Admissible or Not? a Critical Analysis of the U.S. Resettlement Policy of Overseas Inadmissibility Due to Substance Abuse

Background and Purpose: In order to be admitted to the United States, a person applying for refugee status must be admissible under national immigration law and the Immigration and Nationality Act (INA) sets forth various grounds of inadmissibility focused on health and security. This paper wrestles with specific admissibility policies that encode certain discourses about biological and social conditions that lead to inclusion or exclusion of certain bodies. Using Foucauldian frameworks of governmentality and biopower, the paper first addresses how ways of thinking concerning risk and protection center on a body’s ability to interact in a certain type of capitalist political economy, and are central in determining the admissibility and inadmissibility of applicants for refugee status. The paper then moves to examine how substance abuse may be interpreted by “expert” panel physicians that further uphold Foucauldian notions of biopower, as well as socio-culturally and moralist views. Rather than approaching from a social constructivist framework, with a perspective rooted in social determinants of health, these biological and moral frameworks become inscribed in both policy and practice around admissibility decisions.

Methods: This paper uses a critical framework analysis as its main method. The author identifies and applies various intersecting frameworks to primary sources, concluding with advocating for a fifth framework to be incorporated. The main primary sources of analysis are the U.S. Resettlement Policy of Overseas Approval/Inadmissibility: Health Related Reasons for Inadmissibility due to Drug Abuse/Drug Addiction, and the Technical Instructions which are provided by the Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine, Quality Assessment Program (QAP) for both overseas panel of physicians and U.S. based doctors who complete arrival screening. In addition, a historical case study of the policy change made in 2008 around admissibility of persons with HIV, is used to connect frameworks and situate this specific analysis.

Conclusion and Implication: U.S. resettlement policy around substance abuse allows for decision making that are based on the privileging of certain bodies. In addition, those who are in the position of making these decisions may operate out frameworks that rest only on biological or moral understandings that do not fully consider social determinants of health. There are approximately 760 panel physicians appointed by local U.S. embassies or consulates who perform overseas pre-departure medical examinations for those applying for resettlement. There is little discussion of how these physicians apply policy lines and use of the DSM in making their determination. Based on a practitioner's location and perspectives on substance abuse, the point of decision may be extremely varied. Rather than only proposing changes to the U.S. Resettlement policy line concerning admissibility and substance abuse, this paper proposes ways that technical Instructions and training can be employed in order to better assist panel physicians in making their decisions around admissibility in relation to substances. The goal in doing this is to offer these medical personnel, or gatekeepers, new ways of seeing applicants as having agency and the capability to change.