Monday, May 29

The Opioid Epidemic in America – Killing One Million Workers: The Triumph of Capital



The link between capitalism and drugs reaches back to the middle  of the 19th century, when the British Empire forced their surplus opium  crop from their South Asian colonies into the Chinese market creating  massive demand from millions of addicts. The Chinese government, which  had banned the use and sale of opium, was alarmed at the growing social  chaos created by mass addiction and went to war with the Western powers  to halt the flood of drugs. Their defeat at the hands of the British and  their Chinese drug lord allies opened China to massive exploitation and  pillage for the next century. Chinese opium addicts were a tremendous  obstacle to organizing national resistance. In essence, the British East  India Company and its imperial protectors transformed China into the  history’s largest ‘shithole’ – until an earth-shattering revolution  broke the chains of addiction and degradation.

In the 21st century, a similar process of deterioration has been occurring internally in the United States. The  ‘prescription opioid epidemic’ is ravaging American families,  neighborhoods, communities, cities and states – shredding the entire  fabric of US society, especially in rural, mining and former  manufacturing ‘rust belt’ regions. Hundreds of thousands of mostly  working class victims have died and millions of addicts, unable to  resist the destruction of their futures, have replaced a once powerful  labor force.

Official government studies estimate almost 700,000 deaths since 1999,  based on the scattered and incomplete coroner reports and death  certificates that characterize the state of vital statistics in the US.  There is no uniformity in data collection and no interest in developing a  uniform national system on which to formulate social policies. Most  likely additional hundreds of thousands of drug deaths have gone  un-recorded or attributed to ‘pre-existing’ medical conditions, suicides  and accidents – despite clear evidence of over-prescription of  narcotics and sedatives in the victims.

The US opioid epidemic accounts in large part for the ‘declining  numbers of workforce participants among prime age workers’ according to  Senate testimony by Federal Reserve Chairwoman Janet Yellen,  an Obama appointee. An estimated 15% of US construction workers suffer  from substance abuse. The escalating costs of ‘Suboxone’ and other forms  of narcotic addiction treatment threaten to bankrupt the health plans  of several building unions. Shortages of qualified American skilled  building trade workers further allow employers to push for more  immigrant labor to fill the gap.

For over 2 decades the escalating numbers of opioid overdose deaths  were ignored by both political parties, as well as by writers and  academics of the left and right. Doctors and hospital administrators  were either actively complicit or in denial. But more important the  Federal Drug Administration (FDA) continued to approve manufacture,  marketing and prescribing of highly addictive narcotics and sedatives to  tens of millions of American patients earning the pharmaceutical  industry scores of billions in profits despite the devastation. Between  1999-2014 pharmaceutical manufacturers were earning $10 billion dollars  each year in profits from the sale and distribution of opiates.

In the following section, we will discuss the larger picture,  including the powerful socio-economic and political forces that have  profited from the addiction and killing of millions of Americans – past  and present. This deliberate policy, with strong neo-Malthusian  overtones, has decimated a sector of the US working class, rendered  ‘surplus’ or redundant by political-economic decisions of the American  ruling elite. In its wake, the prescription addiction crisis has turned  large swathes of the former manufacturing and mining sectors of the US  into what the current President Donald Trump would characterize as domestic ‘shitholes’ and populated by what his rival, Hillary Clinton,  callously derided as ‘deplorables’. In terms of rapid loss of life and  social stability, this population devastation mirrors the patterns seen  in countries subjected to US/EU neo-liberal economic dictates or to  US/EU imperial invasions.

The Addiction Power Elite

Today there is a public frenzy among government officials clamoring  for hearings and legislation to address the opioid addiction crisis –  with the usual solutions of more imprisonment, expensive private  addiction treatment centers, volunteer ‘support groups’, self-help  courses and educational ‘Just Say No’ campaigns. No policy maker has  dared suggest educating the victims about the socio-economic trends and  elite decisions that devastated their lives and communities and sent  them onto the death spiral of addiction.

Former FDA Administrator David Kessler

Recently a few leftist journalists have attacked the pharmaceutical  industry, while others have cited the lack of oversight from the  US-Federal Drug Administration, asking for a few tepid reforms. The  former FDA Administrator David Kessler, who served  under the Clinton Regime from 1990 to 1997, belatedly condemned his  agency’s negligence over the mass destruction caused by unregulated  prescription of powerful narcotics, which he admitted after 10 years of  silence was ‘one of the biggest mistakes in the history of modern  medicine’, (editorial NYT May 6, 2016).

