US capitalism is facing a whole series of crises: regarding the state of the economy, the threat to its world domination, political turmoil in both establishment parties, ect. But there is another major crisis, which is the least talked about. The opioid crisis has been dubbed an “epidemic”, as 3 million Americans , around 1% of the population, are currently misusing opioid drugs. The percentage itself is huge. To put it into context, this figure is 3 times higher than the EU average. Today, almost half a million Americans are incarcerated for drug offenses.
The data on drug overdoses (ODs) in the US are even more staggering. In 2000, the number of people that died of OD was less than 10,000. By 2017 this number grew to 47,000. Last year, that is 2021, it broke the 100,000 threshold! In 2020 in the US, 45,222 people died of gun-related injuries and 42,915 people died in motor vehicle traffic crashes. If you add the two figures, it’s still less than the 108,000 people that died of ODs in 2021…
In 2018, the rate of drug overdose deaths per million in the US was more than nine times the figure in the EU. Today, it is close to 20 times higher!
Opioids are devastating the lives of millions of people, killing tens of thousands, in numbers far greater than any other country on the planet. How did the US come to this?
The “war on drugs”
Someone has to wonder, how was this outcome possible after almost 50 years that the US has declared a “war on drugs”. In reality, the US establishment’s policy against drugs was one of the most blatant and most destructive failures in their history. Let’s see how all this started.
Mass use of opioids started in the US with morphine after the American Civil War. Morphine was used to treat soldiers, and this led to widespread addiction to it. People used to call it “God’s own medicine”.
In 1895, Bayer patented heroin as a “less addictive” alternative for morphine. It was sold “over-the-counter” to treat cough, diarrhea, “hysteria” in women (…) and practically anything. Heroin quickly surpassed morphine in numbers of people addicted to it.
In 1924, after leading to mass addiction, it was banned. The ban occurred at the time of the Prohibition Era, in which US state’s laws opted for a more offensive stance towards liquor and drugs.
After years of implementation, the ban on drug production and use did not succeed in eliminating the problem. In June 1971, president Nixon in a press statement declared:
“America’s public enemy number one in the United States is drug abuse. In order to fight and defeat this enemy, it is necessary to wage a new, all-out offensive. I have asked the Congress to provide the legislative authority and the funds to fuel this kind of an offensive.”
Thus, the “war on drugs” began. The war on drugs was used as a foreign policy tool to allow the US army to intervene in other countries, especially in Latin America and Asia, with the pretext that it is trying to control drug production. But it was also used to advance the state clampdown on the US establishment’s internal enemy, the movements, the Left and racial/ethnic minorities.
As John Ehrlichman, a top adviser to Nixon, blatantly stated
“The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course, we did”.
The war on drugs is calculated to have cost a total of $1 trillion dollars! Just imagine if this kind of money was targeted to social policies towards the poor and the downtrodden. It could better the lives of millions of people!
While the US’s drug policy helped to advance its establishment’s interests internally and outside its borders, it completely failed to address any of its declared goals. Global drug production, trafficking and consumption overall have not declined. Instead, new opioids have set the stage for a new crisis.
The US establishment started abandoning the war on drugs mantra about a decade ago, when the Obama administration began to change the policy doctrine (further down we’ll see what replaced it).
New drugs on the block
Towards the end of the ’80s and the beginning of the ’90s, parts of capital were looking to find ways to “legally” make profit out of opioids. This was difficult given the prevailing policy of the war on drugs which targeted opium and the experience of mass addiction during the morphine and heroin “legal” periods.
In the middle of the ’90s, a new drug for pain, called OxyContin, would change the landscape. OxyContin is an opioid pain reliever prescribed to treat moderate to severe pain. This turn to opioid analgesics was veiled behind a campaign against the so-called “pain crisis”. Perdue Pharma, the producer of OxyContin, targeted doctors with luxury conferences and hand-outs, persuading lots of them to frantically prescribe the new medicine. This in turn created an army of addicted patients. The Shacklers, the family behind OxyContin, acquired huge wealth by creating this new health crisis. With the mass prescription of this new opioid drug, millions of people and whole communities were wrecked.
