by Sunil Williams
Until recently I never really knew about the opioid crisis in the USA.
I had a sense that such a thing existed. YouTube fed me the odd Vice documentary on the impact of opioid addiction on cities in the USA and Canada. But what really hooked me into the catastrophe was the HBO miniseries Dopesick.
Dopesick is a television miniseries. It takes real people, events and the timeline from Beth Macy’s nonfiction book and mixes in fictional characters who represent the hundreds of thousands of lives disrupted or destroyed by a family of real-life merciless billionaires.
The real people portrayed include members of the ultra-wealthy family, the Sacklers. This family were until September 2021 the owners of Purdue Pharma, the manufacturers and marketers of oxycontin, a highly addictive opioid.
Intrigued by the series I found Macy’s book along with the more recent Empire Of Pain: The Secret History Of The Sackler Dynasty.
Something stands out in these accounts: The impotence of the USA’s national government to protect its own people from ultra-wealthy drug-dealers selling their wares in broad daylight.
The Sackler family, in particular Arthur and Kathe Sackler knew that oxycontin would raise rates of addiction across the USA. It may have been for this reason that their test markets were in remote parts of the USA where social pain is generally ignored by the US federal government: first West Virginia and then outwards into Appalachia.
Keith Walloo explains in his book Pain, A Political History that the US lawmakers address the physical pain of the working class according to the needs of the elite. The degree of legitimacy of physical pain is determined by social status.
In 2017 drug overdose was the leading cause of death for people in the USA under the age of 50. The US Justice Department associates the high rate of deaths directly to criminal activity by Purdue.
When community leaders and grieving parents raised alarms about this criminality, national leaders and regulatory institutions’ official responses were muted. People in authority who might have cared were simply purchased. Either through institutional funding, generous campaign donations or the lure of lucrative future positions in the corporate hierarchy.
The roots of disaster
The opioid crisis shows up contradictions within American history. There was a contest between the public health and capital.
Overprescribing doctors couldn’t resist the enticements given to them by Purdue’s marketing teams. States couldn’t prevent their state attorneys from being bought off. Federal regulatory agencies couldn’t resist key employees being hired by the Sacklers.
The system was not merely defenceless against vampire capital. It had long since chosen a side.
Every chapter of the oxycontin story is marked by exploitation of working class people. Abuse inflicted by pharma companies and enabled by the state.
As regulations tightened against overprescription, addicts moved en masse to cheaper black-market derivatives like heroin. In a bleakly cynical maneuver Purdue began planning a chain of addiction treatment clinics. Had this plan eventuated, Purdue would have profited even more by capturing the lives of people through a cycle starting from overprescription and extending into long periods of addiction and relapse.
“This is a bitter result”
The strongest possible measures by the most passionate in-system avengers have been crippled by the system itself.
After years of legal actions Purdue shifted its assets and declared bankruptcy. Late last year it received one of the biggest fines in corporate history: $8 billion. Money that would never reach government coffers due to creative accounting positioning the company as bankrupt.
A ruling in September this year saw the Sackler’s agreeing to surrender $4.3 billion of family money while being absolved of criminal culpability. An outcome that the dissatisfied presiding judge described as “a bitter result“.
Another company facing legal challenges for its role in the opioid crisis is Johnson & Johnson who supplied ingredients to opioid producers, purpose-breeding an opiate-rich mutant poppy. Owners of Australian farms were gifted high-status automobiles for handing over high crop yields.
Lately we know Johnson & Johnson as a manufacturer of a COVID-19 vaccination. Before the miniseries Dopesick had aired its final episode Johnson & Johnson indulged in self-congratulation for escaping a court ruling that would have fined them $465 million.
A visceral response to exploitation
When a pharmaceutical company contributes to hundreds of thousands of deaths over 25 years it’s easy to see why people are deeply distrustful of medical authority.
Purdue poured millions of dollars into polluting the public sphere with disinformation on the safety of oxycontin, informing doctors that addiction to oxycontin was unlikely to happen to all.
When patients began reporting signs of opioid addiction, Purdue’s sales teams coached doctors into believing that the appropriate response was to increase dosages.
Many doctors knew that they were being lied to, but found the profits from overprescription irresistible.
It’s entirely predictable for people to reject anything they are told about new medical treatments.
People can tell intuitively when they are lied to. Even if the lying stops, relationships that have been exploited for the benefit of a predator may take longer to heal than the length of a lifetime.
The deeper story
The American Public Health Association offer an explanation of the disaster that contrasts with the story told by Dopesick. A paper from APHA looks at conditions of poverty, access to opportunity, and poor public health as powerful contributing factors to the explosion of opioid addiction. They make explicit reference to “diseases of despair” in the Midwest, Appalachia and New England, areas deliberately targeted by Purdue due to the high numbers of labourers in pain.
“Poverty and substance use problems operate synergistically, at the extreme reinforced by psychiatric disorders and unstable housing. The most lucrative employment in poorer communities is dominated by manufacturing and service jobs with elevated physical hazards, including military service. When sustained over years, on-the-job injuries can give rise to chronically painful conditions, potentially resulting in a downward spiral of disability and poverty. Although opioid analgesics may allow those with otherwise debilitating injuries to maintain employment, individuals in manual labor occupations appear to be at increased risk for nonmedical use.”
The paper is worth reading for other facets of its explanation of the roots of the crisis. Even those of us who like myself are not experts in public health can gain insights.
The APHA paper describes recognisable impacts of capitalist abuse. We can expect generations of abuse to produce large numbers of people with PTSD. Gabor Mate, a specialist in addiction and trauma believes that opioid addicts are self-medicating for undiagnosed PTSD. This might partially explain an observation from the New Zealand Ministry of Health: at least one third of people using its service for opioid addiction suffer from PTSD.
Contempt for a rigged game
Pharma executives, salesmen, consultancy firms and retailers made huge profits on the suffering of working class people. The pushing of dangerous drugs was facilitated by state and federal authorities who endorsed disinformation broadcasts by millionaire drug pushers.
The broadcasts hit populations subject to high amounts of physical injury and struggling public health infrastructure. In this context legally commercialised opiates fit the model of ‘disaster capitalism’. A kind of chemical shock doctrine.
In this context why would we be surprised that significant numbers of people resist vaccination drives from pharma companies and their partners in the state?
This isn’t to give credibility to particular narratives espoused by those among the movement described (often with only passing accuracy) as ‘antivaxxers’. They are a diverse group with differing ideas, explanations and justifications – all with varying degrees of credibility – for their own positions.
But generally they share something in common: they have always lived in a world characterised by an abuse of trust between themselves, corporate power and state authority. Where their pain has been a source of corporate profit, state protection has been applied too little, too late. And the wealthiest profiteers continue to thrive.
Under these circumstances why should we not expect resistance?