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Opioid Crisis in America: The Politics of Pain

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May 24, 2017 19:00 EDT

From the latest headlines, it seems that all of sudden America faces an opioid crisis.

“There’s a guy in the bathroom who overdosed,” said a volunteer at a seasonal shelter in Amherst, Massachusetts, where homeless people come for a hot meal, a shower and a place to sleep. The town is relatively affluent, and it might seem unusual to see a drug overdose, much less on heroin.

From the latest headlines, it seems that all of sudden we are faced with an opioid crisis. The truth is that opioids have been with us for a long time and their use has been virtually state-sponsored or facilitated by corporations. The impacts are felt disproportionately by poor communities, more often of color, and now the middle class.

Perhaps in an effort to show that this problem is affecting many strata of society, the media have paid more attention to it as a white problem. In his book, Pill City: How Two Honor Roll Students Foiled the Feds and Built a Drug Empire, investigative journalist Kevin Deutsch reported: “Since 2013, more than 22,000 news stories published in American media outlets have made mention of ‘white’, ‘suburban’, or ‘rural’ addicts battling opiate addiction. Meanwhile, fewer than 20 such stories have focused on black opiate addicts, living — and dying — in poverty stricken cities during that same time.”

Opiates are disproportionately affecting communities of color, who, according to the Centers for Disease Control and Prevention (CDC) statistics cited by Deutsch, saw a 213% increase in heroin deaths between 2000 and 2014. Only now that addiction is creeping into middle-class communities is it making headlines. But it is a problem with considerable history.

In the 18th century, opium was first used as a means of leveling out a trading imbalance between the West and China. While Western countries had great demand for luxury goods from China, there was little demand in return. Initiating the Opium Wars, the British became the largest traffickers of opium into China, creating an artificial demand in a country where the substance was banned.

Other countries, including the United States, followed suit in trafficking the drug to China. In a karmic turn of events, opium later came to the US from China.

“In fact, the first anti-opium ordinances were passed in the late 19th century in the US because you had a lot of Chinese laborers who migrated from the Yunan province of China, where opium was used and grown and been pushed into China by the British as part of the Opium Wars,” Jeremy Kuzmarov tells me. Kuzmarov writes about drug trafficking as a professor of American history at the University of Tulsa. “That was the beginning of the War on Drugs.”

Opium Today

Today, economies are still enmeshed in the opium trade. Lillian Landrau, who earned an associate’s degree in addiction studies at Northwestern State University of Louisiana, one of the few colleges in the country where it is offered, says, “Without drugs the economy would collapse.”

Kuzmarov acknowledges that pharmaceuticals and the illicit drug trade generate huge revenue. “During the 2008 financial crash, some of the banks stayed afloat because of money they had from traffickers who they were loathe to crack down on,” says Kuzmarov. “Drug cartels have an easier time laundering money in banks. So, some banks do flourish or even stay open because of that revenue.” According to Landrau, while oil runs the economy, it is a volatile market. Drug money from cartels has been a steadier source of revenue, and opioids are particularly lucrative. “It does have a major impact on the US economy and various Latin American economies, like Mexico and Afghanistan,” confirms Kuzmarov.

In Afghanistan, opium fields cover more ground than the coca plant does in Latin America. When in power, the Taliban successfully banned planting opium, but in weathering the turmoil of several wars the country has not had a chance to develop its economy in other ways. After the Central Intelligence Agency funded the mujahedeen rebels in a covert operation during the Soviet-Afghan War of the 1980s, economic insecurity prevailed and farmers turned to opium for survival. Today, Afghanistan supplies 90% of heroin, an opium derivative, worldwide.

Landrau wonders how a narcotic like heroin can make its way in such dizzying amounts overseas to the US, where it fuels an underground economy targeting the poor and, increasingly, the middle class.

“It just doesn’t make sense that with so much security in the airports, supposedly in the ocean, on the border, that so much drugs comes into the country without being detected. Somewhere, there’s help. Somewhere.” Landrau believes a “shadow government” of connections to the CIA is facilitating an underground economy.

