Macklemore’s song 'Drug Dealer' a modern example of musical activism

And while it lacks nuance, the song draws attention to key issues in the opioid epidemic

Some say musicians should stick to music—stay out of politics, public issues and social movements. Just make us dance. 

Thank goodness, that’s often not how it works.

Music is art, after all. And musicians—from Nobel Prize winner Bob Dylan to Grammy winner Macklemore—have long given us more than rhythm, melody and harmony.

They also give us lyrics with ideas, feelings and points-of-view that get us thinking about ourselves, our relationships and the world we all share.

Ideally, when we’re done dancing—and listening—we start talking.

That’s exactly what has happened with Macklemore’s latest song Drug Dealer, which in the span of two weeks accumulated more than 10 million views and 12,000 comments on YouTube, drawing enormous attention to the nation’s opioid epidemic.

“This isn’t just a song. It’s a message,” wrote one reviewer on iTunes.

And Macklemore’s three-fold message, as I interpret it, is this: 1) addiction to opioids—the class of drugs that includes heroin and prescription painkillers—is a painful and isolating sickness, not an immoral choice; 2) the pharmaceutical and medical industries share significant responsibility in fueling the epidemic (as well as ending it); and, 3) for those with opioid use disorders, recovery is possible.

Above all, the song is a scathing takedown of “Big Pharma,” which in the late 1990s exaggerated the benefits and minimized the risks of prescription opioid use, misleading doctors and setting into motion the public health crisis we face today. More than a quarter million lives later, the Centers for Disease Control (CDC) calls it the worst drug epidemic in U.S. history, and there are few signs yet of it abating.

“Props to Macklemore for rapping about issues that face Americans,” wrote another iTunes reviewer. “As an ED (emergency department) nurse, the amount of Narcan I use to bring people back (from overdose) keeps increasing. … It’s an epidemic and needs to be addressed. Narcotic pain medication is more addictive than a lot of people think.”

Drug Dealer

Watch the video for Macklemore's new song, blasting Big Pharma's role in the opioid epidemic.

Prescription for Change (Full Documentary)

In this recent documentary, Macklemore teamed up with MTV to go inside America's opioid epidemic, meeting those living with addiction and heading to Washington D.C. for an exclusive talk with President Obama on this important issue.

It isn’t the hip hop artist’s first time speaking into this topic. For years, Macklemore has spoken and rapped about his own experience with substance use (Neon Cathedral) and recovery (Starting Over). And he recently starred with President Obama in an excellent documentary, Prescription for Change, which aired on MTV.

Of course, speaking up also invites criticism, and not just from internet trollers. The musician was challenged in a recent column co-authored by Columbia University professor Carl Hart, PhD, who declared that the song Drug Dealer “unequivocally demonstrates Macklemore’s cluelessness on the subject matter.”

It’s true Macklemore uses rabble-rousing rhetoric to attack pharmaceutical companies. He refers to the people behind them as “billionaires … paying out Congress so we take their drugs—murderers who will never face the judge.”

In the chorus, he also assigns some of the deadly impact of pharmaceutical profit-seeking onto the people who prescribe their products:

My drug dealer was a doctor, doctor
Had the plug from Big Pharma, Pharma
I think he trying to kill me, kill me
He tried to kill me for a dollar, dollar

Unfortunately, Dr. Hart chides Macklemore’s hyperbole with his own, dismissing real concerns as mere “myth.”

The reality—and the valuable message here—is that some medications can, in fact, contribute to addiction and death. The truth is that policies and professional practices helped get us into this mess, and therefore, changes to them can help get us out. Another reality—which always needs more focus—is that recovery from opioid use disorder is possible, as Macklemore promotes by reciting the Serenity Prayer at song’s end.

In dismissing the musician’s personal experience, critics also risk unintentionally stifling other recovery voices.

Meanwhile, the facts remain rather indisputable. From 1999 to 2014, according to the Centers for Disease Control, opioids were involved in an incredible 250,000 American deaths. The annual rate of these deaths more than quadrupled during those 15 years—parallel, as one might suspect, to skyrocketing rates of opioid prescriptions and use, with no corresponding increase in reported pain.  That’s why the CDC is promoting its new opioid prescribing guidelines, which my organization, the Hazelden Betty Ford Foundation, supported.

Macklemore’s message, while delivered with undeniably inflammatory language, hits the mark more than it misses.

At the same time, some of the critiques of the song are spot-on, including that of this lyric: “My homie was takin’ subs and he ain’t wake up.”

‘Subs’ is a reference to Suboxone, a medicine used to treat opioid addictions. It has been stigmatized by some who, despite substantial supporting evidence, eschew the use of medications to treat addiction. Macklemore’s reference does little to help undo that stigma.

Let’s be clear, too, that doctors didn’t actually start overprescribing opioids out of malicious intent but, rather out of a desire to treat pain more compassionately. The top reason people visit a physician is pain, and as mentioned, doctors were mistakenly informed beginning in the 1990s that treating pain with opioids was safe. Adding to the doctor’s dilemma are shorter physician visits, fragmented and underutilized support services for pain patients, and pressure to make decisions and provide quick solutions. Often it is easier for a physician to write a prescription to maintain the ‘status quo’ than to ask the difficult question, “Should I change how I am treating this patient?” It doesn’t help that medical education on addiction, while progressing, remains insufficient.

In the end, while Drug Dealer does not completely capture the nuanced complexity of opioid use disorders and includes uses some obvious hyperbole; it’s a 3-minute song, not a white paper. It succeeds in getting our attention and in making some broad points that are crucial to our national public discourse. Above all else, it is getting Dr. Hart, me and millions of others talking about this life-and-death topic.

Soon, maybe, we’ll begin to see and take more action. 

Jeremiah Gardner, Mgr of Public Affairs and AdvocacyJeremiah Gardner, manager of public affairs and advocacy at the Hazelden Betty Ford Foundation, is a person in long-term recovery with a master's degree in addiction studies and a background in journalism, public affairs, business and music.
Read More
Betsy Farver-Smith cheering at podium

Unite to Face Addiction: Beyond the Concert

Highlights from the Institute for Recovery Advocacy's D.C. weekend. Read More >

Read More
Morning sunlight through tree

The Journey Comes Full Circle

William C. Moyers muses on his unlikely return to the Aspen Institute. Read More >

Read More
Addressing pain in opioid addiction treatment | Dawn over a forest after a fire

Why Addressing Pain is Essential to Treating Opioid Dependence

The importance of addressing pain in opioid addiction treatment Read More >