Race and Addiction

Since the early 20th century, the topic of race and addiction has been a part of the public health conversation. As the 20th century gave way to the 21st, how people bought and sold drugs changed, and how people understood race and demographics also changed. What has not changed is the danger of drugs. Even as we learn more about the deadly influence of drugs across different sections of society, we are constantly reminded that drugs, and the market behind them, do not discriminate.

The ‘Negro Cocaine Fiend’

cocaine The first public intersection of race and addiction came in 1914. In the late 19th century and early 20th, European scientists had successfully isolated the chemical compounds in the South American coca leaf to make cocaine, marketed as everything from a sweetener, to an anesthetic, to an aphrodisiac. Cocaine enjoyed universal popularity, even being endorsed by popes, politicians, Civil War generals, and a number of eminent men of science and medicine of the era, including Sigmund Freud.

But when cocaine’s poisonous effects on the human mind and body became undeniable, the public turned on their elixir. People needed a scapegoat, and they found a readymade supply in the legion of unemployed, uneducated, newly freed African American former slaves. In 1914, The New York Times published an editorial written by a doctor on the “Negro Cocaine Fiend,” the name given to a wave of moral panic that tried to attribute incidents of violence and hallucination to black Americans (where white Americans, usually women, were the victims of crimes of such a primal nature, that law enforcement had to use a bigger caliber of firearm to subdue the enraged black assailants).

There was, of course, no scientific basis for this claim; race and ethnic background do not have any determination in the effects of cocaine, and some of the most infamous cocaine users have been white. But the damage had been done. Almost instantly, the American people fused black people, drugs, and crime together, an impression that defined an entire century of public and private policy.

The propaganda campaign was effective, as cocaine – once the social lubricant of the upper classes – was banished. It remained on the fringes, overshadowed by the bigger events of the early 20th century: the Roaring Twenties, the Depression, World War II, and the Cold War.

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The War on Drugs

war on drugsThe deep-seated unpopularity of America’s military embroilment in Vietnam, combined with changing attitudes toward drugs (growing more positive) and the establishment (growing more negative), and the rising tide of civil rights protests and black nationalism, created a problem for then-President Richard Nixon. With John Ehrlichmann, his Domestic Affairs Advisor, Nixon came up with a plan to strike at his biggest enemies in one fell swoop.

This was done by way of declaring a “War on Drugs” in 1971, a concentrated, coordinated effort to cut off the importation of contraband in the United States, to provide military and financial assistance to countries fighting drug cartels and smuggling rings, and to employ a zero-tolerance policy toward drug violations in the United States. Announcing that drugs were “Public enemy number one,” Nixon vowed to “take every step necessary to deal with this [national] emergency.”

On the face of it, the War on Drugs declaration was America taking a stand against the corrupt governments and criminal organizations that sought to turn the country into the world’s most lucrative drug market. In reality, however, the War on Drugs was a cover for Nixon going after the two biggest thorns in his side: the antiwar left and the African American Civil Rights movement. Since both groups were associated with drug consumption – the antiwar left with their budding marijuana and LSD movements, and many in the South vehemently holding on to the perception of the “Negro cocaine fiend” – Nixon and Ehrlichman painted their biggest undesirable elements with the same “drug” brush, casting the anti-Vietnam War, the antiestablishment, and pro-Civil Rights movements as all parts of the same criminal problem.

This was done by directing law enforcement to disproportionately target people of color for drug violations, using deception and harsh tactics to discredit their leaders and break up their communities. In 1994, Ehrlichman admitted that the entire mission of the War on Drugs was predicated on a lie. But, much like the Negro Cocaine Fiend hysteria 80 years prior, the damage was done.

