Whiteout by Helena Hansen

Author:Helena Hansen
Language: eng
Format: epub
ISBN: 9780520384057
Publisher: University of California Press

PHARMACEUTICALS AS RACIAL PROSTHESIS

From the gender and family imagery of buprenorphine prescribers as first responders to opioid addiction in white suburban communities such as Staten Island, one might draw on sociologist Steve Garner’s analysis of Whiteness as the basis for nation building in colonial states such as the US. In Garner’s view, Whiteness is a situationally contingent quality used to sort those who belong inside the nation, with full citizenship, from those who belong outside the nation. In this frame, buprenorphine maintenance is a prosthetic device for the maintenance of the white nation.72

This function of buprenorphine became clear in our comparison of white, college-educated patients to Black and Latinx patients with less education in our interview sample of seventy-seven people who were being treated in the only two public buprenorphine clinics available in New York City between 2014 and 2017. The clinics hosted middle-class patients who had exhausted their savings and lost their jobs in the course of their opioid addiction, thus qualifying for Medicaid coverage, along with low-income patients who had rejected methadone treatment because of its requirement of daily observed dosing.

The impact of buprenorphine maintenance on their subjectivities and daily lives diverged depending on their race and class status. White, middle-class patients such as a filmmaker whom we will call Alexis spoke of the utility of buprenorphine for preserving her reputation and social capital in the competitive world of film: “I usually like to keep my addiction a very private thing. . . . Professionally speaking I have to be careful, you can lose grants, respect. . . . [With buprenorphine I have] normality—a sense that you can have a sense of goals and without having to depend on a group or a program, like the other options out there for us like [methadone maintenance and Narcotics Anonymous]. I’m able to travel and to have regular life.”

Buprenorphine did allow employed people to keep their addiction “a very private thing” in many ways: at the time of our interview with her, buprenorphine was not a widely recognized drug name, and no employers tested for it on random urine screening of employees. While Alexis had found her way to the only public hospital in New York City to offer outpatient buprenorphine, private hospitals in the city ran cash-only buprenorphine clinics that did not even accept private health insurance, and private practice doctors charged fees of $1,000 and up for an initial half-hour buprenorphine induction visit.

Alexis was focused on the ways buprenorphine helped her maintain her productivity and her professional and personal social networks. She described her public image as “happy and productive” as a result. She saw her physician as an ally and advocate, someone from a similar background who could share her sense of accomplishment. Speaking of the doctor who wrote her first buprenorphine prescription, and whom she contacted years later to tell that she had stayed on buprenorphine treatment since leaving his practice, she said: “it was a very emotional and beautiful thing for him to see me healthy.”

In contrast, low-income Black and Latinx

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