Addictive Drugs and Treatments Said to Have Racial Component

“Pharmaceutical whiteness” asserts itself in the racially divergent ways that American society perceives and uses opioids and other drugs, said Helena Hansen, M.D., Ph.D., at APA’s 2017 Annual Meeting in San Diego. Both drugs of abuse and their treatments can be divided by race.

Hansen spoke at a Presidential Symposium honoring the late Chester Pierce, M.D., which addressed the intersection of race and psychiatry (see story on page 1).

The racialization of narcotics is evident when illegal drugs like heroin are associated with poor black or Latino people, while legal, prescription opioids and their treatments are marketed to whites, argued Hansen, an assistant professor of anthropology and psychiatry at New York University. Analogously, in the 1950s, marijuana was an illegal street drug used by minorities while Valium was marketed as “mother’s little helper” to middle-class suburban housewives with access to physicians.

Of course, not all users of prescription drugs are white, nor are all heroin users or cannabis smokers members of minority groups, but Hansen made a case for the different ways the drugs, their users, and their treatment are racially divided in the medical and legal realms.

This difference became even more acute in recent decades, first with racial disparities in sentencing in the 1970s and for cocaine possession and trafficking in the 1980s. Crack cocaine—associated with inner-city blacks—drew drastically longer sentences than the powdered variant, which was seen as a glamorous drug for whites. In the 1990s, promotion of pain as the “fifth vital sign” and heavy commercial marketing of oxycodone led to the take-off of those prescription medications as drugs of abuse.

“The puzzle is that we saw increasing white opioid use in the midst of an intensified inner-city drug war,” said Hansen. “We have a clinical track for whites and a criminal track for the rest.”

Yet this nominal advantage for white people is also costly for them, she said. “White people pay more money for patented drugs, and some pay again with their lives when they overdose.”

Even the recategorization of addiction as a “chronic, relapsing, brain disease” only enhanced the social stratification of addiction, said Hansen. Ironically, the scientists involved wanted to counteract the punitive drug-war mentality by erasing the social and racial foundations of drug use.

“An image of a brain scan takes gender, race, and class out of the picture, but that implies a white norm,” she said. “It only whitened opioids by molecular means.”

Furthermore, the treatments for drug abuse and addiction present divided racial identities. Methadone was “a poor fit for the suburban spread of narcotic addiction,” Hansen said, quoting a former NIDA director. Thus methadone is handed out to a stigmatized population under tightly controlled conditions at clinics set in marginal neighborhoods. High-priced, on-patent buprenorphine, however, is marketed for a “new kind of addict” (that is, implicitly white and insured) and is dispensed in private physicians’ offices in the suburbs.

Such an approach for buprenorphine was not inevitable and may have been counterproductive, she said. Overdose rates in France—a country with a national health system, she noted—dropped 80 percent in the first four years after buprenorphine was introduced for all addicts, while overdoses in the U.S. have quadrupled in the first 10 years after approval.

“The public health potential of buprenorphine is limited by our racially segregated and commercially driven health care system, which orphans patients with patchy insurance coverage and tenuous access to providers,” she said. “We could use the current despair over white opioid deaths to build a case for a less market-driven health care system and adopt a more public health and social determinants–based approach to both white and non-white patients.” ■