Beyond Magic Bullets:

White Race as Social Determinantof the Opioid Crisis

Helena Hansen, MD, Ph.D.

Associate Professor of Anthropology and PsychiatryNew York University

Technologies of Whiteness

Buprenorphine Patients in U.S.: 91% White, 56% College Educated

Geography of Buprenorphine is the Inverse of Methadone Distribution

Buprenorphine Methadone

Whiteness

Exclusive category -> boundary maintenance

Unmarked: assumed norm

Defined by its “Other:” Black/White interdependent

Costly (to Whites)

Technologies of WhitenessAddiction Neuroscience

New Biotechnologies

Regulatory Structures

Marketing

Technologies of Whiteness

Addiction Neuroscience

Decade of the Brain 1990-1999By the President of the United States of America

A PROCLAMATION The human brain, a 3-pound mass of interwoven nerve cells that controls our activity. is one of the most magnificent-and mysterious-wonders of creation. The seat of human intelligence. interpreter of senses. and controller of

Technologies of Whiteness

New Biotechnologies

Technologies of Whiteness

Regulation

PresenterPresentation Notes Enter DATA 2000, an act of congress that legalized the prescription of approved maintenance opioids for treatment of opiate dependence in private doctor’s offices.An analysis of the congressional records shows a turn away from the War on Drugs discourse to a medicalized response – seen as more appropriate for young suburban whites.An analysis of the congressional debates finds a absence of race mentioned explicitly but a clear emphasis on a ‘new kind of drug user” one that is young, suburban and “not hardcore”.We learn from the congressional record that: Narcotic addiction is spreading from urban to suburban areas. The current system, which tends to concentrated in urban areas, is a poor fit for the suburban spread of narcotic addictionThroughout the record we find a theme that white suburban youth – the real focus of DATA 2000 -- shouldn’t be exposed to the stigmatized world of methadone – which remains the appropriate form of treatment for ‘urban, hard core users’ There’s a need to reclaim addiction treatment for whites and distance it from the kinds of addiction and treatment that were seen as Black and Brown.

And finally in a letter from Secretary Shalala: It [bup] would be available not just to heroin addicts, but to anyone with an opiate problem, including citizens who would not normally be associated with the term addiction (Congressional Record 2000: S9113).

Technologies of Whiteness

Media and Marketing

1. Magic Bullets are a Myth

Buprenorphine Treatment and Opioid Overdose in France(Auriacombe et al Am J Addiction 2004)

Fatal Opioid Overdose in France, 1985-2015

Source : CépiDc / Inserm. Sélection B de l’EMCDDA

Buprenorphine and Methadone Prescription in France, 1995-2017

Source: INSERM

2. Problem Drug Use is Bio-Social

3. Deaths of Despair Call for Racial and Economic Justice

Technologies of Whiteness

1.Universal, comprehensive healthcare

1.Universal, comprehensive healthcare

2. Nationally end criminalization, promote harm reduction and treatment

1.Universal, comprehensive healthcare

2. Nationally end criminalization, promote harm reduction and treatment

3. Bio-Social and Systems Research and Interventions

Acknowledgments

NIDA K01 Award ProgramRWJ Health Policy Investigator Award ProgramRWJ Health and Society Scholar’s ProgramAPA/SAMHSA Minority FellowshipNYU Anthropology DepartmentNYU Psychiatry DepartmentNY State Office of Mental Health Nathan Kline

Institute

Beyond Magic Bullets: ��White Race as Social Determinant�of the Opioid CrisisSlide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Technologies of WhitenessSlide Number 9Buprenorphine Patients in U.S.: �91% White, 56% College EducatedGeography of Buprenorphine is the Inverse of Methadone DistributionSlide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23Slide Number 24WhitenessTechnologies of WhitenessTechnologies of WhitenessSlide Number 28Slide Number 29Slide Number 30Technologies of WhitenessSlide Number 32Slide Number 33Slide Number 34Technologies of WhitenessSlide Number 36Slide Number 37Slide Number 38Slide Number 39Slide Number 40Technologies of WhitenessSlide Number 42Slide Number 43Slide Number 44Slide Number 45Slide Number 46Slide Number 47Slide Number 48Slide Number 49Slide Number 50Slide Number 51Fatal Opioid Overdose in France, 1985-2015��Source : CépiDc / Inserm. Sélection B de l’EMCDDABuprenorphine and Methadone Prescription in France, 1995-2017��Source: INSERMSlide Number 54Slide Number 55Slide Number 56Slide Number 57Technologies of WhitenessSlide Number 59Slide Number 60Slide Number 61Slide Number 62Slide Number 63Slide Number 64Acknowledgments