At the turn of the 21st century America faced two seemingly contradictory drug crises. The first began with an unprecedented increase in opioid addiction, especially in rural white areas such as Maine, Appalachia, and parts of the Midwest. Most observers traced this crisis to the aggressive marketing of OxyContin, a long-acting opioid introduced by Purdue Pharma in 1996. The second was an unprecedented increase in incarceration, especially among racial minorities. Most observers agreed that harsh drug war sentencing contributed significantly to a crisis so severe, and so racially disparate, that some called it the “new Jim Crow.”
There was a brutal irony in this moment of twin social catastrophes: American drug control was too weak to restrain Purdue Pharma, but so strong that it sent countless people to prison. How was it possible for drug laws to have both problems at the same time?
The answer is all too obvious. In early 21st century America, “pharmaceuticals” were not “drugs.” Regulating the pharmaceutical industry was seen as separate from controlling drugs, and the crisis of addiction to pharmaceutical opioids was not seen as connected in any way to the crisis of mass incarceration driven in part by drug arrests. Pharmaceuticals and drugs belonged to separate stories, involving different people and different challenges, and calling for different solutions.
This assumed difference provided cultural fuel for one of the most relentlessly sensationalized narratives about the opioid crisis: that addiction had left its traditional home among poor, urban racial minorities and was, for the first time, invading largely white suburbs and small towns, transforming wholesome children into “a new breed of addict,” supplied by a “new breed of dealer.” The crux of the typical media story on OxyContin was the defilement of white innocence: suburban cheerleader to sex worker, rural honors student to criminal.
To see the opioid crisis as new and unprecedented in this way required a radical act of forgetting. During the last 150 years small town and suburban white communities have suffered repeated crises of addiction to pharmaceuticals. Indeed, they have been home to far more drug use and addiction than poorer communities with less access to the medical system. These previous crises were no carefully held secret; medical and popular media have been covering them breathlessly for over a century. Yet eerily, year after year, decade after decade, this coverage has recounted the same story of addiction appearing for the first time in places and people where it did not belong.
Why has addiction to pharmaceuticals been so widespread, for so long? How is it possible to continually “discover” it as if it were something new? What purposes are served by this bizarre, long-running national surprise?
White Market Drugs answers these questions by remembering the story of what I call “white markets”: legal and medically-approved social institutions within which the vast majority of American experiences with psychoactive drugs and addiction have taken place. White markets, I show, have been home to three major addiction crises in the modern era, far larger than any crises associated with illegal drugs. The first, at the turn of the 20th century, began with sharp increases in medical sales of opioids and cocaine. The second, from the 1930s to the 1970s, came during a historic boom in sales of pharmaceutical sedatives and stimulants. The third, at the turn of the 21st century, grew from dramatic increases in medical use of all three classes of white market drugs—sedatives, stimulants, and opioids. These crises, I argue, all happened for the same reason: a presumption of therapeutic intent that left white markets with insufficient consumer protections. They were also all resolved through a similar set of policies, quite different from (and significantly more effective than) the punitive prohibitions of American drug wars. These policies involved a combination of strong regulation of large commercial suppliers and continued provision of safe, reliable drugs to people who needed them, including people with addiction.
The history of white markets challenges us to take seriously not just the dire risks but also the irreplaceable benefits of addictive drugs. It also, I argue, provides us with rarely consulted tools for doing so: an alternate history of drug policy driven by the goal of consumer protection rather than “free markets” or prohibition.