Really good essay.
«The United States truly did need new approaches to widespread undertreated pain, and unleashing the private sector to offer them had strong political appeal in the anti-regulatory zeal of the Reagan era. Moreover, the scare over crack cocaine in the 1980s had associated addiction with urban racial minorities. Opioid marketers targeted white parts of the country, benefiting from the widespread stereotype that good heartland consumers (“patients”) were unlikely to become addicted.
Of course, race has no impact on someone’s risk of addiction. Trauma does, though. Research suggests that experiences of significant trauma increase the chance that a person will develop an addiction after using drugs. In the 1990s, as opioid sales boomed, rural and small-town white areas were suffering from unemployment, population decline and the erosion of social institutions such as labor unions and churches. The huge industry-driven expansion of opioid white markets [vs. black markets] in these already struggling communities led to a similarly huge rise in addiction.…
People with addiction are strongly motivated to continue using drugs, however. Increasingly unable to buy in white markets, they formed a large potential consumer base for illicit opioids. In the 2010s, new suppliers emerged to meet the demand.
This moment of market disruption in the flow of opioids led to innovations that echoed the 21st century’s e-commerce revolution. Old supply chains moved heroin from poppy fields to central markets in major U.S. cities; traffickers in the 2010s built new supply chains bringing synthetic products such as fentanyl sourced with chemicals from China to American consumers wherever they lived — including the rural areas and small towns struck by the opioid crisis.
Which is to say: Fentanyl traffickers were responding to consumer demand. They did not create it. The opioid crisis initially struck white areas not because of a conspiracy to destroy heartland America. Rather, it was a devastatingly ironic result of white Americans’ privileged access to the medical system. Physicians’ willingness to recognize and treat their pain opened their communities to pharmaceutical companies’ flood of opioids. The drugs’ ubiquity meant that they were easy to get whether one had a prescription for them or not.
Three decades in, the opioid crisis is no longer mostly white. In recent years, overdose rates have been going up fastest among some racial minorities. They are now highest among Native Americans and in some of the poorest Black urban neighborhoods. This is in part because fentanyl outcompeted heroin everywhere, including the segregated, economically struggling urban neighborhoods where heroin’s prohibition markets had been quarantined by municipal authorities.»
