The opioid crisis

Illustration of a skull in front of opioid pills and syringes.
Collage: Freedom Socialist Party. Photos: National Museum of Health and Medicine and The Cincinnati Needle Exchange.
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The current epidemic of opioid addiction and fatalities has been years in the making. With 130 Americans dying daily from opioid overdoses, understanding the causes and finding solutions is urgent.

A pharmaceutical industry high on super-profits and enabled by the government is fundamentally responsible. Their pain pills have led to more pain.

The script is a familiar one. From tobacco to fossil fuels to opioids, markets are manufactured, science is denied, problems are ignored, and working people suffer.

Pain is not a simple physical problem. It is made worse by the social pressures workers constantly experience. Treating it requires both a physical and social diagnosis.

Bogus science creates disaster. What is now called “the opioid crisis” began when Perdue Pharma introduced its blockbuster narcotic OxyContin in 1995. Entirely without scientific evidence, it claimed the drug had negligible addictive potential because of its slow release into the body.

In 1996, the American Pain Society, on Perdue’s payroll, proclaimed that pain was a vital sign, like temperature and blood pressure. This was simply untrue. Yet doctors felt pressured to write more pain prescriptions, at least to whites with excellent health coverage.

In 2001, with OxyContin now bringing in $45 million in annual profit, the Food and Drug Administration approved it for chronic pain, again with no scientific support.

The market for OxyContin grew exponentially. Other legal agents entered, as competing drug companies carved out their niches. Cheaper illicit substances like heroin expanded the street market, and were later cut with super-strong, deadly fentanyl.

The stage was set for true disaster.

A double-edged sword. Opioids very effectively relieve physical pain, greatly benefitting cancer, surgical, and trauma patients. But they also produce euphoria, which relieves emotional pain, a widespread symptom in a society with staggering amounts of stress and depression.

Studies show that work itself is society’s leading cause of stress. Financial difficulties are number two. Between 2014 and 2018, depressive symptoms rose more than 18 percent among U.S. workers, especially affecting the young.

Chronic pain increases risks, because of longer duration of treatment, a bonus for Big Pharma. One federal study found that 15 percent of U.S. workers, even sedentary ones, lived with pain most of the preceding six months. The National Institutes of Health reported that 25 million Americans have chronic pain. That’s an enormous market.

But opioid benefits must be carefully weighed. Being essentially heroin tablets, they carry real dangers of tolerance, addiction, and death.

Physical and emotional pain exacerbate one another. Antidepressants are among the most effective physical pain relievers.

Other safer alternatives, including over-the-counter analgesics and possibly medical marijuana, are often effective even though less potent than opioids. But for-profit opioid corporations are compelled to grow their market. So they push their products indiscriminately.

Both legal and illegal substances cause opioid fatalities. Most illicit opioid users started with the legal ones. Substances bought on the street don’t require a doctor visit or prescription and are relatively cheap.

To someone unemployed or without insurance, this may be the only option.

Race is also a huge factor in who gets treated for pain. Blacks are significantly less likely to receive pain prescriptions than whites, and are more likely to be criminalized for drug use.

What everyone needs is effective pain relief with minimal addictive potential. The industry has no incentive to work for this. Habitual opioid use is too profitable.

Who is dying? A true social phenomenon, patterns of opioid deaths closely parallel the usual U.S. working class fault lines.

Initially described as a white epidemic, African American deaths have recently skyrocketed. The white opioid death rate was double that of Blacks from 2005 to 2013. From 2014 to 2017, the Black death rate rose twice as fast as that of whites.

Economically depressed areas suffer more. The entire Appalachian region has 55 times more drug overdoses than the rest of the country.

Nearly a million veterans live in poverty. They are twice as likely to become homeless. They suffer from inadequately treated mental health problems and high unemployment. So it is no surprise that from 2000 to 2016 there was a 65 percent increase in opioid deaths among veterans. Most of this increase was from heroin and other illicit agents.

Rates are high among Native Americans and growing faster among women.

Now, in a predictable knee-jerk response to the crisis, strict new regulations are frightening many doctors away from prescribing much-needed pain medications.

A working-class solution. Those who caused the problem cannot be trusted to solve it.

Donald Trump’s national emergency scheme uses the crisis as a pretext to promote his anti-immigrant agenda, painting all migrants as drug smugglers.

Healthcare costs and criminalization are huge barriers to treatment for drug abuse or addiction and must be beaten down.

There are safe medicines that block cravings and overdoses. But whites are 35 times more likely than Blacks to receive Suboxone, a pill used to treat opioid addiction.

Counseling also plays a crucial role. For many, opioids must be provided free in a medically supervised, confidential setting. This would reduce rates of AIDS and Hepatitis C infection.

A dedicated payment account to meet the costs of the care must be set up and entirely funded by Big Pharma. The industry needs to be de-privatized and run by workers’ organizations committed to healthcare as a human right.

Healthcare must provide good care for chronic pain conditions, which may require extended physical therapy, home assistance, and other non-opioid treatments.

Crucially, we need to address the complex social variables which are part of the problem. This means comprehensive, socialized healthcare and a massive program to create well-paid jobs with fully funded retirement for all.

Recognizing that pain is both physical and emotional, Marx famously said that “religion is the opium of the masses,” who suffer in “a heartless world.”

Big Pharma tried to make opioids the religion of the masses, helping create our heartless world in its own heartless image.

Working people deserve better. Ultimately, the pain that is capitalism must end.

Send feedback to Dr. Steven Strauss at

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