The meteoric rise of people addicted to OxyContin in turn fed the illegal drug market. People that lose access to the health system or do not fall in the category that can get OxyContin, turn to a black market of either counterfeit OxyContin pills or other opioids, such as heroin, which is cheaper. Much worse, addicts turn to a new synthetic drug called Fentanyl. Fentanyl is a cheap synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. Fentanyl and other synthetic opioids were detected in 73% of all OD deaths in 2021.
This new opioid drive eventually created a backlash for Perdue Pharma, which at some point had 1,600 court cases against it. Some of them revealed internal documents, which the company tried to hide from the public. In a 2001 email, a senior officer wrote
“Abusers [of OxyContin] aren’t victims, they are the victimizers.”
Purdue Pharma in the end filed for bankruptcy, pledging to pay $6 billion, accepting that it will never produce opioid drugs again, in exchange for immunity for the Shacklers. But the Shacklers are one of America’s richest families, and have made more than $10 billion from Purdue Pharma. Not only their huge wealth should have been expropriated but they should also have faced criminal charges and heavy jail sentences!
In any case, the damage done is still here, as millions of people are addicted and hundreds of thousands are dying…
From a failed war to a failed “peace”
To sum up, the war on drugs was a failure on its declared goals, and led to a disaster for working class people. Based on this fact that can no longer be hidden, the establishment has made a new turn in their policy. The war on drugs is now abandoned, and the policy of “harm reduction” is the prevailing policy in the advanced capitalist countries worldwide.
The harm reduction policy means that the declared goal of drug policy is no longer to solve the problem of drugs (by reducing or eliminating drug production and use), but to reduce its most acute manifestations.
This goes hand in hand with the “medicalisation” of the drug problem. Instead of digging into the social roots of the problem of substance addiction, there is a growing trend to consider drug addiction as a “disease”. Addiction is characterised as a “chronic relapsing disorder” by the advocates of this policy. Some go as far as trying to associate addiction with the DNA, i.e. attribute addiction to an individually inherent genetic profile!
While there is no room in this article to analyze this issue in depth, it suffices to say that while addictive substances have been around for centuries, the phenomenon of mass addiction has been the feature of capitalist societies. There certainly are vulnerabilities in addicts’ personalities that can lead them to addiction, and these should be addressed in the process of therapy. However, focusing exclusively on this aspect and leaving out the social factors that lead to the triggering of these vulnerabilities, is like missing the forest for the trees.
The focus of the drug policy is thus directed at the individual, with the view to cushion the most dramatic side effects. It is the concrete manifestation of the “personal responsibility” mantra that capitalist governments have launched as a solution to every problem. Just as in the climate crisis, the establishment wants us to believe that the problem will be solved if we as individuals change our habits – instead of looking at the criminal responsibilities of the big corporations and the state. In this case, the burden falls on the addicts to find a way to deal with “their” problem individually, thus letting the system off the hook.
The practical outcome of this approach is that drug policy accepts substance addiction as an unchangeable reality. Then it adopts measures to treat addiction, such as medicine that reverses overdoses, clean syringes to prevent infection, medication substitutes (such as Methadone and Buprenorphine), etc.
To state the obvious, no sane person would disagree with efforts to reduce the harm done by drug addiction. The problem arises when this is all drug policy intends to do, while not addressing the root causes of the problem. This way, drug addiction will be perpetually reproduced, albeit in a more “controlled” environment. People will continue to become ghost versions of themselves, and continue to die, but the state will present to them a more friendly face. This policy cannot be accepted! The even more infuriating element of this policy, is that its advocates are those responsible for the problem in the first place!
