The opioid crisis has long been associated with white Americans in parts of the country undergoing deindustrialization, said MD-PhD psychiatrist-anthropologist Helena Hansen, who is also a professor at UCLA School of Medicine and UCLA Center for Social Medicine, according to the event description.
“But why opioids — and why white people?” Hansen asked in a virtual talk at the Center for the Study of Slavery and Justice on Tuesday. The answer, she said, is that “the current generation of opioids were designed to have white identities.”
“Social technologies,” Hansen noted, “reinforced racial inequalities while at the same time harming white Americans.”
Opioids — from treatments like buprenorphine to highly addictive drugs such as OxyContin — have consistently taken on a white racial identity, she explained — both in terms of whom they are prescribed to and how society perceives them.
Hansen, who said she has studied the intersection of race and addiction for two decades, noted that only in 2020 did the racial opioid overdose rates reverse, with Black and Native American individuals beginning to die at higher rates.
“What makes the overdose crisis of the past 20 years different in people’s minds is the way the white identity of sufferers has been highlighted,” she said.
Drugs, she said, have always held racial associations: Historically, narcotics have been associated with “opium dens” run by Chinese individuals, cocaine has been associated with Black Americans and marijuana has been associated with Mexican communities. White middle class identity, too, has tied into drug use, she said — but those drugs, such as valium and barbiturates, were advertised in the open and are legal.
For opioids in the late 20th century and early 21st century, a distinct marketing and regulatory paradigm targeted white, middle-class Americans, Hansen explained.
Much of Hansen’s previous work surrounded buprenorphine — an opioid that both treats pain and also works to treat opioid use disorder.
The drug, she said, took on a racial identity compared to its treatment predecessor, methadone. The federal government initially saw methadone as a “weapon in the war on drugs,” only making it available in regulated, observed clinics primarily located in “marginalized neighborhoods.”
While buprenorphine is “pharmacologically similar” to methadone, the Food and Drug Administration approved the drug in 2002 in the form of suboxone and subutex, allowing for doctors to prescribe it for home use, Hansen said. This marked the first time that private doctors could use opioids to treat people dependent on opioids.
But the high cost of suboxone and its limitation to medical practices that completed an extensive certification course dictated its target audience, she said.
“Patented, expensive technologies for expensive deliveries encode white race and middle class,” she added, noting that race stratifies access to medicine. In contrast, public clinics with little profit incentive to prescribe suboxone rarely had the time or saw the incentive to undergo certification, she said.
Another key example, she added, comes from the development and marketing of OxyContin, a drug produced by Purdue Pharmaceuticals that has been repeatedly cited with helping create the opioid crisis.
After the FDA allowed acute pain sufferers to access opioids in 1996, a “new generation of patented opioids” followed shortly after, Hansen said. Purdue hired 700 representatives to encourage 100,000 physicians — “located primarily in white suburban and rural areas” considered low risk for addiction, such as Maine, Ohio, Kentucky and West Virginia — to prescribe OxyContin, she said. Ads for OxyContin featured white, middle-class patients and grandmothers, while doctors primarily directed OxyContin to supposedly “trustworthy” patients who were often white.
“For the most part, the white middle class consumer is the one that pharmaceutical companies first target,” Hansen said.
Opioid marketing in the late 1990s and early 2000s also aimed to legitimize the use and addiction of “white middle-class” patients, she added, detailing a phenomenon called “pseudo-addiction” in which users of prescription opioids exhibit all the same signs of opioid use disorder.
“The treatment for pseudo-addiction (was) not to get them off of opioids,” she said, “but to increase the dose.”
Opioid manufacturers also used coded language in marketing materials to declare opioids a “white drug” with images and descriptions of white, middle-class patients, she said.
And when Purdue began introducing tamper-resistant formulations of OxyContin in response to its abuse, more white Americans addicted to opioids began turning to heroin, she explained.
While drug users had previously been considered “criminals,” white opioid users were painted as “victims,” she added.
Hansen urged the audience to consider systemic intervention — not isolated, “magic bullet” technologies — as the key to improving public health conditions. Any solution introduced to the health care system, she noted, automatically becomes “stratified.”
In the meantime, Hansen urged health officials to consider the impact of social systems on the brain and the social determinants of health.
“The more we focus on a magic bullet, the less we focus on deep social inequalities and how they’re driving overdoses,” she said.
The argument as a whole, she added, will feature in her coming book written with Jules Netherland, a policy analyst for the Drug Policy Alliance, and David Herzberg, a University of Buffalo history professor, titled “Whiteout: How Racial Capitalism Changed the Color of Heroin in America.”