Unveiling the Origin of the Endless Drug Crisis
There is a popular meme that captures the prevailing sentiment of things worsening over time. It features a chart with President Ronald Reagan’s smiling face on the x-axis, showing a steep increase in various indicators post his inauguration. These include healthcare spending, executive pay, government size, privatization of services, social isolation, and economic inequality. Shockingly, only half of the babies born in 1980 are projected to earn as much as their parents did.
In a surprising move, the Sackler family, owners of Purdue Pharma, attempted to shift blame away from OxyContin for the opioid epidemic. Using a Reagan-like chart in a 2021 PR campaign called “Judge For Yourselves,” they aimed to counter the negative press. However, the grim reality revealed by infectious disease modelers, Hawre Jalal and Donald S. Burke, paints a different picture. Drug overdose deaths have been steadily climbing at a rate of 7% each year since 1979, with over a million fatalities recorded since 1999.
Despite the continuous rise in drug-related deaths, the issue is often viewed as isolated epidemics rather than a sustained crisis. From heroin addiction among G.I.s in Vietnam to the crack cocaine and methamphetamine outbreaks, each wave of substance abuse has been seen as a distinct problem. OxyContin’s introduction in 1996 marked the onset of what is now known as the opioid epidemic, a crisis that shows no signs of abating.
The Sackler family sought to distance themselves from blame by pointing to the longstanding trend of drug-related deaths predating OxyContin’s release. However, the exponential increase in fatalities over the years paints a grim reality that transcends individual culprits. Drug mortality in America is a complex issue with a history that stretches far beyond one company’s actions.
The profit-driven medical system involving pharmaceutical manufacturers, drug distributors, insurance companies, doctors, and pharmacies has only served to escalate an already out-of-control situation. With unchecked corporate power and regulators neglecting their duties, drug markets have evolved into more hazardous and lethal environments. Despite decades of intense enforcement efforts, drug-related problems have become more widespread and deadly.
The discovery by Jalal and Burke poses a perplexing question: how have various drug epidemics over the past forty years coalesced into a massive wave of fatalities? This alarming trend continues to gain momentum, prompting concerns about when it will peak. Rather than being a series of isolated drug crises, the situation appears to be a chronic societal issue exacerbated by market forces. Underlying sociological and economic factors are likely at play.
According to Peter Reuter, a seasoned drug policy researcher, attempting to attribute these issues to specific eras is challenging. For example, the cocaine trade expansion in Latin America during the 1970s coincided with the rising demand for the drug in the US. However, it is perplexing to witness this trend persisting for such a lengthy period. Historian David Herzberg suggests that drug markets are following the same patterns as other consumer markets since the neoliberal era, where corporate interests have been given free rein. This deregulation has enabled corporations to exploit opportunities, such as the case of Purdue Pharma with OxyContin.
Throughout this era, illicit drug markets have adopted strategies akin to legal markets, including advanced supply chains, efficient manufacturing processes, and technological advancements. Simultaneously, the societal fragmentation caused by consumerism has left millions of Americans feeling disconnected and struggling to cope.
Contrary to common beliefs, drug addiction is not the root cause of poverty but rather a significant consequence of it. Researchers observing the impact of drug issues in urban areas like New York and Philadelphia have identified a cycle of neglect and violence perpetuated by governmental failures and social decay. This environment of “unlivable lives” has pushed individuals towards substance use as a coping mechanism, particularly in marginalized communities.
The opioid crisis, in particular, has disproportionately affected Black and Indigenous populations, highlighting the systemic inequalities embedded in American society. Overdose deaths often occur in the most vulnerable and neglected segments of the population, reflecting a broader societal failure to address the root causes of addiction and drug-related problems.
I endure the impact of concentrated poverty, recurring state violence, and generational inequality. The ongoing increase in drug-related deaths has failed to prompt any significant changes in the United States’ stagnant drug policies; the current crisis is largely seen as a separate epidemic, detached from its historical context. Instead of exploring the root causes of persistent substance abuse, the prevailing narrative—promoted by the Centers for Disease Control and Prevention and echoed by politicians and business leaders—focuses on individual drugs as sole culprits, while framing addiction as a matter of individual biology. The public is led to believe that conventional epidemic responses will suffice for addressing drug addiction: isolate, quarantine, and treat those affected. This typically results in criminalization, imprisonment, mandatory treatment, or unconventional measures such as the Department of Defense’s quest for a fentanyl “vaccine.” The continuous declaration of new drug epidemics perpetuates a narrow emergency mindset, leading to dramatic disaster responses to each drug “outbreak.” This not only hinders the implementation of effective solutions but also obstructs a deeper understanding of the role of drugs in American society. The exponential trend highlighted by Jalal and Burke reveals the accumulation of our lengthy, gradual, and tumultuous history.
