Drug Decriminalization in Maryland Through an African Centered Research Paradigm- Analysis and Recommendations

Austin professor John Hoberman writes in his book Black and Blue that medicalized racism
against Black people continues to be pervasive and precisely reflects assumptions around Black
patients, which are linked to slavery. Black patients are often prescribed less pain medication, with
research showing this stems from an assumption among medical providers that Black patients are
more likely to abuse drugs and also that they feel less pain. 2 out of 10 doctors said they believed
Black patients have “thicker skin” than whites, a trope which links back to slavery and the belief
that Blacks had a hardier constitution and resistance to mosquito bites which made them uniquely
suited for hard labor in the South (ibid). Thus, it is the doctors, individuals who should be the most
immune from bias with their extensive scientific training, who seem to be propagating some of the
worst examples of racism. Finally, the psychological or even spiritual suffering many Black
Americans face dealing with racism is often completely ignored by medical practitioners. Medical
practitioners continue to falsely pathologize Black coping mechanisms such as overeating,
smoking, or drug use as “personal failures” needing medical intervention; instead of the
manifestations of deep historical oppression requiring more comprehensive solutions.
A more in-depth examination of Hoberman’s analysis shows that these deficits in
understanding are linked to some of the traits of eurocentric scientific study, which Schiele
isolates. As opposed to ignoring race, Hoberman found that medical programs often pursued
extremely perfunctory, individual-based discussions of racism, which stressed Schiele’s point
about checking individual bias. As a result of the failure of these programs to engage in substantive
analysis of the structural reality of racism, many doctors boiled these discussions down to
simplistic notions of not harboring explicitly negative beliefs around racial minorities. This
allowed the implicit manifestations of racism to go unchecked, as many of these medicalized
manifestations were not necessarily solely based upon negative bias by the medical professors but
also their attempts to establish patterns out of what they see as “objective” empirical observations
on patients of different races. This shows the dangers of the “reductionism” that Scheile discusses.
Moreover, it ignores a consistent factor discussed throughout Hobernman’s work - the poor
communication between Black patients and white doctors. Studies have shown doctors often
lecture to Black patients, talk more slowly to them, and show a general pattern of infantilization
or an enhanced belief that Black patients are more likely to be “non-compliant” (Hoberman, 2012,
Nittle, 2020). This shows the flaw of the Eurocentric totem of valuing seemingly objective
“empiricism.” Black patients often don’t trust white doctors, meaning they are usually not entirely
honest with them about their fears, pain, or symptoms. Black patients are less likely to complain
about pain to white doctors because they don’t trust they will understand and maybe even fear that
they are “drug-seeking” or will be seen as being improperly differential to medical authority. This
silence leads some white doctors to believe “objectively” that Blacks feel less pain because they
talk about it less than their white patients (ibid). These failures relate not only to these doctors not
having enough data, or the “science” being done incorrectly but at a fundamental level, the frame
being applied is flawed and needs to be fundamentally questioned. While this example addresses
the broader medical system, it clearly challenges the notion that shifting the structure of addiction
research from the criminal legal system to the medical system is inherently positive.
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