The ‘Opioid Epidemic’ as a public health crisis is often portrayed as a relatively recent development, and characterized as arising from the economic upheaval affecting working class communities. Which is to say, the result of the suffering of the White Working Class:
When economists Anne Casey and Angus Deaton published their landmark 2015 report in the Proceedings of the National Academy of Sciences documenting rising mortality among white, middle-aged Americans, they helped to coin a term: “deaths of despair.”
The rising death rate among whites—driven by increasing suicide rates, diminishing overall health, and, especially, the opioid epidemic—was linked, they said, to economic anxiety. In this way did their report help to cement an image already widely prevalent—that the new opioid crisis is a “white” problem affecting white Americans and linked with social and economic causes: decreasing wages, disappearing jobs, and a diminishing standard of living.
But that narrative is problematic, for a number of reasons:
… recent data from the National Center for Health Statistics show that the fastest rising rate of opioid-related deaths is among African Americans (see chart).
How did the opioid crisis come to be widely regarded as a “white” problem rooted in socioeconomic causes, when drug abuse has plagued inner-city black and minority communities for decades, and the response has been overwhelmingly punitive?
Not by chance, according to Helena Hansen, M.D., Ph.D., vice chair of APA’s Council on Minority Mental Health and Health Disparities.
In an address at the spring educational conference of the Black Psychiatrists of America (BPA) in Memphis in March, she said a conscious and deliberate (and deceptive) strategy by the pharmaceutical industry beginning in the 1990s targeted a vast white suburban and rural market with the introduction of OxyContin as a “minimally addictive” painkiller. This was followed by Food and Drug Administration approval of buprenorphine in 2002 and its marketing to a white audience as a treatment for opioid addiction…
The “whitening” of the new class of opioids occurred against the backdrop of a long history in which heroin and other drugs of abuse were similarly “racialized” as the substances of choice among blacks and other minorities—but with a more sinister, criminal imagery that tended to ignore the socioeconomic conditions that had always contributed to addiction among minority communities.
“While narcotics have long been criminalized through association with marginal racial groups, such as turn-of-the-century images of Chinese opium dens, Negro cocaine fiends in the south, and Mexican marijuana madness, we don’t often look at how this can work in the opposite direction, how a drug can assume ‘whiteness’ within a racialized pharmaceutical logic,” Hansen said. “The current generation of opioids was designed to have white racial identities, and in our stratified health care and justice systems, the biotechnologies and social technologies shaping opioid consumption reinforce racial inequalities while at the same time harming whites.”…
The “white” opioid epidemic today has raised to prominence, in a new way, the importance of underlying socioeconomic influences, never adequately acknowledged when addiction was regarded as a criminal problem of people among communities of color. “Now that the image of the addicted white unemployed rust belt worker is circulating in the press, we have to lobby for economic revitalization, especially in communities of color, which have long been dying from the drug trade as an economy of last resort,” Hansen said.
She added that the opioid crisis and the national response to it “tap into our conflicting cultural logics about whether addiction is a moral, social, or biological problem.”
Dr. Hansen, along with Dr. Julie Netherland, elaborated on the racializing of drugs and drug abuse in an article appearing the journal Biosocieties:
White opioids: Pharmaceutical race and the war on drugs that wasn’t.
