Month: February 2016

“Cocaine is an epidemic now.  White people are doing it.” – Richard Pryor

Heroin has a new face.  The new face of heroin elicits more sympathy, compassion, and understanding.  The new face of heroin is, were told, less threatening.  Ninety percent of new heroin users are white.  From punishment to public health, local and national responses to heroin have been remarkably fluid over time.  In each case, our approach is animated by the esteem—or lack thereof—with which we hold using demographics.  As new heroin and opioid users are disproportionately white and often middle class, how we view the problem and options to address said problem have changed dramatically.  An ahistorical optimist might view our new vibrant discussion and consideration of public health approaches and harm reduction at the local and state level as clear markers of progress.  A drug historian might ask: how will approaches change when users change or new drugs with new using demographics emerge?  Those that prescribe to David Musto’s dictum of periods of tolerance and intolerance in United States drug control might rightly hold their breath for our next period of intolerance.

Perhaps not surprisingly, the reason nonwhite populations have been less adversely effected by heroin’s rise is also steeped in racial prejudice.  The history of medicine has long revealed the ways in which various nonwhite ailments have been ignored or minimized by the medical profession.  In our present context, Dr. Andrew Kolodny, a drug abuse expert argues that doctors are much more reluctant to prescribe painkillers to minority patients, worrying that they might sell them or become addicted.  Had practitioners viewed all of their patients with similar suspicion and caution the iatrogenic addiction of opioids leading to heroin may have been avoided.  In 2012, twelve states processed a volume of opioid prescriptions that outstripped their population.  In Alabama, the staggering ratio rested at 142.9 opioid prescriptions for every 100 citizens.

I first wrote about this trend in 2014, after the Governor of Vermont dedicated his State of the State Address to the heroin problem.  As I argued then: Sound policy steeped in punishment—it turns out—makes much more sense when applied to 1970s Harlem rather than the land of maple syrup, autumn foliage, and good neighbors.  When addressing the same drug with different users in decades past, punishment reigned.  The addict and the peddler–often doubling as the same shadowy figure–became cemented as cultural boogeymen.  Addicts, not society or disease, caused the problem and bore the threat to public safety.  In Vermont however, Governor Peter Shumlin transformed addicts as victims.  De-centering traditional narratives of crime and deviance, Shumlin painted a picture of heroin users as everyday people, victims caught in a downward spiral.  Schulman cited the conclusions of a local Pediatrician Dr. Fred Holmes: “These kids don’t look different, walk different, talk different.  It’s just the nature of the disease that’s different.  A relentless relapsing illness that is potentially fatal.”  A far cry from the “super-predators” of the Crack Era.  

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Popular perceptions of drugs and alcohol are fluid and in many cases highly volatile.  What we think about drugs and addiction, “very much depends on who is addicted.”  This assertion leveled by David Courtwright is amongst drug scholars, a matter of consensus. The public and government response to crack, as well as the drug’s enduring stigma, have much to do with society’s fears and fantasies of poor nonwhites and urban districts.  It is telling that in her infamous 2002 interview with Diane Sawyer, singer Whitney Houston vociferously disavowed previous crack use.  When Sawyer read from a press clipping implying said use, Houston grew indignant reminding viewers that “crack is cheap”.  Continuing, Houston cited her wealth and status.  She “made too much money to smoke crack.”  In the same interview, Houston admitted to the abuse of alcohol, marijuana, cocaine, prescription drugs, and implied past struggles with eating disorders.  However, Houston
would not allow her public image to be stained by the triumvirate of blackness, poverty, and crack.  Borrowing from Keith Haring’s mural and a long-standing cultural meme, Houston concluded dismissively, “crack is wack.”

Houston’s denial was motivated by the class and racial politics of cocaine use. To put it another way, crack is wack because it’s perceived to be a drug dominated by poor, black users. News accounts portrayed it as an almost exclusively black drug, as opposed to its upscale chemical cousin, cocaine.  From the perspective of drug warriors like William Bennett, one might argue that Hoston’s interview represents the fruits of nearly two decades of anti-crack media assaults.  In this respect, the invisible hand of culture may appear to have done the good work of categorizing crack as a vice of disrepute.  The War on Drugs had succeeded in driving down demand for crack as the drug became increasingly stigmatized in popular culture and on the street corner.  But what of other drugs?  Might addicts and corner boys have turned to other less stigmatized drugs as a crutch?  If so, all Houston’s denial and the broader demise of crack represents is a another chapter in the grand saga of wack-a-mole drug enforcement. 

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