Where Movements Matter: Examining Unintended Consequences of the Pain Management Movement in Medical, Criminal Justice, and Public Health Fields

Date01 January 2018
DOIhttp://doi.org/10.1111/lapo.12098
Published date01 January 2018
Where Movements Matter: Examining Unintended
Consequences of the Pain Management Movement in
Medical, Criminal Justice, and Public Health Fields
ELIZABETH CHIARELLO
Social movement scholars have rarely considered professional fields as sites of social movement
consequences and have overlooked how social movement consequences traverse field boundaries.
This research examines where movements matter by examining unintended consequences across
professional fields. Drawing on a case study of the pain management movement, this study asks (1)
under what conditions do movements targeting a focal professional field create consequences in
adjacent fields; (2) what factors affect how adeptly the adjacent field responds; and (3) how do
social movement impacts on adjacent fields affect the focal field? Findings demonstrate how the
success of the pain management movement in medicine helped to fuel the opioid epidemic, which
detrimentally affected the adjacent fields of criminal justice and public health. These adjacent fields’
strategies for curbing spillover, in turn, created a new set of consequences for medicine. Their
responses depended on material and moral resources and authority structures that differed
significantly across the two adjacent fields. This article concludes with a discussi on of factors that
may facilitate or deter cross-field contagion effects and offers suggestions for future research.
I. INTRODUCTION
There is a growing literature on social movement consequences that complements the
extensive literature on social movement mobilization (Bosi, Giugni, and Uba 2016;
Amenta et al. 2010; Amenta and Caren 2004; Earl 2004; Giugni, McAdam, and Tilly
1999; Gamson 1975). However, studies of social movement consequences tend to focus
on formal legal outcomes such as Supreme Court decisions and congressional action
(Andrews and Edwards 2004) or on more amorphous cultural outcomes such as values
and beliefs (Earl 2004; Polletta 2008). Missing from this literature is attention to how
social movements affect professional fields. This focus is critical because professionals
dominate so many arenas of social life and because the laws that social movements seek
to change typically have implications for professional work (Boutcher 2013; Chiarello
2013; Halfmann 2011; Kellogg 2011; Binder 2002; Luker 1984).
For providing insightful comments on earlier drafts, the author would like to thank Calvin Morrill, Josh
Wilson, Steve Boutcher, Lynette Chua, David Cunningham, Ed Amenta, Sandy Johnson, and three anony-
mous reviewers. She would also like to thank Jeff Allison for integral research support. She gratefully acknowl-
edges the ACLS/Mellon Foundation, the US Department of Health and Human Services Agency for
Healthcare Research and Quality, Saint Louis University’s College of Arts and Sciences, Princeton University’s
Office of Population Research and Center for Health and Wellbeing, and UC Irvine’s Center for Organiza-
tional Research for their generous support.
Address correspondence to: Elizabeth Chiarello, Saint Louis University—Sociology & Anthropology, 3700
Lindell Blvd., Morrissey Hall 1921, Saint Louis, MO 63108 USA. Telephone: 314-977-2725; E-mail: liz.
chiarello@slu.edu.
LAW & POLICY, Vol. 40, No. 1, January 2018 ISSN 0265-8240
V
C2017 The Author
Law & Policy V
C2017 The University of Denver/Colorado Seminary
doi: 10.1111/lapo.12098
To understand movements’ effects on professional fields, we must look beyond the pas-
sage of law to examine the extent to which social movement goals are incorporated into
professional fields and professional practice. This requires reconceptualizing the relation-
ship between law, professions, and social movements as one characterized by the interplay
of organizational fields. Adopting a multi-institutional politics approach (Armstrong and
Bernstein 2008) enables us to understand cultural change by examining how movements
target nonstate organizations and match their strategies to focal fields. A promising line
of inquiry draws on sociolegal theory to understand social movement consequences in
professional fields (Boutcher 2013; Chiarello 2013; Kellogg 2011; Epstein 1996). But
scholars have rarely considered the multi-institutional politics approach’s implications
for social movement consequences (Edelman, Leachman, and McAdam 2010) and have
not yet considered how mobilization in a targeted field affects adjacent fields. This over-
sight matters because professions—yielding significant social power—are linked to one
another through a complex division of labor (Abbott 1988), and we can therefore antici-
pate that change in one profession’s work will meaningfully affect the work of other pro-
fessions, often in unexpected ways. To fully understand social movement consequences,
researchers must look across institutional contexts, seeking potential contagion effects of
social movement efforts. In other words, we must ask the following questions: Under
what conditions do movements targeting a single professional field create consequences in
adjacent fields? And how do adjacent fields’ responses impact the movement’s focal field?
Adapting the multi-institutional politics approach (Armstrong and Bernstein 2008) to
address social movement consequences, this study contributes to existing literature on
law, social movements, and professions by examining the impact of mobilization on pro-
fessional fields and the unintended consequences for adjacent fields. Defining social move-
ments as “organized and sustained collective action on behalf of a common, change-
oriented goal” (Banaszak-Holl, Levitsky, and Zald 2010, 5), I take as my focal case the
pain management movement, whose ongoing efforts to combat pain and destigmatize
opioid prescribing have resulted in significant professional change via legal, cultural, and
organizational pathways. Using case study methods, I synthesize scholarly and popular
discourses to trace key moments in the history of US narcotics control and the pain man-
agement movement from the early twentieth century to today. The movement mobilized
and allied with pharmaceutical companies to achieve several of its goals, including alter-
ing the legal and regulatory environment of opioid prescribing (Wailoo 2014b; Meier
2013; Meier 2003). However, these successful endeavors within the medical field also
wrought unintended consequences in health care, criminal justice, and public health,
including the rapid rise in narcotics prescribing rates that have helped to fuel the contem-
porary prescription opioid and heroin crises (Centers for Disease Control and Prevention
2015b). After analyzing the intricacies of mobilization and its aftermath, this article con-
cludes with a discussion of the circumstances under which social movement consequences
spill over between focal and adjacent fields.
II. POSITIONING PROFESSIONAL FIELDS WITHIN A “CONSEQUENCES” FRAMEWORK
Analysis of consequences has traditionally received short shrift in the social movements
literature. While an extensive body of literature examines the causes of social movement
mobilization—such as political opportunity, tactics, resources, and framing—until
recently, few scholars had addressed the extent to which movements actually achieve
social change (Bosi, Giugni, and Uba 2016; Amenta et al. 2010; Earl 2004; Giugni 1998;
Gamson 1975). Consequences constitute a necessary but challenging focus of inquiry—
80 LAW & POLICY January 2018
V
C2017 The Author
Law & Policy V
C2017 The University of Denver/Colorado Seminary

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