(2017) 12(2): 217–238
The US ‘War on Drugs’ has had a profound role in reinforcing racial hierarchies. Drug offenses accounted for two-thirds of the rise in the federal inmate population and more than half of the rise in state prisoners between 1985 and 2000, with more than half of young Black men in large cities in the United States currently under the control of the criminal justice system (Alexander, 2010), and middle aged Black men more likely to have been in prison than in college or the military (Rich et al, 2011). Although Black Americans are no more likely than Whites to use illicit drugs, they are 6–10 times more likely to be incarcerated for drug offenses (Bigg, 2007; Goode, 2013). Alexander (2010), Wacquant(2009), Hart (2013) and others make the case that the criminal justice system is, in effect, a new state-sponsored racial caste system. (pp. 1-2)
The public response to White opioids looked markedly different from the response to illicit drug use in inner city Black and Brown neighborhoods, with policy differentials analogous to the gap between legal penalties for crack as opposed to powder cocaine. This less examined ‘White drug war’ has carved out a less punitive, clinical realm for Whites where their drug use is decriminalized, treated primarily as a biomedical disease, and where White social privilege is preserved. This ‘White drug war’ has historical precedents in which predominantly White populations have used social privilege to invoke ‘medical need’ to secure or maintain access to powerful sedatives or stimulants in the mid to late twentieth century (see Herzberg, 2013). But in the case of opioids, addiction treatment itself is being selectively pharmaceuticalized in ways that preserve a protected space for White opioid users, while leaving intact a punitive, carceral system as the appropriate response for Black and Brown drug use. (pg.2)
The racialized response to drug abuse (medical problem for vulnerable Whites, criminal for immoral and dangerous People of Color) is situated within the broader sociopolitical framework of White Supremacy and the intrinsic moral superiority of Whites:
While not focused on addiction, some scholars have traced the ways that medicine has always been racialized and used to justify less punitive responses for Whites than Blacks.For example, Solinger (2013) traces how a racial divide was produced and maintained by the discourses surrounding “illegitimate” childbirth and the medicalization of abortion. While abortion became available and somewhat acceptable for Whites, the welfare system was being used to publicly shame and punish women of color who had children out of wedlock.Other studies trace how race became embedded in medical technologies and rhetoric in ways that become taken for granted and that reinforce notions of racial difference. Pollock (2012),in a study of the racialization of heart disease, notes that whiteness is reinforced by its using the famous Framingham study as the norm. Braun (2014) traces the ways that the spirometer, originally developed in the antebellum South to demonstrate the physiological inferiority of Black slaves, continues to naturalize racial difference in contemporary usage through “race correction” of “normal” reference ranges. These works remind us that racial projects are inherently implicated in medicine and that race is reified in discourses of legitimacy, normativity and technological precision. (pg. 3)
The mass incarceration of people of color for drug offenses is, in part, legitimated by the belief that drug use results from a failure of will or morality. People are responsible for their use and, therefore, must be held accountable or punished. However, at the same time that more punitive War on Drug policies were enforced in Black and Latino city neighborhoods,President Bush I ushered in the Decade of the Brain at the National Institute on Drug Abuse.The richly funded neuroscience program at NIDA in the 1990’s provided a scientific rationale for addiction as a clinical disease, focusing on altered brain chemistry as the source of addiction and on neuroactive pharmaceuticals and clinical (rather than law enforcement)interventions as the appropriate response. Simply put, neuroscience provided a scientific rationale for treating addictions – at least some addictions – as disease needing medical intervention rather than as crime requiring punishment. While the race of the addict was excluded from this universalizing biological discourse, the very absence of a language of race indexed White subjects. (pg. 4)
The portrayal of those who abuse drugs by the media is divided consistently along racial lines, and of course, between those who are more and less sympathetic:
