Opioids for the Masses — Is Big Pharma America’s Biggest Drug Dealer?

In a critique of Hegel, Karl Marx famously stated: “Religion is the sigh of the oppressed creature, the heart of a heartless world, and the soul of soulless conditions. It is the opium of the people.” While America, in recent years, has faced a disturbing blurring of the line between church and state, paired with increasingly drastic levels of economic inequality, we need not look to abstract ideologies and evangelical movements to see how the suffering cries and the growing cadre of have-nots are quelled. The United States currently faces an increasingly publicized epidemic of physical addiction to, and overdose deaths from, literal opiates in the form of legally prescribed pain medications and street drugs like heroin that are being laced with the deadly and potent fentanyl.    Heroin has been a presence in America for decades but failed to capture mainstream media attention because the populations affected were largely poor and people of color. The current epidemic, however, has been stoked by a large influx of legal prescription opioids. Driven by the imperative of profit that is central to a capitalist economy, pharmaceutical manufacturers have pushed narcotic painkillers on to doctors who, in turn, are prescribing them to patients at alarming rates.   In Hawai‘i, for example, it is estimated that half a million prescriptions were filled last year for oxycodone and hydrocodone alone (and this is in a state whose total population is only 1.4 million). Further, one expert noted that there were enough prescription opioid pills distributed in Hawai‘i last year for every person to have 700 annually. On the other side of the country, West Virginia made national headlines when it was reported that 20.8 million prescription opioid pills were shipped to two pharmacies in a town with a total population of 2,900. Overprescription of narcotics is occurring all over the United States, and many who become physically dependent are forced to resort to illicit sources of heroin when legal pills run out.

In an effort to maximize profits, dealers of illicit drugs are cutting their product with fentanyl, an opiate that is 50 times more potent than heroin. This is causing sharp spikes in overdose deaths.

And, as the epidemic works its way up the socioeconomic ladder, is resulting in more concern from the mainstream media. The reality being that thousands are falling off that ladder entirely.Working with people that are chronically homeless and using injection drugs, one hears over and over stories of middle and working class folks who were innocently prescribed powerful opiates for pain without a clear indication of the addictive risk. Those who engage in physical labor, who are already exploited economically through low wages in relation to value produced, are especially prone to this pattern having been given painkillers after being injured on the job.   Homeless veterans have reported that it is often easier to obtain a prescription for opioids than it is to receive appropriate mental health care, so the rational choice is to get so high that one can block the symptoms of PTSD caused by wars that were arguably fought only to secure the profits of arms manufacturers, oil companies, and privatized security forces. While many point to our current opioid epidemic as evidence of a broken system, it should be made clear that the country is functioning exactly as the ruling class intends.

I contend that this epidemic is not dysfunctional, but rather serving the interests of capital control in the US.

A population that is literally doped up to the point of physical dependence cannot organize politically against growing inequality where power is concentrated in the hands of a few.Ex-coal miners and construction workers who became addicted after workplace injuries must fix daily, or risk flu-like withdrawal symptoms. Physical dependence creates a melancholic acceptance of the structural violence that shapes the lives of poor and homeless addicts. The moralization and stigma surrounding injection drug use often challenges programs like syringe exchanges and Narcan distribution projects that are actively working to save lives and reduce the incidence of infectious diseases like HIV and Hepatitis C. Poor and homeless people that use injection drugs often find that treatment resources are severely limited, or that they lose eligibility for homeless programs if they take up temporary residence at an inpatient rehabilitation facility.Data on wealth inequality demonstrates that a few number of Americans control an increasingly large share of the wealth in this country. The people on whose backs that wealth was created are faced with social structures designed to further their oppression. Pharmaceutical companies make record profits and billionaires tighten their grip on our democracy, while the American ‘Precariat’ is being rendered too high, sick, or dead to fight back. Aashish Hemrajani received his Master's degree from the Department of Anthropology of the University of Hawai‘i at Manoa, focusing his thesis on homelessness and medical care in Honolulu. He is currently doing homeless outreach full-time with the CHOW Project, the oldest statewide syringe exchange program in the US, with the hope of using this work as the basis for a PhD project sometime in the near future.