Opioid Crisis–Profit from Pain

We would like to introduce one of our recent members, Tom Burns, who currently resides in the US South East.

Purdue Pharmaceuticals filed for bankruptcy protection on the night of September 14. In the next few days various groups expressed praise and satisfaction over the maker of OxyContin filing for bankruptcy. Their understanding was that such a move was one of admitting defeat. As the Opioid Crisis continues, many states and individuals have sought recompense from Purdue. They blame this pharmaceutical company for “creating” or “worsening” the crisis. However, such evaluations of the situation fail to fully consider the nature of the opioid crisis. We should emphasize that the entire system of Capital and its reproduction is at-fault for the opioid crisis, both directly and indirectly. Furthermore, we can look to the steps taken by the financial industry in the wake of the 2008/2009 recession as proof that the main malefactors will not see justice.

The Foundation of the Crisis

Opioids are chemical substances which share similar chemical structures. The poppy plant, which produces opium, is the source for non-synthetic opiates used in medicine. Humans have long used opium to treat pain. However, our bodies also produce opioids to function as neurotransmitters and to dull pain. These are referred to as endogenous opioids in scientific literature, while opium and its derivatives (and synthetic forms) are referred to as exogenous opioids.

The modern American Opioid Crisis finds its roots in shifts in the understanding of medical practitioners in the 1980s. During this decade, the medical understanding of pain shifted to a focus on limiting its effects on patients. Pain became a focus of treatment. The medical and scientific community recognized that pain deserved to be limited to an acceptable level for the patient. Soon, individual states passed intractable pain laws. These laws protected doctors from prosecution if they treated their patients’ pain aggressively, most often in the form of controlled substances. In 1995, the American Pain Society, a group of physicians that focuses on the treatment of pain and its mitigation, argued that pain should be considered a “fifth” vital sign.

Present in these “intractable pain laws” are attempts to define pain. In 1985, the term was used by the Federation of State Medical Boards. This was followed by 1990 statutes passed in Texas and California. In both states intractable pain was defined as, “a pain state in which the cause of the pain cannot be removed or otherwise treated and which in the generally accepted course of medical practice, no relief or cure of the cause of pain is possible or none has been found after reasonable efforts.” This definition agrees with federal regulation on controlled substances. However, there is not much agreement between the laws passed in the wake of the 1980s amongst each other. The definition of “intractable pain” became further muddied. Many people suffer from a variety of incurable and severe pain syndromes or diseases (such as arthritis and dysphoria). However, the reality was that as these laws passed, a real phenomenon developed that encouraged the prescribing of opioids.

An Opportunity for Profit from Pain

These movements within the medical industry created an opportunity. Before our current crisis, opioids were prescribed primarily for short-term use or for terminal illnesses. This was due to past lessons from earlier opioid epidemics.

Addiction to opioids had long been a problem in the West as far back as 1847 when Marx wrote the Communist Manifesto. This use was so prevalent that “opium dens” were created throughout Europe. The crisis in the 1800s helps to frame one of Marx’s memorable statements, “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.” Scientific inquiry validated these past observations and lessons. Opioids, in the long term, not only create addiction and dependence through tolerance, but they can also heighten the sensation of pain.

Nonetheless, the pharmaceutical and medical industries, in tandem with the American state, set aside fact in favor of pursuing new profitable ventures. Scientific papers were published which suggested that opioids were not as addictive as previously thought. These papers are claimed to have been “overinterpreted” now. However, virtually all papers which formed part of the push for this increase in prescription opioids, were either fabrications or deeply flawed. We can look to a letter published in the New England Journal of Medicine in 1980 which suggested that only 4 out of ~12,000 patients became addicted to opioids as evidence of these assertions. The letter contains no proofs, arguments, or data to back up their audacious claims. A widely cited study in 1986 used data gathered from 38 patients to advocate for the use of opioids in non-cancer related conditions. However, this paper suffered from the same inherent bias as the letter published in 1980. None of these papers consider previous knowledge gained from past experiences.

A Perfect Storm of Addiction and Profit

Opioid addiction increased because of all of these converging forces. In the mid-1990s, pharmaceutical companies introduced new opioid products to “cash in” on the new frontier of pain treatment. A new formulation called OxyContin played a pivotal role in the surge of opioid prescriptions and became the common drug prescribed to treat chronic pain. OxyContin played this role due to its sustained release formula. With state help, pharmaceutical companies promoted their products heavily. They followed similar claims seen in the 1980 letter. Opioids were “safe.” They were “effective.” They had a “low potential for addiction.”

But while they might be safe and effective for short-term use, as previous practice had shown, these claims were false when it came to long term, sustained use. A 2007 lawsuit proves that Purdue Pharma knew their products were addictive. While the capitalists at the head of the state might now be closing ranks on fellow members of their class, we should understand that all levels of the American state shaped pharmaceutical company policy and made their expansion possible.

