For instance, consider the rapid uptake of the now
notorious opioid OxyContin, which was made famous as the
painkiller that jump-started the current crisis. Many have attributed
this uptake to the wide-reaching and incredibly aggressive marketing
campaign that its manufacturer, Purdue Pharma, launched in order
to sell it. And while I certainly do not disagree, what I found in my
examination of Purdue’s campaign is that the successful branding of
OxyContin was better explained not in terms of the promotional
claims (many of which have since been outed as lies) that were
made about the drug itself, but in terms of the way in which Purdue
branded the problem of pain by defining it as the antithesis of
independence, self-reliance, and the American dream.
In every dimension attended to in this book—which includes the
evolution of opioid use in medical practice as well as in
pharmaceutical marketing, opioid regulation, the history of opioid
addiction, and popular culture—pain is the linchpin. In particular, the
way pain has been constructed within and outside medicine is key to
understanding how and why opioids became so widely prescribed in
the United States. The social construction of pain is what has led us
to the so-called “opioid revolution”—a phrase that has been used to
discuss the rapid popularization of opioid-based treatments in
medicine and their normalization in culture, more generally. On the
political stage, pain has informed calls made by politicians, patients,
and advocates alike to break away from the United States’
historically punitive stance toward opioid use and opt instead for a
more compassionate approach to the problem. In a number of
recent political speeches, pain is the affective link through which
politicians accrue support and promote platforms that commit to
putting an end to opioid overdose, to the misery that accompanies
it, and to the escalation of drug-induced fatalities now being
rendered as “deaths of despair” (Case & Deaton, 2015, 2017).
Through the pathos of pain, the opioid epidemic has itself becomes
legible not so much as a criminal scourge but as a national tragedy,
which is continuing to evolve within American culture today.
 Finally, pain is the lens that forces us to interrogate the logics,
protocols, strategies, and structures that make our health system
function yet that have also contributed to the current crisis. In opioid
regulation, for example, drug regulators’ decision to fast-track
opioids and curb rising rates of pain diagnoses was made in light of
regulators’ self-expressed doubts about how to define and measure
pain. This uncertainty, when combined with the United States’
dominant regulatory logic of ignoring potential risks until the
moment in which they can be quantified, laid an extremely fertile
ground out of which the current crisis could grow.
But to say that the opioid epidemic is more about pain than about
opioid drugs is not to sideline them completely. It is instead a way of
coming to see how pain and opioids became so tightly connected.
Opioids, to be clear, represent a class of drugs that includes
substances derived from the opium poppy (including morphine and
heroin) as well as synthetic and semisynthetic drugs that act on
opioid receptors in the brain.1 These include both prescription drugs
such as codeine, oxycodone (OxyContin), and hydrocodone
(Vicodin), as well as illicit substances such as fentanyl and its more
powerful analogs, like carfentanil. Every year, millions of Americans
use these drugs: In 2020, 9.5 million Americans reported misusing
opioids (SAMHSA, 2020). And despite various efforts on the part of
regulators and law enforcement to crack down on opioid use at local,
regional, and federal levels, these numbers continue to climb. The
extent to which opioids have penetrated American lives is, frankly,
incredible. According to a 2016 survey released by the Kaiser Family
Foundation, roughly half of all Americans said that they personally
know a friend or family member with either a current or past
addiction to prescription opioids (NCADD, 2016). And there are many
others, no doubt, who know someone using opioids outside this
sanctioned medical domain.
It is striking that opioids have come to wreak such disastrous
havoc in the lives of so many people in such a short amount of time
—or that in 2014, in 12 different states, the number of opioid
prescriptions far outnumbered the number of people living in that
state. These numbers tell a story about a nation in pain, where one
in five adults are diagnosed with a chronic pain condition, and where