While hundreds of thousands of Americans have been killed by opioids  and hundreds more are dying every day (at least 65,000 in 2016), the US  Left and the Democratic Party focus on narrow gender identity issues and  cartoonish hearings over ‘Russiagate’ – Moscow ’s alleged plot to seize  control of the US Presidential election. While touting her experience  in health care reform, Candidate Hillary Clinton deliberately ignored  the opioid addiction crisis during her campaign except to characterize  its largely white lower class victims as ‘deplorables’ – ignorant  racists and buffoons – whom she implied deserved their misery and  shortened lives.

The ‘drug epidemic’ in the US is all about the current structure of  power and social relations in an increasingly oligarchic state amidst  growing class inequalities and immiseration. At its roots, American  capitalism in the 21st Century has degraded, impoverished and exploited  US workers and employees with increasing intensity over the past two  decades. Workers have lost almost all collective influence in the  workplace and in politics. Working conditions and safety have  deteriorated – while capitalists hire and fire at will. Salaries,  pensions, health care and death benefits have been slashed or  disappeared.

The deterioration of working conditions is accompanied by a marked  decline in social conditions: family, neighborhood and community life  has been torn asunder. Anxiety and insecurity are rampant among workers  and employees. In real terms, life expectancy in the affected areas has  dropped. Youth and worker suicides are skyrocketing. Maternal and child  mortality are up. American youth are 70% more likely to die before  adulthood than their counterparts in other rich countries. In 2016,  death rates for millennials (ages 25-34) rose to 129/100,000, with  35/100,000 deaths due to narcotic overdose. The carnage surpasses the  height of the US AIDS epidemic in the 1980’s. Rural and small town child  protective services are well beyond the breaking point with the  neglected and orphaned children of addicts. Neonatal intensive care  units are overwhelmed by the number of infants born into life  threatening acute opiate withdrawal crises due to their mothers’  addiction. Despite this grim picture, taxes for the rich are being  slashed and public services decimated.

Meanwhile, the income gap between the working class and the oligarchs  has widened and a sharp class-defined health care and educational  apartheid has emerged. Children of the upper 20% have exclusive,  privileged access to elite universities based on family and ethnic ties.  Elite families, who have no need for ‘health insurance’ have access to  the most thorough and advanced medical services in the world. No  physician would dream of irresponsibly prescribing narcotics to a family  member of an oligarch.

These inequalities are deeply entrenched: Working people in the areas  affected by the opioid epidemic receive only cursory and inadequate, if  not incompetent, care from physician assistants and over-burdened  nurses. They are subjected to long waits in deteriorating emergency  rooms and rarely see a physician. Virtually none have regular family  physicians. If they are injured or suffer from pain, they are prescribed  long courses and large amounts of narcotic pain killers – opioids,  instead of the safer, but more expensive physical therapy and  non-addictive medications. This has occurred with the approval of the  FDA. Even rural high school students with sports injuries would receive  narcotics, despite the well-known increased susceptibility to addiction  among youth. Politically powerful ‘pain lobbies’, funded by the giant  pharmaceutical corporation, have pushed this trend for over two decades  creating huge profits for the billionaire pharmaceutical executives.

The opioid killing fields of America have their origins and logic in  the convergence of several inter-related features of US capitalism. This  was due to the relentless pursuit of profits for the corporations and  elite, while turning the deindustrialized and agricultural parts of the  country into domestic ‘Third Worlds’.

First, the capitalist class cut the production costs by limiting  access to quality health care for labor to increase their profits. In  the US this has led to millions of workers depending on cheap and  available prescription narcotics. Employer-provided insurance companies  routinely deny more costly non-narcotic treatment for injured workers  and insist on prescribing cheap opioids to get the workers back on the  job. Cheap opioids were tolerated by union health plans in the beginning  to save money, while union bosses looked the other way as thousands of  workers became addicts.

Secondly, capitalists freely fire workers who are injured at work and  seek treatment, forcing workers to avoid sick leave and to rely even  more on opioids, like Oxy-Contin, which ‘Big Pharma’ falsely marketed as  non-addictive.