Kuzmarov corroborates that the CIA has historically protected drug traffickers. In fact, former CIA agent Dennis Dayle said on record that during his 30-year career, almost every major trafficking suspect worked for the agency.

“That is one big reason why the War on Drugs fails, because you have very powerful interests protecting traffickers,” says Kuzmarov. “The ravaging effects of wars can also be a big boon to traffickers and smugglers. In the chaos of war, it’s harder to police.”

Big Pharma

Parallel to shadow state actors facilitating the illicit drug trade are corporations, namely pharmaceutical companies and their lobbies, that promote a culture of opioid misuse in the modern world.

Recently, the Cherokee Nation filed a lawsuit against leading drug companies and pharmacies, including Wal-Mart, CVS Pharmacy and Walgreens, as well as the three largest pharmaceutical distributors in the US: Amerisourcebergen, McKesson and Cardinal Health. The Cherokee claim these companies knew they were saturating the market with painkillers for addicts.

The case and others like it are a means of holding corporations accountable for the social implications of their business model, which generates $24 billion globally and has spent over $880 million in the past 10 years on lobbying for opioid use and deregulation in the US, according to Deutsch. That is more money than the gun lobby.

Even if corporate actors are brought to justice, there remain thousands of opioid addicts in the US, where opioid overdose is the leading cause of accidental death, and the number has quadrupled since 1999.

According to the American Society of Addiction Medicine (ASAM), “Of the 52,404 lethal drug overdoses in 2015, opioid addiction was found to be driving the epidemic, with 20,101 overdose deaths related to prescription pain relievers and 12,990 overdose deaths related to heroin in 2015.” Of the 130 Americans who die each day from drug overdoses, a quarter identify as African American, reported Deutsch. Yet both Landrau and Kuzmarov caution using the word epidemic in reference to opioids because it has elicited a legal crackdown on addicts more than it has affected change of the system and rehabilitation of people.

A Global Opium Shortage

The US comprises only 5% of the global population, but it consumes 80% of the world’s opioids. If Canada and Western Europe are included, consumption of the global opioid supply increases to 95%. “[S]o the remaining countries only have access to about 5 percent of the opioid supply,” Vikesh Singh, assistant professor of medicine and director of the Pancreatic Center at Johns Hopkins University, told CNBC.

In this way, painkillers are practically withheld from developing countries. According to the United Nations, the global supply problem could be solved with relatively cheap morphine, another derivative of opium. But “selling it held little allure for multinational drug companies,” reported The Los Angeles Times. Instead, companies prefer to market expensive preparations.

Purdue Pharma, one of the leading pharmaceuticals, sells hundreds of dollars per bottle for a month’s supply of OxyContin — a semisynthetic prescription opioid — when generic morphine costs as little as 15 cents per day. Based on the 2015 sales, Purdue Pharma, Johnson & Johnson, Insys Therapeutics, Mylan and Depomed made the top five opioid products.

According to Kuzmarov, there is much profit to be made, with drug companies incentivizing doctors to prescribe opioids that their patients may not need. “I think we do live in an overly medicated society,” he says, “and doctors can facilitate people’s addiction.”

Some companies attest that they have tried to safeguard the business from abuse by creating opioids with abuse-deterrent properties. They have cited the need for better use of prescription-drug monitoring programs, better education of physicians and public awareness, and better access to anti-overdose drugs like Narcan for law enforcement.

But none of these tactics change the corporate context in which drug overdose in the US and global shortage occurs.

Marketing campaigns, including Purdue Pharma’s inaccurate advertising of OxyContin as a non-addictive opioid, have encouraged Americans into an abyss of addiction. Pharmaceuticals have even gone so far as to offer “continuing education” to medical professionals on the merits of opioids in treating all pain types. Lobbyists have funded groups like the Pain & Policy Studies Group to promote opioid use and discourage regulation.

The government is poised at the time of this writing to spend less than $200 million in the coming months on an epidemic that kills far more Americans each year than terrorism, Ebola, and AIDS combined — yet receives less funding than each of these.

