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Justice  /  Explainer

While Government Cracked Down On Illegal Drugs, Big Pharma Hooked Millions On Opioids

The racist roots of the opioid crisis.
Bottle of OxyContin.
Joe Raedle/Getty Images

For more than a century, American drug policy has operated from the presumption that addiction is a problem native to, and emanating from, poor and nonwhite communities. That presumption helped sustain a mutually reinforcing cultural and regulatory split: on the one hand, a punitive “war” that dismissed addiction as a problem of crime, and on the other, a lightly regulated pharmaceutical industry that reaped billions on the sale of psychoactive drugs to white and respectable “patients.”

This binary architecture dividing “drugs” from “medicines” originated in the Progressive Era, when the demographics of drug use underwent a noticeable shift from white middle-class women to poor immigrant men. The social and political response hardened as addiction appeared to slide down the socioeconomic ladder and turned a medical phenomenon into a criminal one.

That shift was laid bare in the two marquee drug laws of the era. Based on a consumer protection model, the Pure Food and Drug Act of 1906 required honest labeling of drugs in the chaotic legal market and established the Food and Drug Administration (FDA) to enforce it. Eight years later, the Harrison Narcotics Tax Act restricted the use of narcotics to the medical realm but quickly evolved into a system of punitive prohibition, and in 1930 a dedicated police agency — the Federal Bureau of Narcotics (FBN) — was created to further stamp out drug use and “vice” among minorities and the criminal element.

Led by Commissioner Harry J. Anslinger, the FBN built up strong social taboos against illicit drug use, in part by sensationalizing the threat of nonwhite “pushers” preying upon white women. That cultural logic shaped how policymakers responded to new drug threats such as marijuana, which was associated with Mexican laborers and added to the Harrison Act as a “narcotic” (which it is not).

Meanwhile, with addiction ostensibly banished to the criminal realm, authorities were slow to recognize the dangers of new pharmaceuticals such as barbiturates (a class of sedatives introduced in 1903) and amphetamines (stimulants introduced in the 1930s), because they were marketed by respectable drug companies as medical treatments for the ills of the American middle classes.

Sales of uppers and downers boomed under the relatively gentle governance of the FDA, whose mission was to ensure the safety of the drug supply rather than to punitively restrict drug use. By the 1950s, these drugs could be found in up to a quarter of all prescriptions, and enough were sold to provide more than 50 doses per year to every man, woman and child in the United States.