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

Authors

  • Elizabeth Chiarello

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    • Elizabeth Chiarello is an Assistant Professor of Sociology at Saint Louis University where she researches institutional influences on health care provision and frontline work. For providing insightful comments on earlier drafts, the author thanks Calvin Morrill, Carroll Seron, Tracy Weitz, Francesca Polletta, Betsy Armstrong, James Trussell, Michael Musheno, Steven Maynard-Moody, Shannon Portillo, Michael McCann, Kim Lane Scheppele, Bernadette Atuahene, Paul DiMaggio, Miranda Waggoner, members of the LAPA LEGS Seminar and the Social Organization Workshop at Princeton University, and three anonymous reviewers. She also thanks the ACLS/Mellon Foundation, the US Department of Health and Human Services Agency for Healthcare Research and Quality, Princeton University's Office of Population Research and Center for Health and Wellbeing, and UC Irvine's Center for Organizational Research for their generous support. This research was approved by the Institutional Review Board at the University of California, Irvine (HS#2009-6917). The author can be reached at chiarello@slu.edu.

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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