Mass substance addiction as a social problem is clearly related to the need of people to escape reality. All opioid epidemics are connected to the horrors of exploitation, war, alienation, racism etc. To listen to the capitalist establishment representatives who make these horrors happen say that the only thing we can do is to reduce the harm done, can only make us angry! Likewise, no one will say no to providing help to starving children in Africa. But when this “comforting” help is advocated by those who impose hunger through their imperialist exploitation, it is just sheer hypocrisy!
Furthermore, if drug addiction is not a social but a medical problem, a chronic relapsing disease, how can someone explain the huge differences between countries, races and classes? There are several studies , , , , , which document that opioid misuse is connected to social factors such as poverty, unemployment, deindustrialisation, ect.
The harm-reduction / medicalisation policy will be just as failed as the war on drugs one. It is only about saving face for the capitalist establishment and not solving the problem.
Fight against the system that feeds addictions
An indication of this policy turn is the recent (March 1, 2022) press statement on the opioid crisis by the White House. While it’s clear that there is no reversal of plans to engage in crusades in countries of Latin America with the pretext of “fighting drug trafficking”, the statement’s emphasis on “harm-reduction” is obvious. Notably, the only treatment method mentioned is the use of substitutes (Methadone and Buprenorphine), while all other methods of treatment are absent (there is a host of treatment methods, some of which advocate abstinence). In the whole statement, there is no mention of trying to solve the problem of drug addiction at all!
In an article published on January 4, 2022, Nora Volkow, who is the Director of the National Institute on Drug Abuse (a Federal Government institute) goes as far as comparing drug addiction to an “autoimmune disease”!
The article was written to advocate that drug policy’s goal is to “offer them [drug addicts] support to help prevent addiction’s most adverse consequences.” This language is clearly aimed to push public opinion to accept that the problem of drug addiction cannot be solved, but can be managed “better.”
It’s outrageous that policymakers who are responsible for creating the social conditions that lead to drug addiction could not care less about solving the problem. But under capitalism it’s unavoidable. That’s how things work in this system.
Social movements, unions, communities, the Left and addicts themselves, should stand against these policies. While fighting for every real improvement in the lives of addicts and their families and communities, we should also fight to end this system of exploitation and alienation, which sets the stage for mass addiction and (legal or illegal) networks which exploit human vulnerabilities to make profit.
 Some socioeconomic factors such as poverty are correlated with opioid misuse. Nearly 6% of those living in poverty (5.9%, 2.388 million people) misused opioids in 2017, compared with under 5% (4.8%, 2.6 million) among those between the poverty level and twice the poverty level, and just under 4% (3.9%, 6.8 million) among those who are more affluent. Source
 A total of 96,099 homeless and 2,869,230 low-income housed individuals were analyzed. Homeless individuals had significantly higher risk of opioid overdose. Source
 A new study reveals a connection between poverty and opioid-related hospitalization, emergency department visits and deaths in Canada. From 2000 to 2017, Canada’s poorest residents were 3.8 times more likely to die of opioid-related causes than Canada’s richest residents. Source
 For example, Latinx individuals using heroin were only 75% as likely as White Americans to complete a treatment episode (Mennis & Stahler, 2016). Similarly, Black Americans were 69% as likely as White Americans to complete substance use treatment across all types of substances (Mennis & Stahler, 2016). Source
 The Monongahela Valley of Pennsylvania, once a global center of steel production, has suffered a mass exodus of jobs, residents, and businesses since a national manufacturing crisis erupted in the early 1980s; more recently, it has seen a dramatic uptick in accidental drug poisoning deaths. Where recent local and national media attention to overdose has focused on suburban areas and middle class victims, this study concentrates instead on the deteriorating mill city of McKeesport, Pennsylvania. … Tasked with explaining a geographic concentration of overdose in and around McKeesport, interviewees referenced the hopelessness of the area and its lack of opportunity as driving the use of heroin, with many explicitly suggesting the need for jobs and community reinvestment to reduce fatalities. Source