constant suffering, for them and many others, is the norm.
Equally startling is the fact that these drugs, which we have
known for thousands of years are potent, came to occupy space on
the shelves in our medicine cabinets. That is to say, it is telling how
their meanings have shifted, how they have, over time, been
redefined as cures rather than poisons and as first-line medications
rather than dangerous “drugs.”
While the opioid epidemic is not the first overdose crisis to plague
the United States, it is novel in a few important ways. The first has
to do with its scale: Between 1999 and 2019, nearly half a million
people died from an overdose involving an opioid (CDC, 2021)—a
number that outpaces the number of American soldiers killed in
battle during World War II (DVA, 2017). And it is no small thing that
by the time I finish writing this introduction at the end of this
particular Friday, at least 130 more people in this country will be
dead, and their autopsy reports will say that it was opioids that killed
them (NIDA, 2020).
Second, the opioid epidemic is unique in that it represents an
overdose scourge that has involved not only illicit substances, but
also legal ones—chemical compounds produced by pharmaceutical
companies, regulated by the federal government, prescribed by
doctors, and distributed through official channels within the U.S.
healthcare industry. In many ways, as this book will argue, it is
precisely the dynamics of the legal spaces in which opioids have
circulated that contributed to their rapid uptake and to the eventual
opioid surpluses that saturated the pharmaceutical market and
caused these drugs to spill out of their legal context into illict and
gray drug markets. In these unregulated or semiregulated spaces,
synthetic opioids are now produced on a massive scale in
laboratories, advertised through Internet platforms, and distributed
through the U.S. mail system and at brick-and-motor pain clinics that
now populate many of the strip malls that line this country’s streets.
The fact that shadowy gray and illicit markets are intertwined with
the legal market for prescription opioids points to another key
characteristic of the current epidemic, which is the threat that its
existence poses to the legitimacy of U.S. health institutions and to
law enforcement agencies and regulatory administrations, all of
which are now charged with intervening in a problem space that
they helped to create. Put another way, the opioid epidemic sheds
light on a fundamental paradox: The institutions that we would
typically hold responsible for identifying solutions to this problem
find themselves unable to do so. And it’s no surprise, considering
that the very logics, norms, and procedures that bolster their
legitimacy and define their functions have also enabled the
unchecked expansion of pain networks.
An additional characteristic of the opioid epidemic is that it was
framed as a problem that was overwhelmingly white. The
“whiteness” of the opioid epidemic has conditioned many of the
tangible ways in which the health establishment and criminal legal
system have chosen to intervene in drug use and on people who use
drugs (PWUD), just as it has also been a crucial component that has
shaped the public discourse surrounding them. To provide one
example, the construction of opioid use as a criminal issue requiring
punishment and imprisonment—which was a dominant approach to
the use of heroin among people of color throughout the 1980s—now
exists in tension alongside other discourses, some of which advocate
for a public health and human rights approach to drug use. Today,
we are likely to find speeches and political positionings related to
opioid use that take a “compassionate” stance toward it, opting less
for incarceration than for rehabilitation. This narrative is paralleled
by the construction of opioid use as an overwhelmingly white
problem and as something that warrants empathy rather than
punishment. Indeed, the subtexts of race and class—specifically of
whiteness—are embedded in many of the discussions and protocols
that have been used to intervene in the problems of pain and opioid
use. Much has been made of the fact that for the first time in a
generation, the life expectancy of white Americans is declining,
presumably due to painkiller-related overdoses and suicides.
Moreover, race and class shape the political and institutional
positions that condition the ways in which drug use is interpreted
and experienced by different segments of the American population.

