Opiates and the Masses: Populist Oligarchy and the Totalitarian Itch in the U.S.

More a corporate oligarchy than a properly functioning democracy, the U.S. is increasingly characterized by widening income inequality, political polarization and paralysis, and a compromised state regulatory apparatus that has failed to protect the citizenry from opiate addiction, environmental injury, gun violence, the covid pandemic, and financial vulnerability.  The late capitalist U.S. state apparatus, simultaneously overgrown and hollowed out, is now worked by an oligarchy of financial, energy, industrial, pharmaceutical, military and social media elites who jostle for control of the spoils and strive to extract ever more surplus value from those below them while distracting them with incitements to discourse about cancel culture, wokeness, transgender politics and celebrity gossip.  Thinkers such as Martin Wolf (2023) and Peter Turchin (2023) worry that the system is fast approaching the point where it can no longer mediate the contradiction between democracy and widening income inequality, and that we are in danger of transitioning to a regime of what Theda Skocpol calls “minority authoritarianism” and “GOP Leninism” (Edsall 2023).

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Let’s explore these issues through the example of the opiate addiction crisis in the U.S.. This crisis was originally precipitated by the narco-oligarchs of the pharmaceutical industry who made enormous amounts of money addicting Americans to opiates such as oxycontin.  When the full scale of the disaster they had unleashed became apparent, they sought to transfer blame to the petty drug dealers – often people of color – who followed in their tracks while their political allies used the crisis to advocate an authoritarian turn rather than the kinds of policies that many public health experts see as essential to saving lives.

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"For example, one pharmacy in Kermit, West Virginia, population 406, was selling 4.5 million Oxycontin pills a year."

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The opiate epidemic in the US commenced with Purdue Pharmaceutical’s release of Oxycontin in 1995.  Purdue Pharmaceutical was privately held by the Sackler family which, with $13 billion in assets in 2017, was wealthier than either the Mellons or the Rockefellers.  They launched Oxycontin – an opiate twice as powerful as morphine – with a brilliant marketing campaign that lamented the undertreatment of pain, which they now called “the fifth vital sign” (along with temperature, blood pressure, pulse, and respiration). They attributed this undertreatment to “opiophobia.”  These arguments were advanced in ads and videos, but also by a small army of doctors, paid by Purdue to speak at medical conferences, as well as sales reps touring doctors’ offices.  With Purdue making $1 billion a year from Oxycontin by 2000, some of these sales reps were making hundreds of thousands of dollars in commissions (Redden 2017, 2022; Macy 2019).  

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The doctors and sales reps argued that Oxycontin’s special time release mechanism prevented addiction.  This was not true, and Purdue’s internal documents show they soon became aware of this.  Oxycontin was advertised as a twice-a-day pill, but many users were taking it three times a day to ward off withdrawal.  Others soon learned they could get a strong high by crushing the pills, thus circumventing the time-release feature.  This created an enormous black market of recreational users of Oxycontin, and Purdue knew from its prescription tracking that some doctors were functioning as pill mills, prescribing Oxycontin (now nicknamed “hillbilly heroin”) on a mass scale, no questions asked.  For example, one pharmacy in Kermit, West Virginia, population 406, was selling 4.5 million Oxycontin pills a year (Case and Deaton 2020:124). [1]  In journalist Patrick Keeffe Redden’s (2017) words, “everywhere the drug spread, addiction followed.”

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These pill mills attracted the attention of the Drug Enforcement Agency, which began fining pharmaceutical distribution companies and threatening to close some of their distribution centers.  Big Pharma fought back, and their success shows how effectively corporate oligarchies can neuter the regulatory state and supplant the public interest in favor of private corporate interests.  Key to their strategy were Republican allies Tom Marino and Marsha Blackburn in the House of Representatives.  Although Marino and Blackburn both represented areas hard hit by the opiate epidemic, they were strong allies of the pharmaceutical industry, which would give them $1.4 million in campaign contributions in the following years.  They allied with Linden Barber, formerly a senior DEA official but now working as a lawyer for pharmaceutical companies.  Using his knowledge of DEA processes, he wrote legislation – The Marino Bill – that changed the standard the DEA would have to meet to close down a distribution centre from one of proving “imminent danger to public health or safety” to proving that a distribution center threatened “a significant and immediate risk of death or serious bodily harm.”  This may seem like a minor semantic shift, but DEA lawyers complained it made it almost impossible to close a distribution center because it required proving that someone’s death was actually imminent. 

For good measure, Representatives Marino and Blackburn pressured the DEA inspector-general into doing an internal investigation of Joe Rannazzisi, the senior DEA official seeking tighter control of opiates, thus derailing his government career.  Meanwhile Representative Tom Marino who had worked so hard to make it easier for the pharmaceutical industry to turn ordinary Americans into addicts was, in 2017, nominated by Donald Trump to be the nation’s “drug czar.”  (I am not making this up!)  In a sign that democratic processes of accountability were not completely dead, his nomination was withdrawn when a Washington Post investigative team revealed his backstage plotting to keep the pill mills open (Higham et al 2019).