Whiteout: How Racial Capitalism Changed the Color of Opioids in America

by Helena Hansen, Julie Netherland (Contributor), David L Herzberg (Contributor)

The first critical analysis of how Whiteness drove the opioid crisis.
 
In the past two decades, media images of the surprisingly white “new face” of the US opioid crisis abounded. But why was the crisis so white? Some argued that skyrocketing overdoses were “deaths of despair” signaling deeper socioeconomic anguish in white communities. Whiteout makes the counterintuitive case that the opioid crisis was the product of white racial privilege as well as despair.
 
Anchored by interviews, data, and riveting firsthand narratives from three leading experts—an addiction psychiatrist, a policy advocate, and a drug historian—Whiteout reveals how a century of structural racism in drug policy, and in profit-oriented medical industries led to mass white overdose deaths. The authors implicate racially segregated health care systems, the racial assumptions of addiction scientists, and relaxed regulation of pharmaceutical marketing to white consumers. Whiteout is an unflinching account of how racial capitalism is toxic for all Americans.

Genres: Nonfiction, Race, Addiction, Sociology, History, Drugs

384 pages, Hardcover

Published March 28, 2023

Reviews

[Lawrence Grandpre · Rating 5 out of 5]

This is a pretty solid attempt to reframe conversations around overdose and addiction away from techbocracy abd abstract nations of universal biologic and brain disease and add historical, economic, and racial context. Many of these points have been made before, but having it all in one place is useful. The authors do a good job of presenting personal experience that is relevant to the content without getting lost in biography.

[Whitney Menarcheck · Rating 5 out of 5]

This book needs to be required reading for doctors, politicians, pharmaceutical execs, policy makers…everyone.

With each innovation in the world of substance use there needs to be a thorough examination of the question “will this contribute to health disparities.” For the most part, all innovations in this space do, in fact, increase the gap between rich white and all others.

This isn’t a fast or easy read. It’s dense and will likely take a lot of your energy. It’s worth it, though.

[Jessica Minor · Rating 5 out of 5]

An excellent reframing of the opioid crisis in the context of the system of Whiteness in the US. The book considers how political constructions of “white innocence,” the criminalization of Black and Latinx people who use drugs, and the racial imaginaries of pharmaceutical drug marketers shape drug policy and politicize demographic narratives (e.g., “deaths of despair”).

[Jennifer J. · Rating 5 out of 5]

I feel it is only fair to admit that I can't give a completely unbiased review of this book, because I appear in the book several times. I appear in the acknowledgements as someone who helped shape the development of this text, in the conclusion as an activist pointed out for doing "good work," and again in the conclusion (under the euphemistic pseudonym "some of our colleagues") as a person who fundamentally disagrees with one of the ideas that has shaped the authors' understandings of the policy implications of their research.

But even as someone who is implicated in all those ways in the text--and even as someone who knows the authors and respects them deeply--there is a singular fact that I believe remains true far beyond and outside of the reach of those social and emotional threads: that we have needed this book for so, so long, and now that it has finally arrived, it is undeniably so, so good.

I am also someone who works in addiction research and drug policy work, and I fancy these authors my colleagues (even though they have also been mentors, teachers, boosters, role models, friends). For that reason, I've been privileged to hear these ideas--sometimes in conference presentations, sometimes over beers--develop over the past few years. So, if there was any expectation I brought to my reading of this book, it was that little of the content within it was going to surprise me. I could not have been more wrong. These three have put to words--and put to clear, lucid, uncomplicated words--observations that I too have made with respect to US drug policy but have not been able to articulate well; relationships and consequences of scientific values that I instinctually found problematic but couldn't really put my finger on why.

For instance, the analysis that frames brain imaging research as the production of an unmarked, individual subject in isolation from social environment, resulting in a default (i.e. 'unmarked') imagination of a white subject totally free form the influences of external social policy or environment is something I have not put together in years, despite having countless discussion and teaching countless class sessions on the topic of brain imaging and the technology's utility in reinforcing previously held social beliefs through the myth of empirical irreducibility.

