➀ U.S. laws have often been passed in response to substance use by specific racial or ethnic groups. In the 1870s, one of the first laws against drug use in the United States was an ordinance passed in San Francisco to ban the smoking of opium in opium dens – then prevalent in Chinese immigrant neighborhoods. In the early 1900s, cocaine use by Black people triggered national anti-drug legislation. In the 1930s, marijuana use by Mexican immigrants led to states outlawing that drug. While white Americans had also used these drugs, it wasn’t until they were associated with non-white populations that the law was brought to bear. “History itself demonstrates that there is a direct line between how we criminalize addiction and then how that loop results in a racialization of substance use,” said Dr. Jessica Isom, a clinical instructor in psychiatry at the Yale School of Medicine.
➁ The “War on Drugs” levied harsher penalties on people of color. Prison sentences for use of crack cocaine prevalent in Black neighborhood were heavier than for use of powder cocaine favored by whites. The disparity had its roots in the drug policies of the Nixon administration – as Nixon’s domestic policy adviser John Ehrlichman admitted to an author in the 1990s: “The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”
➂Popular culture and the media helped fuel the image of drugs as a non-white problem. Dr. Helena Hansen, a professor at the David Geffen School of Medicine at UCLA, showed images of media outlets referring to Chinese “opium fiends,” Black “cocaine fiends” and Latino marijuana smokers. The use of Valium and prescription opioid pain relievers by middle-class white populations were portrayed differently, Hansen said. When opioid addiction ravaged poor, rural white communities, the media tone was far more sympathetic than similar addiction problems in poor, urban Black communities.
➃ One in 5 incarcerated people is imprisoned for a drug offense. Whites are underrepresented, while Blacks, Latinos and Native Americans are overrepresented. But Black people, Latinos and whites each have illicit drug use rates of about 10%. Isom said that on any given day, 450,000 people are incarcerated for nonviolent drug offenses. Isom and Hansen called for a shift from criminalization to medicalization of drug treatment.
➄ The treatments available in Black and white neighborhoods are also skewed. The two main drugs to treat opioid addiction, buprenorphine and methadone, have similar pharmacology. Both block opiate receptors in the brains of addicted patients. But methadone is seen as a Black and brown drug, and patients are required to line up daily at treatment clinics to receive their dose under observation, which is stigmatizing. Buprenorphine costs more but can be prescribed from the privacy of a doctor’s office for a month’s use at home. “The shortage of public sector prescribers, along with the cost of buprenorphine itself, have long kept buprenorphine in the private sector,” Hansen said. A 2019 Journal of the American Medical Association paper documented that white Americans were far more likely to get buprenorphine than Black Americans.
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