“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.