Pain and Uncertainty

On October 26, 2017, then President Trump signed a presidential
memorandum ordering the Secretary of Health and Human Services
to declare the opioid epidemic a “nationwide public health
emergency” (Hirschfeld Davis, 2017; Wagner et al., 2017). But what
makes a situation an emergency, or an “epidemic”? Uncertainty and
unpreparedness are problems that are central to the construction of
the opioid epidemic as both an epidemic and a public health
emergency. We were, in many ways, unprepared for the opioid
crisis. We were, for reasons that will be laid out in Chapter 2, poorly
equipped to anticipate the extent of opioid use that would come in
the wake of approving new opioid products. And we have since been
uncertain as to how to deal with the consequences of these
decisions.
And after all, what is a declaration of a “public health emergency” if
not a very public manifestation of panic in the face of extreme
uncertainty? In particular, the uncertainty regarding the relationship
between opioids and pain is one that has long plagued medical
professionals, regulators, patients, and politicians. It has dominated
their various meetings and discussions, ultimately anticipating a host
of hasty decisions, undergirded by weak or nonexistent knowledge
(which these experts themselves admit to) about how to measure
the intensity of pain, to what extent opioids can be used to treat it,
how to measure their effectiveness, and how to know whether or
not they pose a risk to pain patients.
The discourse of uncertainty in the face of pain management, opioid
development, regulation, marketing, and treatment is absolutely
crucial to accurately telling the story of the opioid epidemic. It is
important in part because it is a discourse that anticipates the use of
particular kinds of interventions that are designed to manage it (Lak
off, 2017). In the opioid crisis, interventions that have been utilized
in the face of uncertainty about a present predicament have tended
to rely on historical data. And they have used that data to attempt to
anticipate the evolution of the crisis. Regulators and scientific
experts attempted to overcome their uncertainties regarding pain
and the risks of opioids through the mobilization of two major
techniques: (1) the production and promotion of new “life-saving
anti-abuse” technologies and (2) surveillance, or
“pharmacovigilance” techniques, explicitly designed to identify and
mitigate health risks as they unfold in real time.2 Both types of
intervention, which were developed and widely lauded in the name
of eradicating uncertainty and ending opioid abuse, were developed
relying on historical data about similar, but not identical, patterns of
drug use. In doing so, they made the mistake of neglecting to
incorporate the novel realities of opioid use and, as a result, had
incredibly negative effects both on opioid consumption trends and on
the ability of regulators and law enforcement to anticipate and
manage new kinds of risks associated with opioid use.
As a public health emergency rooted in extreme uncertainty and a
series of failed attempts to remedy the problem, the opioid epidemic
is also a reflection of widespread public concerns and doubts
regarding the promise of scientific expertise, pharmaceutical
innovation, and the usefulness of our nation’s health system. As are
all public health emergencies, the opioid epidemic is emblematic of
many of the shortcomings of institutional expertise in dealing with
seemingly unmanageable risks. It is, in Lakoff and Collier’s words, a
product “of the scientific frameworks and governmental practices
that seek to know and manage” it (Lakoff & Collier, 2008, p. 7).
Perhaps what the public has found, in expressing such anger and
disappointment at the public health establishment and other
associated actors, is their creation of and tepid response to
something that Ulrich Beck (1992) referred to as “modernization
risks”—risks that not only give rise to emergencies but are actually
produced from within the workings of modernization itself, often by
the very same institutions, knowledges, and practices that were
meant to contain them. Put another way, the opioid epidemic is a
problem that did not emerge out of thin air. It should instead be
understood as something that grew out of the specific knowledges,
practices, and logics being applied from various domains of expertise
within our health-related institutions (medicine, pharmacology,
regulation, accreditation, etc.)—those same institutions that
Americans have relied on for the promotion and protection of their
health, comfort, and safety. In recent years, these experts and
institutions have emerged as key contributors to the current crisis
and, in many media accounts of the epidemic, are disparaged for
their irresponsibility in failing to predict it as well as for their
subsequent failure to respond to it (Frydl, 2017; Von Drehle, 2018).
One example of expert knowledge that appears to have collapsed
under its own weight in the opioid crisis is the logic of medicine
taken “as prescribed.” This logic, which is most often expressed as a
directive in medication guides, suggests that a given medicine will
work as it should so long as it is taken in the proper way—so long as
patients use it “as prescribed.” By extension, when a patient takes
their medicine in a way other than “as prescribed,” they are seen as
having put themselves at risk—and the risks are unknown. The rule
of “as prescribed” has a number of key functions within the U.S.
health system: First, it serves as a safety measure, which helps fulfill
the FDA’s basic regulatory tenets—safety and efficacy. Second, it
provides a legal logic that protects regulators, manufacturers,
physicians, and pharmacists from prosecution should a patient suffer
an injury or die as a result of taking their medication not “as
prescribed.” Third, it provides a means of classifying individual
consumers as well as their consumption behaviors: Those who take
their drugs “as prescribed” are patients, and their behavior is
neutrally understood as medication “use.” Those who deviate from
the rule of “as prescribed” take on a different status; they are not
patients but addicts, whose consumption practices are reconstrued
as “abuse.”
The usefulness of the logic of “as prescribed,” which has long
attempted to control and police pharmaceutical drug consumption, is
breaking down. We see this in media accounts of the opioid crisis
that relay the stories of patients who took opioids just as their
Another random document with
no related content on Scribd:
The Project Gutenberg eBook of The missing
chums
This ebook is for the use of anyone anywhere in the United States
and most other parts of the world at no cost and with almost no
restrictions whatsoever. You may copy it, give it away or re-use it
under the terms of the Project Gutenberg License included with this
ebook or online at www.gutenberg.org. If you are not located in the
United States, you will have to check the laws of the country where
you are located before using this eBook.

