How Race Made the Opioid Crisis

The fundamental division between “dope” and medicine has always been the race and class of users.

“The success of OxyContin hinged on racially bifurcated understandings of addiction.”

In March 2018, President Donald Trump delivered a forty-minute speech about the crisis of addiction and overdose in New Hampshire. Standing before a wall tiled with the words “Opioids: The Crisis Next Door,” Trump blankly recited the many contributors to the current drug epidemic, including doctors, dealers, and manufacturers. Trump droned on mechanically until he reached a venomous crescendo about Customs and Border Protection’s seizure of 1,500 pounds of fentanyl. He brightened as he shifted focus to three of his most hated enemies, first blaming China and Mexico for saturating the United States with deadly synthetic opioids, then moving seamlessly to what he considered one of the great internal threats: “My administration is also confronting things called ‘sanctuary cities,’” Trump declared. “Ending sanctuary cities is crucial to stopping the drug addiction crisis.”

Like so many of Trump’s proclamations, this rhetoric is sheer political fantasy.

Since the late 1990s, yearly rates of overdose deaths from legal “white market” opioids have consistently exceeded those from heroin. According to the Centers for Disease Control and Prevention, between 1999 and 2017, opioid overdoses killed nearly 400,000 people with 68 percent of those deaths linked to prescription medications. Moreover, as regulators and drug companies tightened controls on diversion and misuse after 2010, the American Society of Addiction Medicine determined that at least 80 percent of “new heroin users started out misusing prescription pain killers.” Some data sets point to even higher numbers. In response to a 2014 survey of people undergoing treatments for opioid addiction, 94 percent of people surveyed said that they turned to heroin because prescription opioids were “far more expensive and harder to obtain.”

“At least 80 percent of new heroin users started out misusing prescription pain killers.”

In the face of these statistics, the claim that the opioid crisis is the product of Mexican and Central American migration—rather than the deregulation of Big Pharma and the failures of a private health care system—is not only absurd, but insidious. It substitutes racial myth for fact, thereby rationalizing an ever-expanding machinery of punishment while absolving one of the most lucrative, and politically influential, business lobbies in the United States. This paradoxical relationship between a racialized regime of illegal drug prohibition and a highly commercial, laissez-faire approach to prescription pharmaceuticals cannot be understood without recourse to how racial capitalism has structured pharmacological markets throughout U.S. history. The linguistic convention of “white” and “black” markets points to how steeped our ideas of licit and illicit are in the metalanguage of race.

Historically, the fundamental division between “dope” and medicine was the race and class of users. The earliest salvos in the U.S. domestic drug wars can be traced to anti-opium ordinances in late nineteenth-century California as Chinese laborers poured into the state during the railroad building boom. In 1914 the federal government passed the Harrison Narcotics Act, which taxed and regulated opiates and coca products. Similarly, as rates of immigration increased in the aftermath of the Mexican revolution, Congress passed the Marijuana Tax Act of 1937, which targeted the customs and culture of newly settled migrants. Although “cannabis” was well known in the United States—it was used in numerous tinctures and medicines—a racial scare campaign swept the country and warned that “marijuana” aroused men of color’s violent lust for white women.

As bad as the early drug panics were, they paled in comparison to the carceral regime of drug prohibition and policing that emerged in the years after the civil rights movement. In the 1980s and 1990s, mass incarceration and the overlapping War(s) on Drugs and Gangs became de facto urban policy for impoverished communities of color in U.S. cities. Legislation expanded state and federal mandatory minimums for drug offenses, denied public housing to entire families if any member was even suspected of a drug crime, lengthened the list of crimes eligible for the federal death penalty, and imposed draconian restrictions of parole. Ultimately, multiple generations of youth of color found themselves confined under long prison sentences and faced with lifelong social and economic marginality.

“Racial capitalism has structured pharmacological markets throughout U.S. history.”

Today, much of the Trump administration’s rhetoric is taken from decades of drug and incarceration frenzies past, including the threat of the death penalty for drug trafficking (Bill Clinton), Just Say No campaigns (Ronald Reagan), and the reinvigoration of the War on Gangs (Bill Clinton again). “We are all facing a deadly lucrative international drug trade,” warned Trump’s then attorney general, Jeff Sessions. As he spoke before the International Association of Chiefs of Police in the fall of 2017, Sessions laid out a law-and-order platform that promised to “back the blue,” reduce crime, and dismantle “transnational criminal organizations.” He drew so heavily from 1980s anti-drug hysteria, in fact, that he earned giddy praise from Edwin Meese III, Reagan’s attorney general who helped enshrined the 100-to-1 sentencing disparity between crack and powder cocaine. “Largely unnoticed has been the extraordinary work that . . . Sessions has done in the Department of Justice to create a Reaganesque resurgence of law and order,” Meese opined in USA Today in January 2018.

Over the past two years, Trump and Sessions repeatedly used the threat of drugs and racial contagion for a reactionary portfolio ranging from reversals of modest criminal justice reforms of the Obama era— including reinstating federal civil forfeiture, limiting federal power to implement consent decrees at the local level, and the expansion of mandatory minimum sentencing in the federal system—to the building of a wall along the Mexican border. And, although anti-crime rhetoric no longer has the same purchase as it did in the era of Willie Horton or Ricky Ray Rector—thanks in large part to activist efforts to delegitimize mass incarceration—the reinvigorated machinery of criminalization remains firmly in place.

Integrating the opioid crisis with the War on Drugs raises questions beyond familiar narratives and political discourses. In the United States, prohibition of illicit drugs and the mass marketing of licit pharmaceuticals fit together in a larger framework of racial capitalism and deregulation that are deeply intertwined and mutually reinforcing. The opioid crisis would not have been possible without the racial regimes that have long structured both illicit and licit modes of consumption. As we will see, the demonization of urban, nonwhite drug users played a crucial role in the opening of “white” pharmaceutical markets in the 1990s that proved so enormously profitable to companies such as Purdue Pharma and paved the way for our current public health crisis.

“The opioid crisis would not have been possible without the racial regimes that have long structured both illicit and licit modes of consumption.”

In the 1990s, Purdue created aggressive marketing campaigns to convince doctors and state regulators of the safety of a new class of timed-release opioid analgesics. Given their status as Schedule II controlled substances, Purdue faced potentially enormous pushback, especially at a time when the number of people incarcerated for drug offenses was reaching an all-time high. However, a major shift had taken place in regulatory policy a decade before that made this possible. In the 1980s, President Reagan initiated a radical program of corporate deregulation that opened the door to a new era of pharmaceutical mass marketing. Reagan’s “Second American Revolution” slashed government oversight, pushed through expedited review by the Food and Drug Administration (FDA), and for the first time allowed direct-to-consumer advertising for pharmaceutical drugs.

Amazingly, the deregulation of Big Pharma took place while the Reagan administration was launching a bombastic “second” War on Drugs that established a new standard for illicit drug prohibition, one his successors George H. W. Bush and Bill Clinton not only met but exceeded. This potent mix of racialized drug prosecution and corporate empowerment created the environment in which Purdue and other companies sought out new commercial strategies for marketing opioids.

By Donna Murch/BAR/fullstory

Posted by The non-Conformist