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Disproportionate Rates of Suspicion and Arrest

race and rates As The Huffington Post reports, even though drug use among white and black Americans is roughly the same, black Americans are 13 times more likely to be arrested for buying, selling, and using drugs than their white counterparts. That rate can climb up to 57 percent in some states. In 2013, black Americans and Hispanics together constituted 29 percent of the American population, but they made up 75 percent of prisoners in state and federal prisons for drug offenses. In 2012, the US Sentencing Commission wrote that black Americans are given longer prison sentences for drug-related offenses than white Americans who are convicted for the same crimes.

Further statistics shed light on the extent to which black Americans find themselves disproportionately carrying the burden of the War on Drugs. In 2012, the Bureau of Justice Statistics revealed that of the 225,242 inmates in state prisons for drug-related crime that year, 45 percent were black and 30 percent were white. The Chicago Sun-Times attributes this to how often police make arrests in communities primarily populated by low-income and ethnic minority residents. Cook County, Illinois, for example, has 5.24 million residents. While 25 percent of its residents are black Americans, black Americans make up 73 percent of the county’s incarcerated population. Those arrested tend to be of low income, without significant education, and have negligible job prospects. They tend to have a mental health condition of some kind, and cases of trauma and abuse in childhood are not uncommon. There is rarely a positive family or social network that they can rely on, but they usually have children they are required to support. Perhaps most damningly, the Sun-Times found that black Americans are typically convicted for possessing even small amounts.

The real issue, says the Sun-Times, is that minorities and people of low income are arrested at disproportionately high rates for drug-related offenses.

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Crime and Punishment

crime and punishment One possible reason for this is that white Americans tend to have better access to adequate legal representation to argue for reduced charges (or even complete exoneration) compared to the black Americans who are easily (and quickly) arrested and convicted, because they have little to no resources to secure competent legal defense. A blog on The Huffington Post claims that the criminal justice system in the United States “is a race-based institution” that not only directly targets African Americans, but punishes them “in a much more aggressive way than white people.” In addition to black Americans being arrested more often than white Americans for the same drug-related offenses, police tend to stop black and Hispanic people more often than they do white people. In New York City, for example, where in 2000, there were more black Americans than there were in four entire states, most of the people stopped and frisked by law enforcement were black, young, and male.

Additionally, when black Americans are arrested, they have to endure longer waits in prison before their case goes to trial; white Americans tend to enjoy a much speedier process. In 1995, the Division of Criminal Justice Services in New York found that black residents of the state were 33 percent more likely to be detained as they awaited felony trials than white residents also facing felony trials.

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Black Defendants and ‘White Prosecutorial Restraint’

Investigations into law enforcement and the criminal justice system after a spate of high-profile killings of black youths by white police officers in 2014 and 2015 revealed that America’s policemen and lawyers are almost all white. The American Bar Association reports that 88 percent of its lawyers are white and just 4.8 percent are African American. In principle, says The Guardian, this shouldn’t matter; but when white police officers were facing charges for shooting and killing unarmed black youths, “white prosecutors appeared reluctant” to pursue indictments against those officers.

However, in the words of The Guardian, “white prosecutorial restraint does not extend to black defendants.”

The result of this, says TIME magazine, is that black Americans are exposed to many more risk factors than white Americans, leading to arrest rates that are 10 times higher than those among white Americans, fundamental distrust of law enforcement and the criminal justice system, and propagation of the stereotype that drugs are a “minority problem” or a “poor people problem”; even though, according to a 2011 study published in the Archives of General Psychiatry, young African Americans are less likely to use drugs, and less likely to develop addictions, compared to white Americans.

Even after a state like Colorado legalized the sale and use of recreational marijuana in 2012 (as part of an attempt to undo the damage caused by the War on Drugs), the

cards remain stacked against people of color. Vox quotes statistics released by the Colorado Department of Public Safety as showing that black youths have a higher chance of being arrested for possession of recreational marijuana than white youths, who are less likely to be picked up for the same reason.