Title: The missing chums

Author: Franklin W. Dixon

Illustrator: Walter S. Rogers

Release date: January 31, 2024 [eBook #72840]

Most recently updated: April 30, 2024

Language: English

Original publication: Bedford, MA: Applewood Books, 1928

Credits: Greg Weeks, Mary Meehan and the Online Distributed

Proofreading Team at http://www.pgdp.net

*** START OF THE PROJECT GUTENBERG EBOOK THE

MISSING CHUMS ***
 THE HARDY BOYS

THE MISSING CHUMS

By FRANKLIN W. DIXON

Author of
The Hardy Boys: The Tower Treasure
The Hardy Boys: The Secret of the Old Mill

ILLUSTRATED BY
Walter S. Rogers

NEW YORK
GROSSET & DUNLAP
PUBLISHERS

Made in the United States of America

 Copyright, 1928, by
GROSSET & DUNLAP, Inc.

All Rights Reserved

The Hardy Boys: The Missing Chums

HE CRAWLED ON HANDS AND KNEES.
 CONTENTS
I. The Three Strangers
II. Quick Thinking
III. A Shady Trio
IV. The Send-Off
V. No Word from the Chums
VI. Missing
VII. Wreckage
VIII. The Strange Letter
IX. Blacksnake Island
X. The Boy on the Deck
XI. The Island
XII. Into the Cave
XIII. The Four Men
XIV. The Storm
XV. A Startling Announcement
XVI. The Alarm
XVII. Capture
XVIII. Back to the Cave
XIX. Separated
XX. Seizing the Boats
XXI. At the Island
XXII. The Chase
XXIII. Home Again
 THE HARDY BOYS:
THE MISSING CHUMS

CHAPTER I
The Three Strangers
"You certainly ought to have a dandy trip."
"I'll say we will, Frank! We sure wish you could come along."
Frank Hardy grinned ruefully and shook his head.
"I'm afraid we're out of luck. Joe and I may take a little trip later on,
but we can't make it this time."
"Just think of it!" said Chet Morton, the other speaker. "A whole week
motorboating along the coast! We're the lucky boys, eh, Biff?"
Biff Hooper, at the wheel of his father's new motorboat, nodded
emphatically.
"You bet we're lucky. I'm glad dad got this boat in time for the
summer holidays. I've been dreaming of a trip like that for years."
"It won't be the same without the Hardy Boys," returned Chet. "I had
it all planned out that Frank and Joe would be coming along with us
in their own boat and we'd make a real party of it."
"Can't be done," observed Joe Hardy, settling himself more
comfortably in the back of the boat. "There's nothing Frank and I
would like better—but duty calls!" he exclaimed dramatically,
slapping himself on the chest.
"Duty, my neck!" grunted Frank. "We just have to stay at home while
dad is in Chicago, that's all. It'll be pretty dull without Chet and Biff
around to help us kill time."
"You can put in the hours thinking of Biff and me," consoled Chet. "At
night you can just picture us sitting around our campfire away up the
coast, and in the daytime you can imagine us speeding away out
over the bounding main." He postured with one foot on the gunwale.
"A sailor's life for me, my hearties! Yo, ho, and a bottle of ink!"
The boat gave a sudden lurch at that moment, for Biff Hooper had
not yet mastered the art of navigation and Chet wavered
precariously for a few seconds, finally losing his balance and sitting
down heavily in a smear of grease at the bottom of the craft.

