Abstract
Racialized attitudes toward addiction have shaped medical and institutional responses in the United States since the nineteenth century. This racialization has been made salient by the recent rise in opioid abuse and dependence among whites, which has precipitated unprecedented efforts at caring for individuals with opioid use disorder. Such a response was not mounted in an attempt to treat Native American communities, which have similar rates of opioid overdose mortality as whites, nor was it mobilized in response to past and current drug epidemics in African American communities. Treatment and policy innovations have primarily targeted white communities, under the assumption that medicalization of addiction treatment will reduce stigma in treatment. In this chapter, the authors argue that stratified medicalization furthers racial inequalities in addiction treatment while also failing to reduce treatment stigma even among white Americans. Racialization of opioid use disorder has led to disparate policy and clinical responses, and it has led to criminalization of addiction among nonwhites and medicalization of addiction among whites, thereby deeply influencing and differentiating the experiences of stigma among these groups.
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Alexander M. The new Jim Crow: mass incarceration in the age of colorblindness. New York: The New Press; 2010.
Andrews CM, D’Aunno TA, Pollack HA, Friedmann PD. Adoption of evidence-based clinical innovations: the case of buprenorphine use by opioid treatment programs. Med Care Res Rev. 2014;71(1):43–60. https://doi.org/10.1177/1077558713503188. Epub 18 Sep 2013.
Barnett AI, Hall W, Fry CL, Dilkes-Frayne E, Carter A. Drug and alcohol treatment providers’ views about the disease model of addiction and its impact on clinical practice: a systematic review. Drug Alcohol Rev. 2018;37(6):697–720. https://doi.org/10.1111/dar.12632. Epub 2017 Dec 14.
Barry DT, Irwin KS, Jones ES, Becker WC, Tetrault JM, Sullivan LE, Hansen H, O'Connor PG, Schottenfeld RS, Fiellin DA. Opioids, chronic pain, and addiction in primary care. J Pain. 2010;11(12):1442–50. https://doi.org/10.1016/j.jpain.2010.04.002. Epub 2 Jun 2010.
Broz D, Ouellet LJ. Racial and ethnic changes in heroin injection in the United States: implications for the HIV/AIDS epidemic. Drug Alcohol Depend. 2008;94(1–3):221–33. https://doi.org/10.1016/j.drugalcdep.2007.11.020.
Campbell ND. Discovering addiction. : The science and politics of substance abuse research. Michigan: University of Michigan Press; 2007. https://doi.org/10.3998/mpub.269246.
Casadonte PP, Kolodner GF, Horton T, McMurphy SM. Community treatment programs take up buprenorphine. Sci Pract Perspect. 2004;2(2):24–9.
Centers for Disease Control (CDC). Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. Morb Mortal Wkly Rep. 2011;60:1487–92.
Centers for Disease Control (CDC). Overdose deaths involving opioids, cocaine, and psychostimulants — United States, 2015–2016. Morb Mortal Wkly Rep. 2018;67(12):349–58. https://doi.org/10.15585/mmwr.mm6712a1.
Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiat. 2014;71(7):821–6. https://doi.org/10.1001/jamapsychiatry.2014.366.
Corrigan PW, Shapiro JR. Measuring the impact of programs that challenge the public stigma of mental illness. Clin Psychol Rev. 2010;30(8):907–22.
Cummings JR, Wen H, Ko M, Druss BG. Race/ethnicity and geographic access to medicaid substance use disorder treatment facilities in the United States. JAMA Psychiat. 2014;71(2):190–6. https://doi.org/10.1001/jamapsychiatry.2013.3575.
Delgado R, Stefancic J. Critical race theory: an introduction. New York: NYU Press; 2017.
Dick AW, Pacula RL, Gordon AJ, Sorbero M, Burns RM, Leslie D, Stein BD. Growth in buprenorphine waivers for physicians increased potential access to opioid agonist treatment, 2002-11. Health Aff (Millwood). 2015;34(6):1028–34. https://doi.org/10.1377/hlthaff.2014.1205.
Duncan LG, Mendoza S, Hansen H. Buprenorphine maintenance for opioid dependence in public sector healthcare: benefits and barriers. J Addict Med Ther Sci. 2015;1(1):031–6.
Fiellin DA. The first three years of buprenorphine in the United States: experience to date and future directions. J Addict Med. 2007;1(2):62–7. https://doi.org/10.1097/ADM.0b013e3180473c11.
Gone JP, Trimble JE. American Indian and Alaska native mental health: diverse perspectives on enduring disparities. Annu Rev Clin Psychol. 2012;8:131–60. https://doi.org/10.1146/annurev-clinpsy-032511-143127.
Gryczynski J, Jaffe JH, Schwartz RP, Dusek KA, Gugsa N, Monroe CL, et al. Patient perspectives on choosing buprenorphine over methadone in an urban, equal-access system. Am J Addict. 2013;22(3):285–91. https://doi.org/10.1111/j.1521-0391.2012.12004.x.
Hansen HB, Skinner ME. From white bullets to black markets and greened medicine: the neuroeconomics and neuroracial politics of opioid pharmaceuticals. Ann Anthropol Pract. 2012;36:167–87.
Hansen HB, Siegel CE, Case BG, Bertollo DN, DiRocco D, Galanter M. Variation in use of buprenorphine and methadone treatment by racial, ethnic, and income characteristics of residential social areas in New York City. J Behav Health Serv Res. 2013;40(3):367–77. https://doi.org/10.1007/s11414-013-9341-3.