Linguistic Misinterpretations
When faced with a significant, complex issue, Americans often resort to the metaphor of an epidemic. Mass shootings, gun violence, suicide, and loneliness are all deemed epidemics. With guns, drugs, despair, and actual illnesses in the mix, America appears inundated by epidemics. Susan Sontag famously argued in “Illness as Metaphor,” “Any disease that is treated as a mystery and acutely enough feared will be felt to be morally, if not literally, contagious.” Despite neuroscience shedding light on addiction’s neurological mechanisms, the metaphorical implications persist: drugs “hijack” the brain, leading to a “disease of free will” that seemingly strips individuals of agency. The sense of losing control over one’s desires is intertwined with the belief that those grappling with addiction are morally feeble and spiritually unwell.
Anxiety surrounding drugs has dominated public discussions for as long as Americans have used them, to the extent that the New York City health commissioner called substance use “decidedly an American affliction” as far back as 1919. However, relying on this kind of language comes at a cost. Unlike viruses, which spread naturally from person to person, drug use and addiction require a different rationale. Opioids, in particular, have a much lengthier history in the U.S. than commonly acknowledged. Herzberg’s “White Market Drugs” points out that perceiving the opioid crisis as entirely new and unique necessitates a deliberate act of forgetting. Media outlets frequently rediscover the realities of opioid use among white individuals, women, and well-off suburban and rural populations. This was particularly evident during the initial wave of overdose cases linked to pharmaceutical opioids, when the media sensationalized the idea that opioid
The problem that expanded and developed into the current “largest drug epidemic” today was not a new issue for the United States. The earliest documented “opioid epidemic” in the country traces back to the nineteenth century, a time of rapid industrialization that brought about a surge in consumer goods. As author Herzberg highlights, derivatives of the opium poppy and coca plant became prevalent among these consumer goods, leading to a tripling in opioid use from 1870 to the mid-1890s. Consumers faced a confusing array of potentially harmful products, including tonics and elixirs containing stimulants like cocaine and opioids like heroin, all marketed as remedies for common illnesses and conditions. The prevalence of these drugs in a swiftly industrializing America prompted initial efforts to regulate and limit their usage.
In his book “Quick Fixes: Drugs in America from Prohibition to the 21st Century Binge,” Benjamin Fong emphasizes that drug issues are not just about the drugs themselves, but also about controlling other aspects of society. The earliest regulations on drugs were often driven by racial fears. The first known US drug law, targeting opium dens in San Francisco in 1875, was more a response to baseless concerns about young white individuals frequenting “Chinese” opium establishments, rather than the drug’s effects. Historian David F. Musto’s work, “The American Disease,” delves into the historical regulation of cocaine starting in 1914, largely instigated by Southern white communities’ anxieties over alleged superhuman strength exhibited by “cocainized blacks.” The trend of drug legislation disproportionately affecting racial minorities persisted into the 1930s with the countrywide prohibition of marijuana, accompanied by propaganda depicting violent acts committed by Mexicans under the drug’s influence.
Despite these regulatory measures, drug usage continued, alongside the exploitation of fears surrounding drugs for political purposes. President Richard Nixon’s Operation Intercept in 1969 exemplified this, as two thousand customs agents were dispatched to enforce a zero-tolerance inspection policy on vehicles entering from Mexico to disrupt drug trafficking. While the operation faced practical challenges and yielded minimal drug seizures, it forced Mexico to agree to an anti-drug trafficking pact named Operation Cooperation. The impact of these operations on drug supply remains ambiguous, with reports of potential shifts in smuggling routes and sources. Nevertheless, Nixon aide G. Gordon Liddy deemed Operation Intercept successful in his memoir, portraying it as a form of international pressure.