“It points to the irony that we spend so much money trying to police certain substances, yet you have corporations that facilitate addiction that could be just as harmful to people’s health and the health of communities like the Cherokee,” says Kuzmarov.

Deutsch reported that: “The DEA, too, can slow the rate of opiate deaths, simply by reducing the number of prescription opiate drug makers are permitted to manufacture. Such a move would ensure there are enough pills in circulation for those who need them but not the surplus of painkillers that exists today.”

Holistic Treatment

Both Landrau and Kuzmarov believe that drugs should be legalized but carefully regulated. “For harder drugs it’s debatable,” says Kuzmarov, “but I think that would be the best approach. The drugs are more a symptom of a problem than an evil in itself.”

Landrau agrees: “The problem is not on the sheets that cover the sick person. The problem is deep. The problem is society.”

Landrau says she will not be part of the recovery movement, referring to programs like the 12 Steps and similar models, which require addicts to admit to a moral failing.

In truth, the problem is systemic, one that Landrau believes targets the poor and benefits from overly-medicating the middle class. Although the language in treating opioid addiction has changed somewhat to one that acknowledges it as a chronic disease, Landrau believes the health care system inculcates people into dependence in other ways.

For one, patients identify with the addiction group as their sole community, and they find themselves relapsing to return to where they feel they belong: as an addict. “That is false,” says Landrau. “The brain has plasticity.”

The process of healing is gradual. But, according to Landrau, the way society responds is by putting pressure on addicts to solve problems quickly and in a one-size-fits-all mode of steps.

Instead, Landrau believes in a holistic method, including nutrition and sensory therapeutic techniques, which she says facilitate recovery much better than any anti-addiction drug like methadone ever could. “The use of substances changes the pathways in which the neural transmitters are working and it changes behavior,” she explains, describing the breakdown that occurs of the myelin sheath, a protective layer that surrounds the nerve cells where electrical impulses are transmitted.

The sensory techniques Landrau has learned make it possible for the protective covering of those neurons to regain wellness. “It’s difficult, but the senses have a lot to do with the regeneration of the nervous system.”

This kind of rehabilitation means more than just offering clean needle exchanges and methadone, although these are very important strategies. Indeed, some countries have decriminalized psychoactive drugs and fully cover the cost of pain-relieving, addiction-fighting substances like Suboxone.

But that will not eliminate the root causes of addiction, according to Kuzmarov, who blames inequality, isolation and a lack of opportunity.

“This society demands that you always feel happy and you have no problems, no pain, no issues and it doesn’t matter how oppressed you are,” says Landrau. “You have to be happy. You have to put on a face.”

The only helpful thing about pain is it lets you know something is wrong. And there is no denying that. “It is the poor who are holding up the middle class so they can work, and the poor are holding those on the top, and the middle class is holding those on the higher top,” says Landrau. “So you see the pressure on the poor from the other layers of society. But who talks about it?”

In Baltimore, a city infamous for opiates trafficking, the “opportunity” available to young, poor men and women is drug dealing. Unless they are given the environment to prosper otherwise, dealing is where the tech prowess and intention of a considerable portion of the populace, young and old, will go. And for now, the funding for community and rehabilitation centers within inner cities is frightfully low.

The need to support holistic rehabilitation and community revival is pressing, and the time to do it is now. “The government is poised at the time of this writing to spend less than $200 million in the coming months on an epidemic that kills far more Americans each year than terrorism, Ebola, and AIDS combined — yet receives less funding than each of these,” Deutsch wrote in the concluding chapters of his book.

The CDC has fortunately changed its prescribing guidelines so doctors are advised not to prescribe opiates for chronic pain. “But we need more than just guidelines,” an interviewee told Deutsch. The US needs to appropriate $10 to $15 billion to “a massive, sustained, serious effort all across this country dedicated to ending this epidemic everywhere, including communities of color.”

*[This article was updated on May 27, 2017.]

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.

Photo Credit: smartstock

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