Heroin, initially named and marketed for its therapeutic (or heroic) qualities as a medicine, is now unforgettable to us as one of the world's most dangerous and addictive drugs. It also shows us that drugs and medicines are actually the same, but years of sociocultural, legal and scientific influence have created a distinction that remains until this day. White Market Drugs carefully carves open policies that govern the sales of medicines, or legal drugs, which Herzberg calls ‘white markets’ through a racial, legal, political and historical lens.
Evident in its name, the story of white markets and policies that govern them is a story of a racially segregated world created by healthcare professionals, consumer advocates, white evangelical religious moral crusaders, drug consumers, government authorities and, mainly, pharmaceutical companies who vehemently sold addictive legal drugs to a largely white clientele. While racial minorities were imprisoned for possessing or being addicted to opiates (and eventually sedatives and stimulants), white people were being provided these drugs over the counter by pharmacists and physicians – a story between medicines and drugs, between white markets and informal markets, between consumer protection policies and punitive prohibition. This book asks this of arbitrary but cruel divide, ‘Who built it, why, and how has it been maintained despite its many contradictions?’ (p. 16).
White Market Drugs attempts to answer these questions by discussing three crises. The first crisis was one of opioids and cocaine at the beginning of the twentieth century. Chinese immigrant-run opium dens in America, a result of British opium politics, represented a small part of how opium was used there. Despite this, xenophobic moral crusaders and physicians united to ban Chinese-run opium dens while simultaneously enabling the prescription of opioids for medical use. The ban resulted in the creation of racialized informal markets and white markets for medical opioids. Legislation, such as the Harrison Act, was established to regulate these markets. Enforced by the Federal Bureau of Narcotics (FBN), addicts from informal markets were arrested and denied treatment, treated as dangers to society, whereas addicts from white markets, seen as moral human beings with well-run lives, were victims. The drug–medicine divide deepens. Herzberg uncovers that in white markets, physicians treated addiction with medical maintenance, allowing white people to live their ‘morally good lives’. White physicians reserved these judgements for white country dwellers. Enforcement of informal markets, on the other hand, landed vulnerable youths in prison. Still, the author believes the policy of medical maintenance a white-market success, ‘good policy, not good people, explains white market success’ (p. 83), largely ignoring that the same policy reinforced racial segregation, gender roles and social classification.
Consistent and heavy regulatory requirements set out by the FBN and its head, Anslinger, reduced opioid sales. The FBN even began testing pharmaceutical opioids, albeit in an unethical government prison/lab. Devious pharmaceutical companies were held back by this consumer-protectionist regulatory regime, but this did not stop barbiturates from taking the place of opioids in the 1930s. This is the second large crisis. Pharmaceutical companies implemented ingenious marketing strategies by expanding the use of barbiturates (sedatives) to everyday insomnia, and explored market niches such as combining barbiturates with other drugs and selling insomnia as a sickness. Addiction, or the debate attached to it, was again at its core. To avoid the ‘addiction’ stigma, white-market drugs were labeled as ‘habit-forming’. Until the late 1960s, putting this sedative-led crisis to sleep was almost impossible.
The Controlled Substances Act (CSA) was thus introduced, as the author recognizes, through political nuances and the growth of civil rights and feminist activism. Having skimmed through the impact on class and gender, he shows how these activists played a key role in trying to erase the medicine–drug divide. The CSA represented a consumer-protectionist policy for all, encouraging the treatment of addiction, limiting manufacturers and prescribers, and informing consumers. A federal crackdown on pharmaceutical companies, via the CSA and a push for safer sedatives, made the white market a more hospitable place. However, this period gave birth to grey markets, where stubborn and profit-hungry doctors ignored stricter regulations to continue prescribing pills, again mainly to white people. These ‘dope doctors’, ‘scrip mills’ and other pharmaceutical fightbacks ensured that the medicine–drug divide remained.
The author's fantastic eye for politically led motives recognizes how the third crisis in this book continues until today. Rockefeller, a business magnate who intended to reform his political identity, reignited punitive policing on informal markets. Again, the medical community's role in this crisis is rightfully and strategically included. For example, new criteria set out by the American Psychiatric Association allowed pharmaceutical companies to rebrand old drugs as antidepressants and expand the usage of pharmaceuticals for pain relief. The third crisis, as a result, was an extreme increase in the use of opioids, barbiturates and stimulants during the turn of the twenty-first century. Purdue Pharma, a serial problem maker identified throughout the book, revived an old drug, OxyContin. Purdue falsely advertised a drug proven to be addictive as less addictive than other drugs, a form of techno-solutionism that should have been engaged with throughout the book. Worse, the company worked with the FDA to educate hospitals on pain-killing opioids while internally considering it a promotional initiative. This was the beginning of a crisis that America is still dealing with, a crisis that, Herzberg says, needs lessons from past white-market policies, because until now punitive prohibition and freedom for pharmaceutical companies have provided the same results: ‘insufficient protection for consumers’ (p. 278).
Herzberg's painting of white-market policies shows us the brush strokes of different political influences over the past century, but details on gender inequity and racialized informal markets remain insufficiently expressed. Yet one hopes that the brilliant lessons this book provides on white-market policy are taken in the context of erasing the arbitrary, yet cruel, medicine–drug divide. Consumers, regardless of their race, need to be heard and protected.