Thirdly, capitalists profit immensely from the premature deaths by  overdose and related preventable causes among older workers because this  lowers pension costs and health insurance payments. Wall Street has  brazenly celebrated the billions of dollars of pension and health care  liabilities saved by the shortened life expectancy among US workers. The  drop in life expectancy and rise in premature death in the US resembles  the pattern seen in Russia during the first decades after the  dissolution of the Soviet Union and the rampant pillage by the US-backed  mafia oligarchs under Boris Yeltsin.

Fourthly, capitalists are free to hire young replacement workers  (eighteen to thirty years old) as temporary labor at lower wages and  without any benefits. They are subject to the insecurities of contingent  employment, as part of the ‘gig economy’ (outsourcing to  ‘self-employed’ workers and employees). These overstressed workers, with  no future, turn to opioids to overcome physical pain and emotional  stress – until they drop out as slaves to addiction. This is the main  reason for the declining numbers of young workers available in the US –  despite relatively high employment levels.

Fifthly, and to add a morbid insult to injury, the opioid death  epidemic has been a bonanza for the tissue and organ transplant  industry, where ‘materials’ harvested from young overdose victims,  including bones, skin, cornea, tendons, heart valves, teeth and blood  vessels are worth tens of thousands of dollars per corpse. Organs  harvested from brain-dead overdose victims are valued in the hundreds of  thousands of dollars. And harvest companies and tissue brokers hover  around hospital emergency rooms like carrion birds waiting for news of  new victims – often contacting next of kin before the authorities. This  bizarre profiting from the completely preventable domestic deaths of US  capitalism recalls Jonathan Swift’s satiric ‘Modest Proposal’ for  British entrepreneurs to harvest the skin of the Irish Potato Famine  victims to make commercial items, like ladies’ purses!

In sum, the structure and relations of contemporary US capitalism is  the general cause and beneficiary of the opioid epidemic. The inevitable  result is a rapid destruction of communities marginalized by capitalist  decisions. This has benefited capital by culling the surplus, and  potentially restive, population in a manner reminiscent of the British  Empire during the famines in India in the previous two centuries. Social  Darwinism and Neo-Malthusian rationales proliferate among the  oligarchs, politicians, medical professionals and even seep into the  language used by the public (‘survival of the fittest’) providing the  ideological justification for the carnage.

Specific Operative Power Elites Driving the Epidemic

Multi-billion dollar pharmaceutical corporations manufacture and  market narcotics and highly addictive sedatives. Their agents manipulate  the medical community and lobby among the politicians for a ‘pain-free’  America.

Image result for Sacklers

The producer of the leading commercial ‘gateway’ into addiction,  Oxy-Contin, is Purdue Pharmaceuticals. The company was founded and run  entirely by the Sackler family under the leadership of the recently  deceased Raymond Sackler and his brothers.  They started by  manufacturing laxatives and ear wax, then introducing the highly  addictive tranquilizer, Valium, to finally producing and pushing the  most profitable prescription drug in history, Oxy-Contin in the 1990’s,  during President Bill Clinton’s ‘health care reform’ administration.

The Sacklers set up an aggressive large-scale sales force to convince  physicians that their product was not addictive. They paid  physician-researchers to publish fraudulent data on the safety of  Oxy-Contin. These experts-for- hire in the burgeoning pain industry  received huge fees to peddle Sackler’s products. They peddled the notion  of American patients enjoying a completely ‘pain free’ existence –  touting the value of the highly subjective ‘pain scale’ as the fifth  vital sign in the assessment of all patients. The ‘pain scale’ never  caught on in other wealthy countries, where objective assessment  remained the primary basis for diagnosis and therapy. Interestingly, the  ‘pain scale’ has been less frequently used with African American and  Hispanic patients, due largely to an inherent racism in US medicine that  views minorities as potential addicts and unreliable with prescribed  narcotics. As a result, African American and Hispanic patients were  largely spared the prescription narcotic addiction epidemic – where over  95% of overdose deaths were white, mostly working class. It was also  evident that African American patients presenting to emergency rooms in  severe pain receive far less care than their white compatriots – even  when their pain is a symptom of a serious life-threatening medical or  surgical emergency.

The Sackler family’s net worth rose to over $14 billion dollars,  according the Forbes billionaires listing, while Purdue Pharmaceuticals  reaped over $35 billion dollars in profit from Oxy-Contin.