"Yo ho, and a bottle of ink

And he nearly fell into the drink,"

chanted Frank Hardy, as the boys roared with laughter at their

chum's discomfiture.
"Poet!" sniffed Chet, as he got up. Then, as he gingerly felt the seat
of his trousers: "Another pair of pants ready for the cleaners. I ought
to wear overalls when I go boating." He grinned as he said it, for
Chet Morton was the soul of good nature and it took a great deal
more than a smear of grease to erase his ready smile.
The four boys, Frank and Joe Hardy, Chet Morton and Biff Hooper,
all chums in the same set at the Bayport high school, were out on
Barmet Bay in the Envoy, the Hooper motorboat, helping Biff learn to
run the craft. Their assistance consisted chiefly of mocking criticisms
of the luckless Biff's posture at the helm and sundry false alarms to
the effect that the boat was springing a leak or that the engine was
about to blow up. Each announcement had the effect of precipitating
the steersman into a panic of apprehension and sending his
tormentors into convulsions of laughter.
Biff had made good progress, however, as he had been with the
Hardy boys on previous occasions in their own motorboat, the
Sleuth, and he had picked up the rudiments of handling the craft. He
was anxious to be a first-rate pilot before starting up the coast on his
projected trip with Chet Morton the following week. He had an
aptitude for mechanics and he was satisfied that he would have a
thorough understanding of his boat by the time they were ready to
start.
"If the coast guards find two little boys like you roaming around in a
great big motorboat they're likely to give you a spanking and send
you back home," laughed Frank. "I'll bet you'll be back in Bayport
inside of two days."
"Rats!" replied Chet, inelegantly, if forcefully. "If our grub holds out
we'll be away more than the week."
"There's no danger of that. Not with you along," Joe remarked, and
deftly dodged a wad of waste that Chet flung at him. Chet Morton's
enormous appetite was proverbial among the chums.
"Just sore because you can't come along with us," Chet scoffed.
"You know mighty well that the two of you would give your eye-teeth
to be on this trip. Oh, well, we'll tell you all about it when we get
back."
"A lot of comfort that will be!"
"A leak!" roared Chet suddenly, pounding Biff on the back. "The boat
has sprung a leak. Get a pail!"
"What!" shouted Biff, in alarm, starting up from the wheel. Then, for
the fifth time that afternoon, he realized that he had been fooled and
he sank back with a look of disgust on his face.
"Some time that boat will spring a leak and I won't believe you," he
warned, settling down to his steering again.
"I'll be good," promised Chet, sitting down and looking out over the
bay. "Say, there's a big brute of a motorboat coming along behind us,
isn't it?"
"I'll say she's big," Frank agreed, looking back. "I don't remember
ever having seen that boat around here before."
"Me neither," declared Joe. "I wonder where it came from."
The strange craft was painted a dingy gray. It was large and
unwieldy and did not ride easily in the water. Although that boat was
some distance in the wake of their own craft the boys could
distinguish the figures of three men, all seated well up toward the
front. Biff glanced back.
"It's a new one on me," he said. "I've never seen it before."
"Sure has lots of power, anyway," Chet commented. The roar of the
engine could be plainly heard across the water. In spite of its clumsy
appearance, the big boat ploughed ahead at good speed, and, as
Bill had the Envoy, his craft, throttled down, the second boat was
slowly overtaking them.
"Let's wait till they get abreast of us and give them a race," Chet
suggested.
"Not on your life," objected Biff. "I'm only learning to run this tub and
I'm not in the racing class yet. Besides, there are too many other
boats out in the bay this afternoon. I'd be sure to run into one of
