Dissent

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Reams have been written about the misdeeds of Purdue Pharma, the manufacturer of OxyContin, and Purdue’s majority owners, the Sackler family. After years of litigation prompted by spiking overdose rates, in November 2020 Purdue pleaded guilty to conspiracy to aid and abet doctors in dispensing OxyContin without a legitimate medical purpose. The company was ordered to pay $8.3 billion in penalties, damage, and forfeiture. This sum is less impressive than it looked in headlines: Purdue’s bankruptcy in 2019 means that the money is unlikely to be collected. Though they were branded as villains in the eyes of the public, the Sacklers escaped criminal charges and had to pay only $225 million of their family money—small potatoes for a family that took some $10 billion out of Purdue between 2007 and 2017.

Mostly overlooked was the fact that OxyContin was only the latest in America’s long history of pharmaceutical disasters. David Herzberg’s White Market Drugs: Big Pharma and the Hidden History of Addiction in America seeks to correct this “radical act of forgetting” by examining the troubled history of psychoactive drugs in America. He considers licit and illicit drugs together, arguing that the marketing of medicine relies on the stigmatization and criminalization of those who consume drugs outside the medical system; the development of America’s gargantuan pharmaceutical markets must be understood alongside the growth of the illicit drug market. His choice of the phrase “white market” to describe pharmaceuticals reflects the racial bias that has been baked into this system from the start.

The distinction between licit and illicit drugs hinges on binaries: healing versus harm, relief of suffering versus desire for pleasure, medication versus recreation, obedience versus rebellion. These oppositions crumble under the slightest pressure. There are countless examples of harm caused by medical interventions. In the case of psychoactive medications, the most severe unwanted effects include addiction, psychosis, overdose, and suicide. Illicit psychoactive drugs, meanwhile, can heal. Ibogaine can help those addicted to heroin; psychedelics and MDMA can help relieve PTSD, depression, and anxiety in some people; opiates, stimulants, and sedatives can help people survive the aftermath of trauma or the suffering of unhappy everyday life. Relief is a kind of pleasure, engendering desire. Recreation relieves pain, and obedience can be a form of self-harm.

Drugs often move from one category to the other. Cocaine was first marketed to Americans as a pharmaceutical. Bayer’s Heroin (diacetylmorphine), named for its [End Page 131] heroic powers, was introduced in 1898. Today, cannabis, MDMA, psilocybin, and ketamine are all in the process of moving from the illicit to the white market. They’re the same as they ever were; we’re the ones who have changed. A bottle of Adderall prescribed for a student struggling with term papers or a banker exhausted by long working hours can have a new existence at an all-night party. A drug becomes illicit when it’s used for fun.

Medical diagnoses legitimize the need for relief in the eyes of the law, but diagnosis is subjective, shaped by a doctor’s preconceptions about a patient on the basis of race, class, gender, age, sexual orientation, and self-presentation. A diagnosis and prescription can be a reward for conformity or a blunt instrument used to enforce it. In the 1970s, feminists protested the widespread prescription of Valium, which they viewed as a tool to suppress female rebellion. If, on the other hand, you’re looking to be prescribed a particular drug, be sure to dress neatly—imagine you’re going to court—and tell the doctor you need the pills for your office job.