However, a major shift had taken place in regulatory policy a decade before that made this possible. In the s, President Reagan initiated a radical program of corporate deregulation that opened the door to a new era of pharmaceutical mass marketing. Bush and Bill Clinton not only met but exceeded. This potent mix of racialized drug prosecution and corporate empowerment created the environment in which Purdue and other companies sought out new commercial strategies for marketing opioids. So when Purdue introduced OxyContin in , it proceeded with an awareness of both the opportunities and potential pitfalls.
The company developed a number of marketing strategies to increase sales and to navigate the deeply segregated waters of drug consumption.
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Driven by sophisticated data collection methods that revealed the highest and lowest prescribers in every zip code throughout the United States, Purdue identified medical practices with the largest numbers of pain patients and with physicians who were the least discriminate prescribers.
A potent mix of drug prosecution and corporate empowerment gave birth to new forms of Big Pharma marketing. Drug sales representatives directed advertisement to overwhelmingly white suburban and rural areas to avoid the stigma of racially coded urban drug markets. Not surprisingly, the regions that initially showed the highest rates of opioid abuse in the early s—including rural Maine, West Virginia, Kentucky, and western Pennsylvania—had overwhelmingly white populations.
In a similar line of analysis, pharmaceutical historian David Herzberg, author of Happy Pills in America: From Miltown to Prozac , places the opioid crisis in the larger sweep of U. According to Herzberg, there is no real difference between prescription medicines and illicit drugs. Both possess physical and psychoactive effects, but the social meaning attributed to them has more to do with race, class, and differential application of state power than pharmacology. In the years after World War II, the civil rights movement challenged racial discrimination in consumer markets, rendering illegal the most overt forms of discrimination, such as segregated lunch counters, public conveyances, and housing covenants.
But the racialized division between licit and illicit drug markets endured. Today African Americans and Latinos make up 80 percent of those incarcerated in federal prisons for drug crimes and 60 percent of those in state prisons. In the same period that Richard Nixon launched the first War on Drugs, white consumers steeped in the discourse of the silent majority demanded access to pharmaceuticals as a citizenship right.
Prohibition of urban vice required a space of white absolution that enabled the profitable mass-marketing of licit pharmaceuticals. Viewed in this way, the opioid crisis appears not as an unprecedented phenomenon, but the product of longstanding historical processes. The role of white absolution is even clearer when looking at the disparate consequences for illicit drug use across the color line. Nothing speaks more profoundly to how the state artificially constructed segregated drug markets than federal prosecutions for crack use.
Few realize that almost no white people were ever charged with crack offenses by federal authorities. Instead, prosecutors shunted their cases into the state system, which had much lower rates of conviction and shorter sentences. At the heart of this disparity is the paradoxical relationship in the United States between prohibition and provision: some of the harshest advocates for punishment and the criminalization of illicit drug use have also enthusiastically supported and defended pharmaceutical deregulation and expanded access to opioids.
Some of the harshest advocates for the criminalization of illicit drug use also enthusiastically support expanded access to opioids. The career of Rudolph Giuliani is one of the best examples of this cognitive dissonance around drug policy that can only properly be understood as a product of racial capitalism. In fact, the highest number of marijuana possession arrests ever recorded in New York City took place under the Giuliani administration, with 51, arrests in the year Giuliani also led a vicious campaign against methadone treatment in the s, advocating complete abstinence as the only acceptable response to illicit drugs.
John Brownlee, a U.
In the Viriginia case, Giuliani provided Purdue with legal services as well as access to his extensive network of political connections in Washington. He finessed an agreement that kept senior executives from serving prison time and attempted to restrict future prosecution of Purdue. Activists, investigative journalists, and public sector attorneys have produced a significant body of work documenting the culpability of pharmaceutical companies in the contemporary opioid crisis. Unfortunately, the young have been the hardest hit. The New York Times recently estimated that nearly , people currently addicted to prescription opioids or heroin are between 18 and 25 years old.
Even more troubling is that in states such as Ohio and West Virginia with the highest rates of prescription opioid consumption, 50—80 percent of foster care placements are linked to substance abuse in the home. In the realm of health and human pain, free market fundamentalism has proved quite deadly. The origins of the opioid crisis in the licit pharmaceutical market calls not only for a rethinking of the politics of deregulation, but also an end to the sclerotic, racialized War on Drugs narrative still mobilized by the Trump administration.
Recent immigrants are rare, yet opioid addiction is rampant. Prescription opioids come from American companies and are prescribed by American doctors overseen by American regulators. Like many crises, our current dilemma also presents opportunities to radically rethink our approaches to both prohibition and provision.
In addition to recognizing the role of Big Pharma, a critical look at the opioid crisis also requires examining the larger environment in which this predatory marketing campaign took place. The European question: Migration, race, and postcoloniality in Europe. Social Text, 24 3 , New keywords: Migration and borders. Cultural Studies, 29 1 , Dillon, M. Biopolitics of security in the 21st century: An introduction.
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Mezzadra, J. But for someone on Medicare, the drug can cost 50 times as much, out-of-pocket. The pharmaceutical industry argues that drugs are not overpriced. One devastating spot targets Republican representative Bruce Poliquin of Maine, who has taken large donations from the insurance industry while voting against the Affordable Care Act and in favor of tax cuts for pharmaceutical companies.
Mitchell said the group has heard some blowback for attacking targets such as Democratic senator Tom Carper of Delaware. Another Democratic target is Anna Eshoo, whose 25 years in Congress have left her as the top cumulative recipient of donations from pharmaceutical interests. Eshoo does not appear to be in any earthly danger of losing her race; the 18th district in Silicon Valley, California, which boasts the highest median household income of any district in the country, went for Clinton by 53 points.
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Healthcare is the top theme for political ads in , said Franz, especially on the Democratic side. As Mitchell and his group see it, the truce in the Obamacare wars has created an opportunity to finally strike a blow against a problem that patients of all political persuasions agree on: runaway drug prices.