Race and the Law Article 133 Harv. L. Rev. 770

Race, Pregnancy, and the Opioid Epidemic: White Privilege and the Criminalization of Opioid Use During Pregnancy


Common formulations of the concept of white privilege propose that white privilege guarantees white people positive results. So, when bad things happen to white people — when the jobs and the industries on which they once relied disappear, when they are denied admission to their preferred university, when they lose a promotion to a nonwhite candidate, when they die from suicide and drug overdoses at unprecedented rates — we are left to believe that white people experiencing these adverse consequences did not have white privilege or that their white privilege did not work for them. That is, we are left to conclude that white privilege is meaningless when white disadvantage is present. Further, given the undeniable fact of widespread white disadvantage, we are left vulnerable to the claim that for many, if not most, white people, white privilege is inconsequential, insignificant, or altogether nonexistent.

In reality, the fact of white privilege is much more complicated than this facile, mechanical formulation suggests. This Article proposes that we ought to understand white privilege to be something that can lead to unfavorable results just as capably as it can lead to favorable ones. That is, white privilege is a double-edged sword. Theorizing both edges of white privilege provides a more nuanced rendering of the concept. This complexly rendered formulation may help us understand how white privilege can coexist with white disadvantage. Indeed, it might help us understand how white privilege actively produces white disadvantage.

The Article uses the recent arrests and prosecutions of women for using opioids during their pregnancies as an opportunity to engage with and theorize the idea of white privilege. The analysis proceeds in four Parts. Part I explains the origins of the opioid epidemic as well as the government’s response to it, emphasizing that the current drug crisis has hit white people and white communities the hardest and, further, that pregnant women have not been immune from it. Part II explores how the State has responded to substance use during pregnancy. At times, the State has responded with its civil systems, choosing to involve the child welfare system and child protective services; at other times, it has responded with its criminal systems, choosing to arrest and prosecute women for using substances while pregnant. Part III then analyzes the demographics of these arrests and prosecutions. It explains that prosecuting women for substance use during pregnancy began in earnest in the 1980s and 1990s, when the crack cocaine scare gripped the nation. During this time, those who were prosecuted were largely black women. However, the opioid epidemic (and the methamphetamine scare before it) has hit white communities particularly hard. Consequently, the demographics of arrests and prosecutions for substance use during pregnancy have shifted, with white women coming to predominate among those subjected to penal state power. Part IV theorizes the significance of these shifted demographics — investigating what they might mean for the concept of white privilege. A brief Conclusion follows.

* Professor of Law, University of California, Berkeley, School of Law. I am grateful to Wendy Bach, Leo Beletsky, Grace Howard, Yuvraj Joshi, Jules Netherland, and Lynn Paltrow for offering incredibly helpful and insightful comments on drafts of this Article. Thanks are also owed to Brian Flaherty in the Boston University Law Library, who provided phenomenal research support. Thanks also to Kristina Fried and Chelsea Tejada for superlative research assistance. Finally, thank you to Gert Reynaert, mijn perfecte echtgenoot, for finding me. All errors remain my own.