In detail, the statistics show that for white Americans aged 10-17, the arrest rate for marijuana fell by 9 percent from 2012 to 2014 (the period from the last year of illegal cannabis sales to the first year of legal cannabis sales). However, the arrest rate for black Americans of the same age, in the same time span, went up by 52 percent. Additionally, Hispanic youths were subject to a 22 percent increase in arrest rates.

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The Painkiller Epidemic

painkillersBlack and white Americans consume drugs at mostly the same rate, but the decades of the “Negro Cocaine Fiend” and the War on Drugs have tipped the judicial scales in favor of white Americans for decades. However, the drug-related problems facing white Americans are no less serious; even so, the nature of those problems has changed the tone of the public conversation about drugs. For a new generation of Americans – most of them white – the problem started with painkillers. Specifically, the problem started with one pharmaceutical company called Purdue Pharma.

In 1995, the Food & Drug Administration approved OxyContin, a product manufactured by Purdue Pharma, for sale and promotion in the United States. A painkiller that promised to alleviate pain symptoms for 12 hours at a time, the distribution of OxyContin spread like wildfire. In 1996, Purdue Pharma made $45 million in OxyContin sales; in 2000, revenue topped $1.1 billion; and in 2010, the same year that OxyContin accounted for 30 percent of all painkillers sold in the United States, Purdue Pharma made $3.1 billion.

OxyContin was unstoppable, and lots of people in the medical profession wanted a share of the profits. Purdue Pharma aggressively courted doctors, offering them lucrative speaking engagements and lavish gifts if they prescribed OxyContin – a powerful and addictive medication – to patients who didn’t need the full brunt of its opioid effects. Between 1997 and 2002, prescriptions increased by 10 times; the dosage per pill went up from 80 mg to 160 mg.

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‘Mostly White’

As more and more Americans became hooked on OxyContin, they started to look elsewhere for the same kind of narcotic bliss they got when they took a pill. As an opioid, OxyContin’s chemical structure is based on the composition of opium, which is used in the production of heroin. When an OxyContin prescription ran out, when the pills became too expensive, or when the craving for the euphoria became too much to deny, heroin became the next big thing, and its victims were (and are) mostly white.

In New Jersey, where some of the chemically purest heroin is found, 49 percent of the state’s residents who need substance abuse treatment have issues of opioid abuse. Put together, that many people could make up what would be the state’s fourth biggest city, what NJ.com calls the hypothetical “Herointown.” But unlike the squalid urban wastelands of the past, Herointown is populated by rich, well-educated white Americans who are wealthy and technologically savvy enough to buy drugs off the Internet.

Studying data from the Centers for Disease Control, The New York Times writes that because of the number of white Americans aged 25-34 dying from heroin and prescription medication overdoses, theirs is the first generation since the Vietnam War “to experience higher death rates in early adulthood than the generation preceding it.” The chief medical officer of a nonprofit treatment institution that has facilities in 10 states tells Vice (in an article entitled “Heroin Kills More White People Than Anyone Else”) that the wave of heroin fatalities, powered by exposure to prescription opioids like OxyContin and Vicodin, “has hit every white socioeconomic class.” In “a retrospective analysis of the past 50 years,” the American Medical Association’s JAMA Psychiatry found that heroin users are “primarily white men and women.” Figures released by the Centers for Disease Control have found that heroin use has doubled among white Americans, and, in particular, female white Americans.

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The White Face of Heroin

heroin The rise of the prescription painkiller epidemic has changed the public perception of drug addiction in the United States, especially as it pertains to race. The Economist writes of how a generation ago, the common image of a drug user was usually a poor African American living under a bridge. Today, “the face of heroin use in America has changed utterly,” and is more likely to be white, female, and living in an affluent suburb.

