Righteous Dopefiend

Heroin and crack use takes a physical toll on the body. Withdrawal is an excruciating experience, so users seek to avoid becoming “dopesick” at all costs. The use of drugs is divided along racial lines: Crack is associated with Black people who use drugs, along with a form of shooting up called “booting-and-jacking,” or inserting needles directly into the vein; by contrast, white people who use drugs are more likely to give up on shooting into their scarred veins and instead shoot directly into fatty tissue. This results in different physical marks of addiction, depending on race and/or ethnicity. The intersection of addiction, masculinity, and sexuality comes with additional racial differences, as Black and Latino male users claim to be very sexually active, while white users generally trend in the opposite direction, claiming to experience erectile dysfunction.

The healthcare system commits violence against people addicted to substances in a variety of ways. For example, interlocutor Hogan has had several near-death encounters from abscesses, which has attempted to resolve himself due to lack of access to health services. Medical staff treats him and others like him with frustration, nicknaming them “frequent flyers.” Surgeons are less likely to provide “frequent flyers” anesthesia and painkillers for painful procedures, especially if the person they are serving is Black.

Public health campaigns within the neoliberal paradigm hold individuals accountable for their health without seriously acknowledging the ways they are victims of the systems and institutions they work within. The example Bourgois and Schonberg use is a campaign against Hepatitis C, a disease that affects nearly all the addicted people in this area. They were informed how they acquired the illness, but not given any tangible actions to take. As a result, this campaign created a mindset of willful self-destruction among this community, because “being willfully and oppositionally self-destructive feels like an empowering alternative to conceiving of oneself as a sick failure who lacks self-control” (121).

Law enforcement, the main institutional arm to interact with those who experience poverty and addiction, also has a harmful impact.

The chapter ends with the general pain of experiencing addiction and homelessness, impressing upon the reader how desperate of a life these people are living and the damage caused by maltreatment from institutional actors such as nurses and police officers.