The text describes the historical and current impact of drug policy in the United States, highlighting manipulative tactics and the escalation of enforcement measures. It also discusses the challenges posed by the rise of illicitly manufactured fentanyl, leading to intensified efforts in combating its spread. The unique characteristics of fentanyl, such as its potency and synthetic nature, present significant hurdles in detection and control. The text raises concerns about the scale and complexity of the fentanyl problem, emphasizing the need for innovative approaches to address this evolving crisis.
At present, India and China are major producers of America’s generic drugs, highlighting the rapid growth of the global market. This emphasizes the ineffectiveness of traditional enforcement tactics on the supply side and health interventions on the demand side. The U.S. policy response appears inadequate and ill-suited for addressing the current drug crisis. Despite significant investments to combat the fentanyl epidemic, authorities’ efforts, such as handshake agreements with foreign leaders and high-profile drug seizures, have failed to curb the rising overdose rates. For instance, California’s 2023 anti-drug plan allocated over $1 billion, including funds for overdose prevention and enforcement, yet overdose deaths continued to rise significantly. Seizure methods have not effectively contained the drug’s spread. A grieving father in Oklahoma questions the value of supply interdiction efforts, suggesting that the focus should be on preventing deaths rather than disrupting commerce. The symbiotic relationship between legal and illegal markets poses a challenge to disrupting the fentanyl trade without hindering legitimate trade between the U.S. and Mexico. Most fentanyl seizures occur at legal entry points, and U.S. citizens are the primary traffickers. The flow of illicit drugs mirrors that of consumer goods, demonstrating the complexity of the issue. In 2022, disease modelers projected a high number of drug overdose deaths in the coming years, highlighting the urgent need for a new approach to drug policy. The escalating drug mortality rates underscore the failure of current strategies and the necessity for innovative solutions to address this ongoing crisis.
The emergence of fentanyl has shifted the focus on drug policy towards a more punitive approach, reversing progressive efforts for decriminalization and emphasizing public health, harm reduction, and treatment. Reaction against these efforts has been swift, with measures like drug testing for welfare recipients and the end of decriminalization in Oregon. As social approaches retreat, the idea of full legalization seems out of touch with reality. But is complete legalization the answer? When considering the hazards of legal substances like alcohol and tobacco, which cause hundreds of thousands of deaths annually, the argument for full drug legalization becomes less clear. Alcohol and tobacco, despite being regulated, pose significant health risks and contribute to societal harm. The current trend of increased alcohol consumption during the pandemic raises concerns about the potential consequences of drug legalization. While some advocate for regulating all psychoactive drugs to minimize the impacts of black markets, the profit-driven nature of legalization raises questions about its effectiveness in addressing substance abuse issues. The proliferation of addictive products and the commercialization of marijuana and other substances suggest that the current approach to drug policy may not be sufficient to address the underlying causes of drug abuse. A more comprehensive paradigm that acknowledges the root causes of substance abuse and prioritizes prevention and treatment is needed to address the rising number of overdose deaths effectively.
It is crucial to be attuned to the ever-changing market dynamics and the resulting social dysfunction. A consumer-protection model should focus on addressing the root causes of suffering without resorting to criminalization. It must also tackle the underlying anxiety and despair that drive individuals towards compulsive, chaotic, and risky substance use. The objective should be to move beyond the extremes of brute force prohibition and profit-driven free-for-all drug markets.
How can we envision a world where people do not feel compelled to turn to drugs as a coping mechanism? And in cases where drug use does occur, whether for relief, enhancement, or recreational purposes, how do we ensure that the consequences are not addiction, imprisonment, or death? The Purdue lawyers believed that the Jalal and Burke chart could exonerate the Sackler family, yet it ended up highlighting their exploitative actions and exposing the flaws in the economic, political, and social systems that have evolved since 1979.
Contrary to popular belief, we are not merely facing an opioid epidemic that began in 1999 or a fentanyl crisis that emerged in 2014. There is a deeper, inherent issue at play. The strategy of addressing each wave of drug use as a separate, short-term crisis has proven ineffective over the past four and a half decades. As long as we persist in misidentifying the core problem, our efforts will continue to fall short.
This article was a collaborative effort between the Economic Hardship Reporting Project and The Baffler and was reviewed and distributed by Stacker.
