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Public Policy Made Americans the Biggest Consumers of Opioids in the World

RACIAL CAPITALISM, this forum has shown, is a powerful analytical tool. It provides a framework robust enough to account for the racial logic of the opioid crisis, the Trump-era War on Drugs, and the country’s punitive turn. The responses to my essay expand its reach even further, offering multiple points of departure for enriching the narrative. Our conversation highlights the power of integrating public health scholarship and activism with writings on mass incarceration and the drug war. It was not until I attempted to suture together different threads of this story, drawing on both schools of thought, that I saw how much the narrative arc of drug prohibition changes in light of the recent history of Big Pharma.

The core paradox of the opioid crisis is how extreme criminalization of a racialized, illicit drug economy underwrote and enabled the larger project of licit drug deregulation. The United States is simultaneously the largest incarcerator of people convicted of using and selling drugs and the largest consumer of legal (and illegal) narcotics in the developed world, by far. Although Americans make up only 5 percent of the world’s population, they consume over 80 percent of the world’s opioids. Public policy has enabled the steady growth of pharmaceutical consumption as multiple iterations of the drug war raged on. And of course, as in all aspects of U.S. society, race functions as the structuring principle, in this case dividing the aboveground and netherworld of drug business. As Britt Rusert notes in her response, “We continue to live in a world made by Reagan, one where corporate empowerment both benefits from and reinforces racial regimes of punishment.”

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