Synthetic opiates (opioids) have created among the most profitable markets worldwide. Two decades ago, FDA approval of Oxycontin® as a “minimally addictive” opioid pain reliever fueled an unprecedented rise in prescription opioid abuse. This was followed by a little known act of U.S. Congress enabling general physicians to use an opioid maintenance medication, buprenorphine, for addiction treatment in their private practices, leading to enormous growth in the U.S. addiction treatment market. Based on participant-observation and interviews among pharmaceutical executives, policy makers, patients and prescribers, this article describes the neuroeconomics and neuropolitics of new opioid maintenance treatments. This article contrasts the historical emergence of methadone clinics from the 1960s to the 1980s as a treatment for the Black and Latino urban poor, with the current emergence of buprenorphine, a maintenance opioid approved for prescription on doctor's offices, as a treatment for white, middle-class prescription opioid abusers. The article then traces the counterintuitive result of bringing addiction pharmaceuticals into the medical mainstream in an effort to reduce the stigma of addiction: a two tiered system of addiction treatment that reinforces stigma among the urban poor, and enhances the biological, political, and economic dependence of all classes on opioid markets, both legal and illegal.