them."
The boys watched as the other craft overtook them. The big
motorboat ploughed noisily ahead, keeping directly in their wake.
"I wonder if the man at the helm is asleep," said Frank. "He doesn't
seem to be making any attempt to pull over."
"He's awake, all right," declared Chet. "I can see him talking to the
man beside him. He won't run us down. Don't worry—not with
Captain Hooper at the helm, my hearties!"
The roaring of the pursuing craft suddenly took on a new note and
the big boat seemed to leap out of the water as it increased its speed
and bore rapidly down on the Envoy. Spray flew about the heads of
the helmsman and his two passengers and a high crest of foam rose
from either side of the bow. Biff Hooper shifted the wheel slightly and
the Envoy veered in toward the shore. To the surprise of the boys,
the other boat also changed its course and continued directly in their
wake.
"The idiots!" exclaimed Biff.
"I don't get the idea of this at all," muttered Frank Hardy to his
brother. "What are they following us so closely for?"
Joe shrugged. "Probably just trying to give us a scare."
The other boat was now almost upon their craft. It nosed out to the
right and drew alongside, coming dangerously close. The boys could
see the three men clearly and they noticed that all three scrutinized
them, seeming to pay particular attention to Chet and Biff.
The men were unsavory looking fellows, unshaven, surly of
expression. The man at the helm was sharp-featured and keen-
eyed, while the other two were of heavier build. One of the pair wore
a cap, while the other man was bare-headed, revealing a scant
thatch of carroty hair so close-cropped that it seemed to stick out at
all angles to his cranium. This man, the boys saw, nudged his
companion and pointed to Biff, who was too busy at the helm of his
own craft to notice.
"Not so close!" yelled Chet, seeing that the other boat was running
broadside in dangerous proximity to the Envoy.
In reply, the man at the helm of the other craft merely sneered and
brought his boat in until the two speeding launches were almost
touching sides.
"What's the idea?" Joe shouted. "Trying to run us down?"
Biff Hooper shifted the wheel so that the Envoy would edge away
from the other boat, and in this effort he was successful, for a gap of
water was soon apparent between the speeding craft. But in
escaping one danger he had risked another.
Two sailboats that had been flitting about Barmet Bay that afternoon
were racing with the wind, and they now came threshing along with
billowing canvas, immediately into the course of the motorboat. Biff
had seen the sailboats previously and had judged his own course
accordingly, but in his efforts to get away from the mysterious launch
he had unwittingly maneuvered the Envoy into such a position that a
collision now seemed inevitable.
The sailboats seemed to loom right up before him, not more than a
hundred yards away. They were racing close together, one boat but
a nose in the lead. They were scudding along with the wind at high
speed and the motorboat roared down upon them.
Biff Hooper bent desperately over the helm. He was so close that no
matter which way he turned it seemed impossible that he could miss
one or the other of the sailboats. If he turned to the right he would
crash into them head-on; if he turned to the left he would run before
them and a general smash-up might be the result.
The men in the sailboats were also aware of their danger.
The boys had a glimpse of one man waving his arms. One of the
boats veered out abruptly and the yardarm swung around. The
sailboat was lying directly in the path of the Envoy.
The roaring of the engine, the threshing of the sails, the warning
shouts of the boys, all created a confusion of sound. The white sails
seemed to loom high above the speeding boat. A hideous collision
appeared to be inevitable.