Addiction’s evolution into a new demographic has also changed how the country talks about addiction. The New York Times writes when people thought of drug users as vagrants living in “poor, predominantly black urban areas,” the response of communities and politicians was the harsh, zero-tolerance policies that characterized the War on Drugs. Now that heroin and prescription painkiller abuse has crippled locales with a majority white population, however (to the point that heroin use has “skyrocketed among whites”), the entire tone of the conversation has changed. Instead of framing drug use as a problem of criminal justice as Richard Nixon did when he declared the War on Drugs, now there is a call to improve mental health services; instead of calling drug users “fiends” and advocating for tough prison sentences, now there is an understanding that drug users are sick people in need of help.

In the words of The Atlantic, “white [drug] users made heroin a public health problem.”

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Addiction in Rural America

The effect was especially felt in small, rural towns in New England and the Northeast, a world away from the crowded and sprawling inner cities that were often portrayed and depicted as dens of drug abuse. There was a racial element as well; those urban areas were typically populated by black Americans, who, the Journal of Sociology & Social Welfare writes, “struggled for generations with persistent poverty.” In turn, this added to the problem (and the perception) of economically disadvantaged black Americans turning to drugs as a way of coping with the harsh and hostile world they lived in.

On the other hand, the bucolic setting of small-town America is overwhelmingly white, the skyline populated more by barns and farm silos than high-rise apartment blocks. But it was among this overwhelmingly white population in rustic, remote towns that OxyContin (and other

prescription medications that were derived from opium) struck deepest. Populations are largely poor and uneducated, but the nature of work also tends to be physical – primarily farming and mining – and on-the-job injuries are commonplace. In these small towns, where life is slow, everybody knows everybody else, and suicide rates are already high, addiction spreads quickly.

Such is the case in Kutztown, Pennsylvania, population 5,012 and 95.8 percent white, at the time of the 2010 census. It’s a small town, in the words of NPR; it’s also the scene of a deeply embedded opioid epidemic. A local paramedic explains that with heroin cheaply and easily transported from larger cities, every single demographic in a town that is almost 96 percent white has been affected.

The problems of Kermit, West Virginia, highlight the new frontier of addiction

in America. The town has a population of 406 (98.8 percent white) as of the 2010 census, but thanks to a former Sav-Rite pharmacy, no other town in the United States has had more trouble with prescription pills than Kermit. Two pharmacies in the area distributed almost 3.2 million units of hydrocodone (an opioid painkiller sold under the brand name Vicodin) without verifying prescriptions in 2006 alone (when the national average for hydrocodone prescriptions was 97,000). One pharmacist in Kermit ordered over 3 million doses of hydrocodone – for a town of fewer than 500 people. He made over $6 million in a single year and served six months in prison for the illegal dispensation of prescription drugs. Salon magazine called Kermit, with its almost 99 percent white population, “the pill-popping capital” of the country.

The market for supplying poor, rural white Americans with prescription pills is a big one. AmerisourceBergen, the third largest drug distributor in the United States, supplied 118 million pills of generic Vicodin and OxyContin to West Virginia, enough to give every resident of the state – 93.2 percent white – 13 doses for an entire year.

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America’s Newest Public Health Crisis

public health crisis Even far beyond the farms and towns of rural America, middle-aged white Americans are dying faster than every other racial and ethnic group. Findings by two Nobel Prize-winning Princeton economists, studying data from the Centers for Disease Control, revealed that while previous generations of white Americans struggled with fatal rates of diabetes and heart disease, today’s white Americans are hit hardest by suicides related to substance abuse, liver disease brought on by alcoholism, and overdoses brought on by heroin and prescription painkillers. One of those economists said that the only comparable public health crisis that has ever faced white Americans has been the HIV/AIDS epidemic.

Much of America’s history has been defined by racial issues, from the Civil War to the Civil Rights movement, from Barack Obama’s historic election to the Black Lives Matter movement. But with the overwhelming and insidious power of illicit drugs, and the unending demand for them, the past, present, and future of the United State’s relationship with race will always be stained by the reality of drug addiction and how the country responds to the people who need help.

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