Meanwhile scores of thousands of prescription addicts died each year  and millions sunk into addiction, ill health and degradation, dragging  their communities with them.

Following Sackler’s example, other pharma billionaires joined in.  Opioid pain medication was so cheap to produce and had created its own  ever-expanding demand as teenagers raided grandmother’s medicine cabinet  in search of narcotics and poor workers lined up at ‘pill mills’.  Oxy-Contin and its siblings produced the highest profit margin in  pharmaceutical history – far exceeding the so-called block-buster drugs.

Image result for Oxy-Contin

The totally preventable and predictable devastation eventually led to  Purdue Pharmaceuticals being fined $634.5 million dollars in 2007 for  fraudulently covering up the addiction and overdose potential of  Oxy-Contin. The political influence of the Sackler family protected  their members from any accusation of misconduct or criminal conspiracy.  Their influence in elite political and judicial circles was  unparalleled.

Oxy-Contin and other addictive drugs are still being mass produced,  massively prescribed and are contributing to the death of over 65,000  workers each year. In response to the recent crack-down on prescriptions  of narcotics, millions of addicts have transitioned to cheap street  heroin and the dangerously potent illegal fentanyl to feed their  craving. Physicians provided the gateway to a life of street addiction,  violence and eventually death – while authorities throughout the United  States deliberately looked away.

The second operative power elite are the medical professionals who  prescribed the drugs in an irresponsible and callous manner to millions  of American over the past 2-3 decades. They too have been largely spared  by the political and judicial system and even remain the ‘pillars’ of  local communities ravaged by drug addiction.

For two thousand years, a guiding moral and professional principle in  medicine had been to ‘first do no harm’ in the course of treating a  patient. There has been a huge difference in the way working class and  elite patients are treated in the US . Thousands of physicians and other  medical professionals ignored the obvious addiction and deaths among  their lower and middle class patients and succumbed to bribes and greed  to promote opioids. Millions of patients and their family members have  been betrayed by this grotesque failure to address the addiction crisis.  The economic changes in medicine pressured many doctors in corporate  medicine to rush patients in and out of their offices with only cursory  examinations and prescriptions for multiple narcotics and sedatives.  Physicians allowed the for-profit goals of their corporate employers to  dictate how they served their patients – thereby betraying the sacred  trust. Many physicians relied on poorly supervised and over-worked  physician assistants and nurse practitioners to diagnose and treat  patients – already addicted to narcotics. It is easier and cheaper to  write a prescription than to thoroughly examine and properly treat a low  income patient. All accepted the corporate and capitalist ideology that  the addicts were the regrettable victims of their own inherent moral or  genetic degeneracy.

The chain of causation went from systemic capitalist profiteering to  billionaire pharmaceutical corporations to hospital enterprises to  doctors and their poorly supervised staff.

The principal political accomplice of death by addiction is the  federal government and elected representatives who accepted scores of  millions of dollars in ‘donations’ from the pharmaceutical lobby.

The President and Congress, Democrats and Republicans ignored the  epidemic because they were bought off by their campaign donor-owners at  ‘Big Pharma’, the term used to describe the powerful pharmaceutical  industry and its lobby. Over the past twenty years, the political elite  received many millions of dollars in campaign funds from Big Pharma  lobbies – including politicians from states ravaged by prescription  narcotics.

The Federal Drug Enforcement Agency (DEA) allowed the overuse and  distribution of narcotics and then ignored the terrible consequences for  over 20 years. One cannot imagine US veterinarians and their regulators  noting the drug deaths of 3,000 family pets without quickly identifying  and correcting the situation, while the FDA, DEA and US elite ‘ignored’  the deaths of hundreds of thousands of poor and working class  Americans.

Finally, after two decades, local politicians and state attorneys  general saw a new potential source of revenue with lawsuits against the  offending drug companies and major distributors. Some senators have  sponsored hearings but no decisive action has been taken over the  carnage among the poor civilian population. In 2010, the Pentagon and  Senate Armed Services committee held hearings on the huge increase in  prescription drug abuse overdose deaths among US military personnel and  have taken some effective measures to address the issue. At that time,  US senators in the hearings warned jokingly about the perils of  upsetting ‘Big Pharma’. Clearly, unlike the generals who need healthy  soldiers, US capitalist and politicians have had no interest in  protecting working class citizens – given the overall profits their  addiction and deaths bring to the elite.

