Book Review: Revier,K.,Policing Pain: The Opioid Crisis,Abolition,and a New Ethic of Care

Policing Pain is a compelling account of the carerality of the political and policy response to the North American overdose crisis. Revier’s deep and rich engagement with people who use drugs, advocates and front-line workers in local communities in the Southern Tier of New York, in places like Broome County, Binghamton, and how they have been impacted by the unfathomable loss of life in the opioid crisis is an impressive scholarly intervention. This is patient, careful and thoughtful work – it is also more than just data about the on-the-ground realities of the crisis. The material in this book provides as much of an empirical contribution as it does a contribution to advocacy on, and critical analysis of, race and drugs.

Revier highlights an important contrast between mediated narratives about the impact of the overdose crisis on working-class white communities, and the stark realities of its impact on racially and class diverse communities. While important work has been done on the way the “opioid crisis” has been presented in media accounts as foremost impacting white communities (Dertadian and Rance, 2023; Johnston, 2020; Revier, 2020), which has informed political discourses of a “nicer” and “gentler” war on drugs (Beckett and Brydolf-Horwitz, 2020), the analysis in this book brings these accounts into conflict with the lived realities of Black, Brown and Indigenous communities also experiencing significant harm, but excluded from programs meant to interrupt the ordinary inclination to “arrest our way out of this mess.” Diversionary programs that form part of the political messaging that white communities deserve non-criminal responses to drug-related harm are realized in practice by explicitly presenting white people as a “better fit” for such programs. One community organizer was told that police-led diversion is “starting small so we have to start white.”

The book presents its argument in two main ways. First, by deepening the critical race analysis so often applied to pharmaceutical consumption and whiteness. And second, by empirically demonstrating the fallacy of the myth that this is a crisis largely of white communities, and that policy responses have subsequently been less cruel or carceral to everyone impacted by the crisis. Looking to the first argument, the book assesses the way whiteness structures media coverage of the “zombie” white user, and its proximity to blackness. Revier demonstrates how sympathy for white victims of the crisis is cast through the lens of their inability to live up to the image of proper whiteness. Sympathy for the desperate situation and loss of life among white people experiencing harm related to pain medications is structured by the claim that they could have been, and can still be potentially redeemed to, the status of “proper” whiteness. This is reaffirmed by media accounts of the apparent greed and predatory conduct of communities of color “forcing” (rather than responding to demand for) pharmaceuticals onto innocent white communities who are not the “natural” market for drugs that kill.

Yet, as Revier notes, “through the anti-Black construction of the dealer, whites are also caught in the carceral apparatus” (2025: 39). This is at the heart of the second main argument of the book, which is that well documented media and political discourse which has presented policy responses to the overdose crisis as more focused on a health response and less reliant on criminal legal intervention, is not the way it is experienced on the ground. The accounts of people subject to police programs, court processes and prison systems that are canvassed in this book give lie to the now popular position that health responses are not carceral.

Revier explores the impact of the police adoption of health language and framing. This includes documenting client and advocate experiences of programs like the Law Enforcement Assisted Diversion (LEAD), Police Assisted Addiction Recovery Initiative (PAARI) and the Save Addicts From Epidemic (SAVE). The book shows how exclusionary these programs are (reserved largely for white participants) and how they reproduced stigmatizing and racialized policing practices, because “police set the boundaries of program access and community participation, and clients are framed as dangerous” (Revier, 2025: 60). The dynamic this establishes around police as actors in public health extends beyond such programs and into the way “police act as first responders for overdose” (Revier, 2025: 61). This includes the way police continue to charge and arrest people calling for help related to overdose, even when Good Samaritan laws are technically in place to prevent this. Through claiming to be concerned for the health of people who use drugs, police justify ongoing carceral violence, and are able to present themselves as “caring cops” who are here to “help with handcuffs” (Revier, 2025: 51).

The way the criminal legal system embraces a health framing to justify carceral expansion is not limited to police either. The book shows, with considerable qualitative detail, the way drug courts and treatment in prison function in much the same way. For instance, Revier shows how drug courts enforce an easy to recognize story of decline to “rock bottom,” which position the court not as a reluctant last resort, but rather as an ideal place to facilitate the upward trajectory of recovery. At times, this even involves judges and lawyers coaching drug court participants to “associate their criminal offense to their drug addiction” (Revier, 2025: 72) through managed stories about why they need the court’s help. The harms of linking recovery and treatment to prison are perhaps most pronounced in media and political discourse, where such narratives work to “bolster sheriffs’ and legislators’ calls to increase jail funding on the basis of treatment support” (Revier, 2025: 87). These calls help to elide the racist abuse, gendered violence and other sexual harms that the book documents among people under the “controlling embrace” of the “caring” (Revier, 2025: 66) drug courts and the newly conceived “caring cages” (Revier, 2025: 82) of prison treatment. The consolidation of treatment in carceral settings also ignores the near total abandonment of people traumatized by their incarceration upon release, which is known to be a period of increased likelihood for overdose (Binswanger et al., 2013; Bukten et al., 2017) - or as one participant put it: “The clean time is what kills people” (Revier, 2025: 95).

The book closes with a compelling account of the way treatment-based reforms to carceral systems rarely build new ways of supporting people impacted by the crisis. Instead, these systems are remaking themselves in their own image. Here Revier advocates for abolitionist visions of care, which tear down harmful carceral systems that harm everyone they touch, while building up communities through strategic engagement with state funded initiatives that do not expand carceral control. This includes mutual aid practices which recognize that “the opioid crisis is not a singular social problem, nor is it solely about opioids, addiction or overdose: it is about state violence [and] organized abandonment” (Revier, 2025: 109). In closing, “Policing Pain” aptly defers to long histories of abolitionist movements in North America, from those focused on slavery to Jim Crow, and their connection to more recent movements to defund the police and dismantle the prison system as a way out of a crisis that racial capitalism created.