CHAPTER II
Quick Thinking
Every second was precious.
Frank Hardy realized the full extent of their peril and in the same
moment he realized the only way of averting it.
Without a word he sprang toward the helm, brushing Biff Hooper
aside. In this emergency, Biff was helpless. Swiftly, Frank bore down
on the wheel, bringing the boat around into the wind. At the same
time, he opened up the throttle so that the Envoy leaped forward at
her highest speed.
The motorboat passed just a few inches in front of the bow of the
first sailboat; so close, Chet Morton said afterward, that he "could
count every stitch on the patch in the sailcloth." But the danger was
not yet over. There was still the other sailboat to be considered. It
was pounding along immediately ahead of them; the man at the tiller
was making frantic efforts to get out of the way, but the danger lay in
the fact that in trying to guess the possible course of the Envoy he
might make a false move that would have him shoot directly across
its path.
Frank swung the helm around again. Once more, the Envoy veered
to the left so sharply that a cloud of spray drenched the boys.
Another shift of the wheel and the motorboat zig-zagged safely past
the sailboat and on out into open water.
Not one of the boys had uttered a word during this. They had been
tense and anxious, but now that the peril of a smash-up had been
averted, they sank back with sighs of relief.
"I sure thought we were headed for Davy Jones' locker that time!"
breathed Chet.
Biff Hooper looked up at Frank.
"Thanks," he said. "I'd have never got out of that mess if you hadn't
taken the wheel. I was so rattled that I didn't know what to do."
"After you've run the boat a few more weeks you'll get so used to it
that it'll be second nature to you. But that sure was a tight squeeze,"
Frank admitted. "It mighty near meant that you wouldn't have had
any motorboat left to go on that trip with."
"It mighty near meant that we wouldn't have been left to make the
trip at all," Chet declared solemnly. "What say we go home? I've had
enough excitement for one day."
"It's beginning to rain, anyway," Biff remarked, glancing up at the sky.
"I guess we may as well go back."
The sky had clouded over in the past hour and the eastern sky was
black, while scurrying masses of ragged clouds flew overhead before
the stiffening wind. A few drops of water splashed into the boat, then
came a gust of rain, followed by a light shower that passed over in a
few minutes. The big motorboat that had crowded them had
disappeared.
"A real storm coming up," Frank said. "Let's make for the
boathouse."
The Envoy headed for Bayport.
"I'd like to tell those three fellows in that other boat what I think of
them," declared Biff. "They got us into that jam. They were crowding
me so close that I didn't have a chance to keep an eye on the
sailboats."
"I still can't see why they drew up alongside," Joe observed. "They
seemed mighty inquisitive. Gave us all the once-over."
Chet offered a solution.
"Perhaps they thought we were some one else and when they found
out their mistake they went away."
"But they didn't go away," Frank pointed out. "They kept crowding us
over. And one of them pointed at Biff."
"At me?"
"Yes."
"I didn't notice that."
"He seemed to recognize you and was pointing you out to the other
men."
"Well, if he recognized me I can't return the compliment. I never saw
any of them before in my life."
"He was probably pointing you out as a unique specimen," ventured
Joe, with a grin. "Probably those fellows are from a museum, Biff.
They'll likely make an offer for your carcass after you're dead and
they'll have it stuffed and put it on display in a glass case. That's why
they were so interested."
Joe's suggestion elicited warm words from Biff and a friendly
struggle ensued. Inasmuch as Biff Hooper was the champion boxer
and wrestler of Bayport High, Joe was at a disadvantage, and paid
for his derogatory remarks by being held over the side by the scruff
of the neck and given a ducking until he pleaded for mercy.
By the time the boys reached Bayport it was raining heavily, and
after leaving the Envoy in the boathouse they raced up the street to
the Hardy boys' home. The barn in the back yard was a favorite
retreat of the chums and there they spent many of their Saturday
afternoons. The barn was fitted up as a gymnasium, with parallel
bars, a trapeze, boxing gloves and a punching bag, and was an ideal
refuge on a rainy day. The thrilling experience with the sailboats and
the mystery of the strange motorboat were soon forgotten.
Phil Cohen and Tony Prito, school chums of the Hardy boys, drifted
in during the afternoon, as well as Jerry Gilroy and "Slim" Robinson.
