A U.S. public discourse of addiction as a disabling psychiatric condition (as opposed to a moral flaw or social deviancy) was codified into Social Security policy in 1972, following its emergence in post-war clinical science and popular media (Conrad & Schneider, 1980; Duster, 1970). In recent years, this discourse has taken divergent forms in policy and media debates surrounding black and brown urban heroin users on one hand, and white suburban and rural prescription opioid users on the other. In both populations, efforts to decriminalize addiction led treatment advocates to rebrand it a disabling “chronic brain disease.” Whites, however, are imagined as in need of rescue within the gentle discipline of private medical offices, while brown and black heroin users are seen as in need of public discipline within federally-regulated methadone programs and/or the criminal justice system. Whether white, black, or brown, the U.S. social imaginary associates urban heroin use with violence and welfare dependency, inspiring public fear.
To quell the potential public dangers associated with heroin users, U.S. policies support what I am calling “pharmaceutical containment,” with adherence to multiple, sedating psychotropic medications a requirement to qualify for Social Security benefits. For white prescription opioid users, federal and state legislatures, pharmaceutical manufacturers, and community physicians have conjointly developed a new apparatus of private office opioid maintenance designed to rescue youth from “wasting their whiteness,” in line with a trope of white drug use as a tragedy of wasted potential as documented by analyses of popular media (Daniels, 2012). This apparatus of private clinical care endows them with “pharmaceutical citizenship” through which they have access to psychotropics that “bring the patient back into (middle-class consumer) society” (Ecks, 2005).
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