Built to exclude: the law is a super-determinant of racial disparities in addiction treatment

16/10/2026

AI Summary

Law acts as a super determinant, constituting eligibility, providers, settings and interventions that produce structural racial disparities in addiction treatment.
A century of racialised drug law created legal categories that sort care into racially segregated community and carceral treatment environments.
Addiction medicine must integrate legal analysis and critical race methods, treat policy reform as treatment, and centre legally excluded groups as the measure of equity.

TL;DR (AI Generated)

This article argues that closing the gap rests on recognizing law as a super-determinant of population health: not a contextual influence but a constitutive force that creates the categories through which treatment is organized.

Drawing on constitutive legal theory, racial formation, Public Health Critical Race Praxis, and administrative violence, it shows how law defines who is eligible for care, who may provide it, which facilities are recognized, and which practices count as treatment, and how each category was forged through a century of racialized drug policy.

It argues that addiction medicine must integrate legal analysis and critical race methodology as core competencies, treat legal and policy reform as treatment strategies, and center the most legally excluded populations as the starting point for equitable care.

Basic summary

Front Psychiatry. 2026 Sep 30;17:1811329. doi: 10.3389/fpsyt.2026.1811329. eCollection 2026.

ABSTRACT

The United States built an evidence-based substance use treatment system that works, just not for everyone. Fewer than one in five adults who needed treatment in 2024 received any form of care, including medications for opioid use disorder (MOUD), and Black and American Indian/Alaska Native communities died of drug overdose at the highest rates. This article argues that closing the gap rests on recognizing law as a super-determinant of population health: not a contextual influence but a constitutive force that creates the categories through which treatment is organized. Drawing on constitutive legal theory, racial formation, Public Health Critical Race Praxis, and administrative violence, it shows how law defines who is eligible for care, who may provide it, which facilities are recognized, and which practices count as treatment, and how each category was forged through a century of racialized drug policy. The article traces these legal categories across four domains – people, providers, settings, and interventions – and demonstrates how they converge to yield racially sorted treatment environments in community and carceral settings alike. It argues that addiction medicine must integrate legal analysis and critical race methodology as core competencies, treat legal and policy reform as treatment strategies, and center the most legally excluded populations as the starting point for equitable care. Drawing on abolitionist frameworks in public health and drug policy, it insists that reforms be evaluated not by whether they expand access within existing categories, but by whether they dismantle the arrangements that produce racialized exclusion in the first place.

PMID:42877669 | PMC:PMC13663877 | DOI:10.3389/fpsyt.2026.1811329

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