Chronicle Book Review: Whiteout

Whiteout: How Racial Capitalism Changed the Color of Opioids in America by Helena Hansen, David Herzberg, and Jules Netherland (2023, University of California Press, 369 pp., $29.95 HB)

When the face of opioid addiction turned white, an era that can be marked as beginning with the introduction and mass prescribing of OxyContin in the late 1990s, official attitudes toward drug users shifted away from the punishing and toward the nurturing. They were no longer black deviant criminals, but now white innocent victims.

Republican lawmakers in statehouses around the country who had built careers as fierce drug warriors now sponsored Good Samaritan bills (so that people overdosing and those seeking to help them did not face drug charges), the availability of medicine-assisted treatment (methadone and buprenorphine) spread -- and went upscale, with bupe acting as white people's methadone.

While methadone, associated with the Black and Brown heroin addicts of the 1970s, remains heavily stigmatized, its administration heavily authoritarian, and its dispensing locations almost always deep within poor minority neighborhoods, buprenorphine -- a drug for treating white opioid users of the 21^st Century -- is much more easily accessible, available in doctors' offices instead of grim industrial buildings, but also more expensive, limiting its access for people with little money or insurance.

In Whiteout, an addiction psychiatrist (Hansen), a drug historian (Herzberg), and a policy advocate (Netherland) tease apart the structures of Whiteness (the unspoken ideology of white virtue, purity, and superiority) and demonstrate how racial disparities have been cooked into American drug policies from the beginning -- and how not only Black populations but white ones, too, have suffered for it.

In the first great wave of opioid addiction in the late 19^th Century, it was middle class white women who suffered the grip of the poppy, and they were largely treated in the doctor's office. As relatively well-off people, they had the ability to access the health care system of the time, to be prescribed the pills they wanted, and to be helped off them if necessary.

Meanwhile, Black Americans more often lacked the money to gain access to the health care system, and once drug prohibition fell into place in the 1910s, they were shunted into the black market, criminalized, and stigmatized. Their neighborhoods became epicenters of the illicit drug trade. Black market drugs in the ghetto, white market drugs at the doctor's office and the drugstore.

But white privilege had its price -- a price that hundreds of thousands of white opioid users have paid since the turn of the century as overdose deaths quintupled in 20 years. Affluent white drug consumers would be provided their drugs by a lightly regulated pharmaceutical industry that the authors demonstrate portrayed the users of its products as white people and marketed their products directly at white people. The poster child for this behavior is Purdue Pharma, the manufacturer of OxyContin, which zeroed in on mostly white Appalachia as its force of zealous sales reps went to work. This is the racial capitalism of the title.

Anyone who is uncomfortable with terms like "racial capitalism" is really going to be squirming when Critical Race Theory makes its entrance. Unlike the case with the moral panic around Critical Race Theory in children's schoolbooks (which it isn't), the academic tool is actually applied here and, indeed, is central to the argument the authors make.

It also colors their recommendations for what is to be done. In line with the critique of capitalism, a little more harm reduction here or a little more criminal justice reform there are not going to solve the social problems that give rise to the current opioid crisis. It is going to require real social change, things like universal health care and a real social safety net. And an ongoing interrogation of Whiteness.