How opioids became “safe”: pharmaceutical splitting and the racial politics of opioid safety

This article explores how opioid painkillers, known for over a century to be highly addictive, came to be considered a safe treatment for chronic pain. Based on a critical content analysis of industry-sponsored medical education, biomedical opioid research, and opioid marketing strategy it identifies the unacknowledged racialized category distinctions between ‘pain patients’ and ‘opioid abusers’ that have influenced medical opinion on opioid safety since the 1990s. It develops the concept of pharmaceutical splitting to understand how distinctions between ‘pain patients’ and ‘opioid abusers’ drew on racial and class-based imagery enabling prescribers to reconcile long-standing evidence of opioids’ addictive properties with the argument that they were a safe treatment for common chronic pain. Overall, this article contributes to understandings of the cultural and racial politics of pharmaceutical marketing and commercially-sponsored pharmacology.