Purpose - To compare the histories of two opioid medications that are pharmacologically similar but subject to contrasting regulations in their use in treatment of opiate dependence in the United States - methadone and buprenorphine - in order to analyze the role of racial imagery and racial politics in the legalization and clinical promotion of their use. Methodology/approach - Historical methods of archival analysis of published articles and unpublished governmental records were used in researching methadone. Ethnographic methods of participant observation and semistructured interviews were used in researching buprenorphine. Findings - Contrasting uses of racial imagery played a major role in shaping the current regulatory differences between the two treatments. The association of methadone with black and Latino heroin users has contributed to its increased federal regulation while the association of buprenorphine with white middle class prescription opioid users enabled its use in deregulated private physicians' offices. Originality/value of paper - Advocates of biomedicalization of behaviors and conditions thought of as social or moral such as addiction argue that biomedicalization reduces the stigma of the condition and imply that in turn it also reduces the racial inequalities associated with the condition. This study of the biomedicalization of treatment for opioid dependence indicates that the very process of biomedicalization depended on heightened racial imagery associated with each treatment and ultimately intensified rather than reduced the stigma of addiction for black and Latino low-income patients.