Of course, the for-profit structure of the United States health-care system exacerbated these problems. Health insurance plans covered pain medication instead of covering other approaches to managing pain. Private practice doctors wanted to ensure a steady volume of patient influx and patient satisfaction. They had every incentive to prescribe these drugs. Pharmaceutical companies were permitted to directly advertise their products to consumers. Since most American workers only see a doctor as a last resort, many people expect (and expected) to receive a prescription when they go see a doctor. Our economic system fed directly into this situation.

Racism and the Opioid Crisis

Racism also plays a pivotal role in this crisis. Purdue focused their advertisements to white suburban and rural communities. Their strategy took advantage of racist attitudes which framed drug abuse as an “inner city” issue that didn’t apply to their targeted demographic. The use of “inner city” is associated with African American and Hispanic communities and not to suburban and rural white people.

The government’s response to the current crisis has also been an indicator of the racism present in our current system. The heroin epidemic and the “crack” epidemic (in the 1980s) are seen as “inner city” problems. State governments and cities responded by increasing police presence in communities as part of a larger “drug war.” This resulted in increasing incarceration rates of people of color in the United States. Thus, the government’s response to a “non-white” problem resulted in fueling the for-profit prison industry.

So, while there has been, most certainly, a facet of lower level policing in the current Opioid Crisis, the focus has been, once it was actually recognized as a problem, on attacking the problem by the targeting of “dealers” like pain clinics and overprescribing doctors rather than the street level users as happened in the crack and heroin crises of the 1980s and before. In other words, since this crisis has been characterized as a “white” and “rural” problem, the response has been focused on medical treatment and increasing awareness, in stark contrast to the “enforcement” strategy with earlier, less white crises. And of course, the difference between the two responses has led to a massive increase in incarceration for communities of color, defining an entire generation of black people, especially men, as “criminals” and ruining their prospects for employment and any sort of wealth building for these communities. If they weren’t killed outright by police gunfire during arrest.

Exporting the Crisis for Profit

While current state policy is aimed at mitigating these crises in the United States (as well as Canada), companies have already moved on to fresh ground. The Los Angeles Times revealed in 2016 that the global counterpart to Purdue Pharma has already been engaging in the same tactics to promote OxyContin in Brazil, China, Colombia, Egypt, Mexico, the Philippines, Singapore, South Korea, Spain, and Australia. Doubtless, other pharmaceutical companies have moved to other vulnerable countries as well. In countries like Brazil and Mexico, capital seeks to “export” this crisis in the name of increasing the bottom line.

Despite the fallout of the 2007/2008 Recession, those CEOs and corporate higher-ups responsible for creating the conditions which led to the Great Recession escaped punishment. These owners of the means of production for finance capital received large bonuses at the same time they fueled a rising unemployment rate amongst the working class across the world. There is no reason to think that Purdue Pharma will be any different. While the owners of Purdue Pharma will transfer as much money into their pockets as possible before filing for bankruptcy, the working class will have to pay the price. The workers of Purdue and their families, by losing their jobs as well as the victims of the opioid crisis by not receiving sufficient help will be the ones who pay. The real cause of the opioid crisis was a state that served the interests of the capitalist, the bourgeoisie, those who own the means of producing prescription drugs. This same state, and the class it represents, opened a new avenue for profit. They knew that they would create a disaster, Purdue Pharma admitted as much in 2007. Yet, they insisted on increasing sales and produced highly addictive drugs all in the name of profit.

So, let the people that are responsible pay for this crisis! The workers of Purdue Pharma as well as the victims should organize together and call for the company to open their books. This way, the workers and the victims can have a clear overview of the financial situation of the company. The demand to open the books should be coupled with the call for expropriation of Purdue Pharma under the control of the workers. The working class should establish a plan of reorganizing the production line of the company and also so the victims can receive sufficient help and support. Under workers control, the company could also be used to produce medicines we actually need, instead of medicines with the highest profit margin.

In this mobilization, the organizations of the working class – especially the trade unions – should be incorporated and actively help the workers of Purdue and other big pharma companies to bring the control of the industry into the hand of the many, for the many.

However, the crisis shows clearly that the current system is also responsible for it. The current system cannot and will not hold those who earned millions of dollars accountable. It also will not allow the workers and victims to achieve the above-mentioned demands and necessary changes to the pharma industry. Only under a system where the working class controls the economy can these crises of capitalism be stopped. We call for the expropriation of assets from Purdue Pharma and the pharmaceutical industry as a whole and to put these ill-gotten gains to the service of the people, and especially the ones who were addicted by this conspiracy to profit from pain. Why do those who created this problem deserve to profit and live comfortably off it? Why should we trust a state, a government that helped to orchestrate this issue in the first place? They show us day in and day out, that their politics is for the rich, not the working class. Thus, we need a political voice for ourselves, a worker’s party. A party of our own that we can use to fight and advocate for our own needs.

A positive step forward would be if organizations like the DSA together with the trade unions would launch a campaign for the aforementioned demands independent of the Democratic Party.