As Federal and state regulators tightened prescription monitoring and quotas on OxyContin®production, reporters quoted physicians who pleaded for their chronic pain patients. Fore xample, an article entitled “For those who need painkiller, stigma hurts” stated “Increased vigilance in administering OxyContin may be causing people to suffer needlessly (Ung,2001a)”. As with Limbaugh and McCain, these ‘legitimate’ pain patients who became addicted to OxyContin® are portrayed sympathetically in the media as innocent victims of iatrogenic medicine or as people struggling with real or existential pain – terms rarely associated with the drug use of Black or Brown individuals. For example, in an article titled“In the Grip of a Deeper Pain”, Newsweek notes: “most people acquire the drugs innocently enough by prescription…The problem with painkillers is they also work on existential pain”(Adler, 2003). In another story titled “In Neighborhoods, Mourning the Lives Lost to a legal drug”, both the police and the users note the racial dividing line between heroin and OxyContin®. For example, a teenage OxyContin® user from a predominantly White neighborhood in Philadelphia says, “It’s weird, because the kids in my neighborhood think if you are on heroin, you’re a junkie. You’re no good. You’re the filth of the earth. If you do Oxys, it’s not that bad” (Ung, 2001b) (pp. 16-17)
What Drs. Hansen and Netherland make clear is that the ‘Opioid Epidemic’ is nothing new, but rather a continuation of racially stratified policies of public health and criminal justice, in the service of maintaining the culture of White Supremacy:
What the stories of OxyContin® and Suboxone® reveal is how much political work is required to keep White opiates out of the War on Drugs and maintain them in a White medicalized space. The constant threat of miscegenation and invasion requires marketers, legislators and manufacturers to stay one step ahead of the darkening of the drug;they ultimately fail and have to (re)invent new White opioids. Another aspect of the racialization of drugs revealed by White opioids is the way that racial ideology works as a crucial element of post-industrial narco-capitalism. The very racial segmentation of markets into licit and illicit, White and Black, clinical and recreational as dictated by the War on Drugs and by the profit imperative of opioid manufacturers helps to drive cycles of demand and sustains a moving target of time-bound patents on new technologies of bioactive molecules and delivery devices. Pharmaceutical manufacturers exploit this temporal cycle in their claim to bring the latest technology to bear to limit the consumption of narcotics by the wrong people for the wrong reasons. The trope of racial invasion and miscegenation upon the province of a White narcotic also builds public political support for segmented marketing and regulation of reformulated drugs and creates pharmaceutical demand among Whites for whom the trope augments the appeal of reformulations as legitimate products for White consumption, while eventually heightening demand among non-Whites for whom such new reformulations are aspirational products,such as among Blacks and Latinos among whom a discourse of unequal treatment and need for access to opioid analgesics for undertreated pain and to buprenorphine for opioid dependence is building. (pg. 18)
Even the notion that there has been a relatively recent and sudden increase in Opiate overdoses, tied to economic factors occurring in the past decade, is a racialized account:
I have had two white friends die of heroin overdoses in the past year. They were good people from middle class homes. I know that their families voted for Trump. I know that their families are also racists. It’s been said that increasing economic hardship is what is driving so many white Americans to turn to the needle – hardships that black Americans have lived under since time immemorial.
And it’s a racialized account that doesn’t square with the data:
The epidemic of drug overdoses in the United States has been inexorably tracking along an exponential growth curve since at least 1979, well before the surge in opioid prescribing in the mid-1990s. Although there have been transient periods of minor acceleration or deceleration, the overall drug overdose mortality rate has regularly returned to the exponential growth curve.
Drug mortality has increased consistently during economic boom times and downturns, periods of low and high unemployment, over the past four decades.
If economic factors don’t correlate with this ‘inexorable increase’ in mortality rates due to substance abuse, what might account for it?
While substance abuse is undoubtedly the result of multiple, overlapping social and individual factors, it’s difficult not to notice this socopolitical coincidence:
The presidency of Ronald Reagan marked the start of a long period of skyrocketing rates of incarceration, largely thanks to his unprecedented expansion of the drug war. The number of people behind bars for nonviolent drug law offenses increased from 50,000 in 1980 to over 400,000 by 1997.
Public concern about illicit drug use built throughout the 1980s, largely due to media portrayals of people addicted to the smokeable form of cocaine dubbed “crack.” Soon after Ronald Reagan took office in 1981, his wife, Nancy Reagan, began a highly-publicized anti-drug campaign, coining the slogan "Just Say No."
This set the stage for the zero tolerance policies implemented in the mid-to-late 1980s.
And as we all know, when we say ‘Crack’, we mean ‘Black’.