Hansen H, Netherland J. Is the prescription opioid epidemic a white problem? Am J Public Health. 2016;106(12):2127–9.
Hansen H, Siegel C, Wanderling J, DiRocco D. Buprenorphine and methadone treatment for opioid dependence by income, ethnicity and race of neighborhoods in New York City. Drug Alcohol Depend. 2016;164:14–21.
Harris S. To be free and normal: addiction, governance, and the therapeutics of buprenorphine. Med Anthropol Q. 2015;29:512–30.
Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013;103(5):813–21. https://doi.org/10.2105/AJPH.2012.301069. Epub 14 Mar 2013.
Herzberg D. Happy pills in America: from Miltown to Prozac. Baltimore: Johns Hopkins University Press; 2009.
Heygi, N. (2017). Cherokee Nation Sues Wal-Mart, CVS, Walgreens over tribal opioid crisis. Retrieved from https://www.npr.org/sections/codeswitch/2017/04/25/485887058/cherokee-nation-sues-wal-mart-cvs-walgreens-over-tribal-opioid-crisis.
Hughes PH, Barker NW, Crawford GA, Jaffe JH. The natural history of a heroin epidemic. Am J Public Health. 1972;62(7):995–1001.
Kaye K. De-medicalizing addiction: toward biocultural understandings. Crit Perspect Addict. 2012;14:27–51.
Kissin W, McLeod C, Sonnefeld J, Stanton A. Experiences of a national sample of qualified addiction specialists who have and have not prescribed buprenorphine for opioid dependence. J Addict Dis. 2006;25(4):91–103.
Larance B, Carragher N, Mattick RP, Lintzeris N, Ali R, Degenhardt L. A latent class analysis of self-reported clinical indicators of psychosocial stability and adherence among opioid substitution therapy patients: do stable patients receive more unsupervised doses? Drug Alcohol Depend. 2014;142:46–55. https://doi.org/10.1016/j.drugalcdep.2014.05.018. Epub 2 Jun 2014.
Link BG, Phelan J. Conceptualizing stigma. Annu Rev Sociol. 2001;27:363–85. https://doi.org/10.1146/annurev.soc.27.1.363.
Magura S, Lee SJ, Salsitz EA, Kolodny A, Whitley SD, Taubes T, Seewald R, Joseph H, Kayman DJ, Fong C, Marsch LA, Rosenblum A. Outcomes of buprenorphine maintenance in office-based practice. J Addict Dis. 2007;26(2):13–23.
McGinty EE, Goldman HH, Pescosolido B, Barry CL. Portraying mental illness and drug addiction as treatable health conditions: effects of a randomized experiment on stigma and discrimination. Soc Sci Med. 2015;126:73–85. https://doi.org/10.1016/j.socscimed.2014.12.010. Epub 5 Dec 2014.
McGinty E, Pescosolido B, Kennedy-Hendricks A, Barry CL. Communication strategies to counter stigma and improve mental illness and substance use disorder policy. Psychiatr Serv. 2018;69(2):136–46. https://doi.org/10.1176/appi.ps.201700076. Epub 2 Oct 2017.
McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284(13):1689–95.
Mennis J, Stahler GJ. Racial and ethnic disparities in outpatient substance use disorder treatment episode completion for different substances. J Subst Abus Treat. 2016;63:25–33.
Merrill JO, Rhodes LA, Deyo RA, Marlatt GA, Bradley KA. Mutual mistrust in the medical care of drug users. J Gen Intern Med. 2002;17:327–33.
Netherland J, Hansen H. White opioids: pharmaceutical race and the war on drugs that wasn’t. BioSocieties. 2017;12(2):217–38.
Omi M, Winant H, editors. Racial formation in the United States: from the 1960s to the 1990s. 2nd ed. New York: Routledge; 1994.
Rice WS, Logie CH, Napoles TM, Walcott M, Batchelder AW, Kempf MC, Wingood GM, Konkle-Parker DJ, Turan B, Wilson TE, Johnson MO, Weiser SD, Turan JM. Perceptions of intersectional stigma among diverse women living with HIV in the United States. Soc Sci Med. 2018;208:9–17. https://doi.org/10.1016/j.socscimed.2018.05.001.
Roman PM, Ducharme LJ, Knudsen HK. Patterns of organization and management in private and public substance abuse treatment programs. J Subst Abus Treat. 2006;31(3):235–43. Epub 14 Aug 2006.
Stanton A, McLeod C, Luckey B, Kissin WB, Sonnefeld LJ. Presentation: SAMHSA/CSAT evaluation of the buprenorphine waiver program: expanding treatment of opioid dependence: initial physician and patient experiences with the adoption of buprenorphine. Substance Abuse Mental Health Ser Admin. 2006.
Williams IL. The intersection of structurally traumatized communities and substance use treatment: dominant discourses and hidden themes. J Ethn Subst Abuse. 2016;15(2):95–126.
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Mendoza, S., Hatcher, A.E., Hansen, H. (2019). Race, Stigma, and Addiction. In: Avery, J., Avery, J. (eds) The Stigma of Addiction. Springer, Cham. https://doi.org/10.1007/978-3-030-02580-9_8
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DOI: https://doi.org/10.1007/978-3-030-02580-9_8
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