Another fantastic and valuable contribution is the way in which the authors really, effectively, successfully zero in on the role of the pharmaceutical market in maintaining safer and more protected access to drugs for mostly white middle class health care consumers and in giving substance to the social construction and moral vilification of the illicit drug market as a space characterized by moral failing and associated with Black and Brown populations.

And the conclusion made me cry. Jules made me f-ing cry y'all. The authors close out the text with concrete and thoughtful recommendations on how to mitigate and even undo the harms that they trace so diligently throughout the text, and the emphasis on just...loving each other better, on love being the antidote to the drug war, touched me so deeply. I already know this to be true. But reading such an impassioned and uncomplicated appeal to just genuinely care--and care deeply--about people just hit differently when it was coming form someone else trying to convince me of its value.

It's just such a stupid good book. I wrote in a previous response to this text that it needs to be taught alongside The New Jim Crow and I stand by that assessment. The two books serve as intellectual partners for one another. They represent two sides of the same coin. The only difference is that this book is written by social scientists, which means that--even though they do talk about policy and privilege--this text focuses more heavily on the stories we tell ourselves about drugs. And health. And race. And ourselves.

I think one of my students put it best, when they said that this book really reveals how US elites who were interested in advancing policies of racial segregation created a false narrative nearly 100 years ago that the harms of substance use would emerge only in "lesser" communities of Black, Brown, and/or immigrant people, and that white folks were good and trustworthy and above all that moral degradation. Then, we forgot that we invented this story, began accepting it as fact, and started creating drug policy with that "fact" as its foundation. Fast forward to today, we're losing over 100,000 people to preventable drug deaths each year and the whole country was caught off guard when white life expectancy started declining as a result.

I could keep going but, just trust me. It's good. It's very very good. Sort of like how it became hard to imagine life without smart phones within a short time after their release, I think we're going to find it hard to imagine how we ever made sense of the rampant destruction felt in our communities as a result of both commercial and criminal drug policies before we had the clarity this book offers. Get thee to Bookshop.org and get thyself a copy in your format of choice.

[Scott · Rating 5 out of 5]

As an addict in recovery and a practitioner in the field of addiction for over 20 years, this book hits deep. Many of us become counselors and therapists because we want to give back, and never bother to interrogate the policies and systems that we work under. Ultimately, many of us become complacent, bureaucratic puppets that hold bourgeois titles and credentials, who end up doing more harm then good while under the illusion that we are "helping". Coming from someone that works inside the belly of a very large city government machine that is always looking for ways to take a sledge hammer to the bureaucracy, I found this book to be empowering and reaffirming. I plan to follow the work of these authors going forward.

[Paula Mendoza · Rating 5 out of 5]

A great read for anyone who is in the field of public health, psychiatry, addiction medicine, addiction psychiatry or just wants to learn more about drugs and racial capitalism.

It really breaks down and analyzes of the opioid epidemic and how race and capitalism played a huge role in not just the criminalization of Black and Latinx community members but also how medicated-assisted treatment was not equally accessible.

Instead of just a ton of facts and history lesson, the ethnography aspect of this book allows us to learn from the experience of the authors during this crucial time period. As they witnessed it happening real time with real patients and their experiences.

The ethnography really makes this really powerful and I recommend it to many :)

[Martha Rigby · Rating 4 out of 5]

More academic than it needed to be, which was occaisionally tough, but it could have been worse and I appreciated all of the research the authors conducted. I feel much more well versed in how companies market drugs, how the medical system treats addiction, how the public(s) thinks about drugs and drug treatment and addiction, how drugs can be so politicized and racialized, and so much more...

Very glad to have read it, but I only managed it because I read it as part of a book club so that kept me on track.

[stella · Rating 5 out of 5]

so excellent i wish everyone was required to read this

[Richard Morgan · Rating 4 out of 5]

I know so much about racialized drug policies now, holy moly