This comprised the "gang," of which the two Hardy boys were the
leading spirits.
Frank and Joe Hardy were the sons of Fenton Hardy, an
internationally famous detective. Mr. Hardy had been for many years
a detective on the New York police force, where he was so
successful that he went into practice for himself. His two sons
already showed signs of inheriting his ability and in a number of
instances had solved difficult criminal cases.
The first of these was the mystery of the theft of valuable jewels and
bonds from Tower Mansion, an old-fashioned building on the
outskirts of Bayport. How the Hardy boys solved the mystery has
already been related in the first volume of this series, entitled, "The
Tower Treasure."
In the second volume, "The House on the Cliff," the Hardy boys and
their chums had a thrilling experience in a reputedly haunted house
on the cliffs overlooking Barmet Bay. This was the starting point of an
exciting chase for smugglers, in which the Hardy boys came to the
rescue of their father after undergoing many dangers in the cliff
caves.
The third volume of the series, "The Mystery of the Old Mill," which
precedes the present book, relates the efforts of the Hardy boys to
run to earth a gang of counterfeiters operating in and about Bayport
and their efforts to solve the mystery surrounding an abandoned mill
in the farming country back of Barmet Bay.
Frank Hardy, a tall, dark-haired boy of sixteen, was a year older than
his brother Joe, and usually took the lead in their exploits, although
Joe was not a whit behind his brother in shrewdness and in
deductive ability.
Mrs. Hardy viewed their passion for detective work with considerable
apprehension, preferring that they plan to go to a university and
direct their energies toward entering one of the professions; but the
success of the lads had been so marked in the cases on which they
had been engaged that she had by now almost resigned herself to
seeing them destined for careers as private detectives when they
should grow older.
Just now, however, detective work was farthest from their thoughts.
Frank and Tony Prito were engaged in some complicated maneuvers
on the parallel bars, Joe was taking a boxing lesson from Biff
Hooper, and Phil Cohen was trying to learn how to walk on his
hands, under the guidance of Jerry Gilroy and Slim Robinson.
As for Chet Morton, the mischief-maker, he was sitting on the
window-sill, meditating. And when Chet Morton meditated, it usually
meant that a practical joke was in the offing.
"I'll bet you can't 'skin the cat' on that trapeze, Jerry," he called out
suddenly.
Jerry Gilroy looked up.
"Skin the cat?" he said. "Of course I can."
"Bet you can't."
"Bet I can."
"Can't."
"Can."
"Do it, then."
"Watch me."
As every boy knows, "skinning the cat" is an acrobatic feat that does
not necessarily embrace cruelty to animals. Jerry Gilroy was not
unjustly proud of his prowess on the trapeze and Chet Morton's
doubt of his ability to perform one of the simplest stunts in his
repertoire made him resolve to "skin the cat" as slowly and
elaborately as lay within his power.
He grasped the trapeze bar with both hands, then swung forward,
raising his feet from the floor, bending his knees. Chet edged
forward, presumably to get a better view of proceedings, but at the
same time he tightened his grip on a long, flat stick that he had found
by the window ledge.
Jerry slowly doubled up until his feet were above his head,
immediately below the bar, and then commenced the second stage
of the elaborate back somersault, coming down slowly toward the
floor. At this juncture the rear of his trousers was presented as a
tempting mark to the waiting Chet. This was the stage of the feat for
which the joker had been waiting and he raised the flat stick, bringing
it down with a resounding smack on his human target.
There was a yelp of pain from Jerry and a roar of laughter from Chet.
Doubled up on the bar as he was, Jerry could not immediately regain
the floor, and Chet managed to belabor him twice more before the
unfortunate acrobat finally found his footing. There he stood,
bewildered, rubbing the seat of his trousers, with a rueful expression
on his face, while Chet leaned against the wall, helpless with
laughter.
The other boys joined in the merriment, for they had stopped to
witness the incident, and after a while Jerry achieved a wry smile,
although he looked reflectively at his tormentor as though wondering
just what form his revenge should take.
No one enjoyed Chet Morton's practical jokes more than he did
himself. He whooped with laughter, wiped the tears from his eyes,
and leaned out of the window, spluttering with mirth.