Conclusion: What is to be Done?

The prescription narcotic and subsequent illegal narcotic addiction  epidemic has become a million-person killing field – sowing havoc in the  poor and marginalized, de-industrialized working class communities of  the US. However the victims and their executioners, all have a name and  location within the capitalist system. The logic and the consequences  are clear.

Most victims are working class, poor and lower middle class, and  overwhelmingly white: the low paid, young and old, the insecure and  under employed, and especially those without adequate or competent  health care.

Over 5 million are afflicted by prescription drug abuse or at least  started on the road to addiction via prescription narcotics. This is a  truly American Holocaust leaving multi-million family survivors. Scores  of thousands of children are living with elderly relatives or swept up  into foster homes and the over-burdened child welfare system.

The executioners and their accomplices have become rich, elite  college-educated patrons of the most sophisticated arts and sciences.  They receive the best health care services in the world; rely on docile  but highly educated servants, nannies and cooks – many of whom are  immigrant. Most of all, they enjoy immunity from public censor and  prosecution. They are the politically well connected, perfectly dressed,  manicured, be-knighted dealers of death and despair.

The addiction crisis is a part of the class war waged by the upper  class against the middle and lower classes of this country. The real, if  not stated, consequence of their trade has been to cull the population  rendered superfluous by elite economic and political decisions and to  destroy the capacity of millions of their victims, family members,  neighbors and friends to understand, organize, unify and fight back  against the onslaught for their own class interests. Here is where we  find a basis to approach a solution.

There are historical precedents for the successful elimination of  drug lords, both elite and criminal and for bringing addicts back to  productive social life.

We begin with the case of China : After a century of British-imposed  opium addiction, the Chinese revolution of 1949 took charge in  arresting, prosecuting and executing the war-lord opium “entrepreneurs”.  Millions of addicts were rehabilitated and returned to their  communities, joining the workforce to build a new society.

Likewise, the 1959 Cuban revolution smashed the drug dens and  brothels run by brutal Cuban gangster oligarchs and death squad-leaders,  together with American mafia bosses, like Meyer Lansky. These thugs and parasites were forced to flee to Miami, Palermo and Tel Aviv.

The first step in an effective class-conscious drug war in the US  would require the organization of mass movements, dedicated anti-drug  lawyers, physicians, medical personnel and community organizers, as well  as brave well-integrated educators and community leaders. A truly  involved national Center for Disease Control, not a mouthpiece for the  corporate elite, would be re-organized to collect quality national data  on the scope and nature of the problem and provide further bases for  reversing the trends of decreased life expectancy, increase child and  maternal mortality and epidemic preventable-premature deaths among  workers.

The second step would involve taking control of the prescription of  narcotics limited to the narrow indications recognized in other  industrialized countries (intractable cancer pain or short term  post-operative pain management) and developing a national data base to  track the prescription practice of physicians, nurse practitioners,  physician assistants and others. Those unwilling to reform their  practice would face arrest and severe prosecution. Heath care would be  patient centered, not profit oriented and the dictum ‘Primum non nocere’  would replace callous Social-Darwinism and greed in medical practice.

The manufacturers and distributors, as well as the lobbyists and  merchants of deadly opioids, would be forced to pay for the devastation  and face prosecution.

The process of restoring viability to drug-ravaged domestic  ‘shit-holes’ created by the US capitalist elite finally would require  attacking and transforming the economic roots of the addiction crisis.  It would require replacing a system that sows pain and suffering among  the workers with one where the workers and their communities finally  take control of their lives. Professionals and intellectuals, rather  than viewing the victims from the point of view of the elite  decision-makers, will have to fully integrate their interests with those  of the masses.

Successful local struggles can build the political power base that  transforms ‘studies’ and ‘critiques’ to direct action and electoral  changes.

Outlawing this revolting source of profit and scourge of thousands of  communities can weaken the power of the billionaire drug dealers and  their political allies.

Millions of lives are at stake, they have their survival to win.  Understanding the root of this class centered affliction and mobilizing  to reverse this trend can have major consequences benefiting the widely  dispersed imperial and capital induced shit-holes of the world!

The original source of this article is Global Research Copyright © Prof. James Petras and Robin Eastman-Abaya, Global Research, 2018

Leave a Reply

Your email address will not be published. Required fields are marked *