White Opioids: Pharmaceutical Race and the War on Drugs

Racial Disparities in Drug Incarceration

  • Black Americans are incarcerated for drug offenses at 6-10 times the rate of Whites, despite similar rates of drug use.
  • This disparity suggests a racial bias in the criminal justice system, effectively creating a new racial caste system.

White Opioid Crisis

  • Beginning in the 1990s, prescription opioid misuse, particularly OxyContin®, rose dramatically among Whites.
  • Public response differed markedly from responses to drug use in Black and Brown neighborhoods, with a less punitive, clinical approach for Whites.

Whiteness as a Sociocultural Construct

  • Whiteness is actively maintained by reinforcing social boundaries.
  • It allows Whites to be seen as simply human, while others are racialized.

Technologies of Whiteness

  • The article examines four technologies of whiteness:
    • Neuroscience
    • Pharmaceutical technology
    • Legislative innovation
    • Marketing
  • These technologies contribute to a separate system for categorizing and disciplining drug use among Whites.

Neuroscience and Addiction

  • Neuroscience provides a rationale for treating addiction as a clinical disease, focusing on altered brain chemistry.
  • Addiction neuroscience connects to whiteness in three key ways:
    • Brain imagery that omits racial identity, presenting a White norm.
    • Silence about environmental factors contributing to addiction.
    • Framing addiction treatment as medication-based rather than punitive.

Pharmaceutical Technologies

  • Opioids have historically blurred the line between legitimate medications and drugs of abuse.
  • New drug delivery technologies, like tamper-resistant formulations, aim to reassure the public that medications are used only as prescribed.

Legislative Innovation

  • Legislative and regulatory guidelines for OxyContin® and Suboxone® include monitoring and certification requirements for prescribers.
  • These innovations shift law enforcement focus from drug users to surveillance of physicians and pharmacies.

Marketing Strategies

  • Pharmaceutical manufacturers shape markets by selectively targeting consumer groups and cultivating the public image of their drugs.
  • OxyContin® was marketed to primary care providers for moderate, chronic pain, while Suboxone® was marketed as a destigmatized treatment for opioid addiction.

DATA 2000 Act

  • The Drug Addiction Treatment Act of 2000 (DATA 2000) allowed certified physicians to prescribe Suboxone® in their offices.
  • It created two tiers of treatment: methadone for \"hard core\" users and Suboxone® for new, suburban users.

Maintaining White Opioids

  • Constant political work is required to keep White opiates out of the War on Drugs and maintain them in a White medicalized space.
  • The racial segmentation of markets drives demand and sustains patents on new technologies.

International Comparison

  • In France, buprenorphine was adopted as a public health intervention to stem HIV transmission and overdose deaths among low-income heroin injectors, with no certification requirements or prescribing restrictions.

Public Health Approach

  • Public health may be an alternative ideology to medical or punitive frames, encompassing structural issues like race, geography, and class.
  • Addiction remains a highly individualized problem, obscuring systemic factors and biases.