The drug-medicine binary
persists today, exacerbated by inequities in the health care system.
One constant throughout the history of American drug use is that racial
minorities do not get to enjoy access to medicine in white markets, and
therefore their drug use is always already criminalized. Even Black people who
deal with painful chronic health conditions like sickle cell anemia receive
inadequate pain management out of prejudice. The medical system
leaves them to suffer in agony rather than prescribe relief through opioids.
Herzberg notes that physicians were even once taught that Black people
experience pain less intensely than whites and therefore didn’t need opioids.
While the media focuses on the “new face” of the so-called heroin epidemic, the
steepest death rates are actually found in
older Black communities, in cities like Chicago and Baltimore, and in The
Bronx, where heroin use is considered endemic and the heroin supply is contaminated
with superpotent synthetic opioids. Today, Black people are 2.5 times more
likely to die from an overdose than white people.
There are small glimpses
of hope in the history of pharmaceutical regulation. In the 1970s, for example,
rather than outright banning sedatives and stimulants, regulators aggressively
stepped in to rein in pharmaceutical power and build consumer protections.
Amphetamines could no longer be prescribed for weight loss (though it still
happens), and sedatives were to be used on a short-term basis (though some
still take them long-term). As prescriptions for speed and downers plummeted,
overdoses fell, too. “Drug controls were designed not to punish consumers into
abstaining from drug use but to limit the way the pursuit of profit magnified
the harms of already dangerous drugs,” Herzberg writes.
Unlike cocaine, heroin,
cannabis, and opium, many of the sedatives and stimulants from this era did not succumb to the iron fist of prohibition. Instead, these drugs remain accessible
through a doctor’s prescription. While far from perfect, cautious regulation is a far more rational response than total prohibition. Of course, white, wealthy people still have an easier time
coming by Adderall and Xanax than the average consumer, especially compared to people of color and
those with a history of addiction. Those who are uninsured or under-insured
cannot afford to pay for doctor’s appointments and prescriptions for these substances, either, and are thus
economically excluded from white markets. But Herzberg’s point is that
these policies designed to control pharmaceuticals, rather than prohibit them
outright, can also be applied to the so-called dangerous substances we refer to as “drugs.” (Even writing this review is a linguistic minefield, almost impossible to accomplish without subtly reinforcing the logic of the drug-medicine divide.)
In Switzerland, for
example, people addicted to heroin are able to access a legal, pharmaceutical supply
of heroin that they take in sterile, monitored settings. No one dies from
overdoses in these clinics, and people get their lives back because they no
longer have to hustle to get the drug they need. Instead of punishing people
who become addicted, a system can be designed to protect people from the
dangers of the illicit market and from corporate greed, while still providing
access to what they need. In the U.S. and Canada, there are grassroots movements calling
for a “safe supply,”
setup to the one in the late nineteenth century, when physicians maintained their well-to-do
patients on morphine even though it was legally forbidden.