Against the Current, No. 219, July/
The Rightwing's Supreme Court Coup
— The Editors
Assange, Donziger and the DNC Media
— Cliff Conner
A Letter from California's Death Row
— Kevin Cooper
COVID & the Global South: the Nigerian Case
— Emilia Micunovic
Ukrainian Leftist Speaks
— an interview with Taras Bilous
After Russia's Invasion of Ukraine
— Ashley Smith
The Murder of Shireen Abu-Akleh
— David Finkel
- The Case of Derrick Jordan
- Struggle in the University
The Competence Curse
— Purnima Bose
Faculty Governance in Academia
— Eva Cherniavsky
Renewal of Shared Governance?
— Benjamin Robinson
- Revolutionary Experience
An Introduction, A Conclusion
— The Editors
To the Working Class, 1969-1980
— Dan La Botz
— Sam Friedman
Migration Politics and Criminalization
— Cynthia Wright
Disability Studies from South to North
— Owólabi Aboyade (William Copeland)
Mass Misery, Mass Addiction
— Dave Hazzan
A Giant Rescued from Oblivion
— John Woodford
Three Mothers Who Shaped a Nation
— Malik Miah
The High Price of Delusion
— Guy Miller
- In Memoriam
Oscar Paskal, 1920-2022
— Nancy Brigham
A Paramedic’s Dispatches from the Front Lines of the Opium Epidemic
By Peter Canning
Johns Hopkins University Press, 2021, 314 pages, $27.95.
Deaths of Despair and the Future of Capitalism
By Anne Case and Angus Deaton
Princeton University Press, 2020, 312 pages, Illus: 26 b/w illus. 2 maps, $27.95.
DRUG ADDICTION FOLLOWS misery, and where you have mass misery, you will often have mass addiction.
China at the turn of the last century was a devastated country, carved up by western powers and ruthless warlords, with tens of millions dead, homeless, and hungry from war and rebellion. Millions took to the opium pipe as a source of solace.
Following years of brutal combat and American bombing, including the atomic attacks at Hiroshima and Nagasaki, Japan was not so much defeated in World War II as obliterated. A million and a half survivors took to the stocks of amphetamine (speed) the Imperial forces had used to keep their personnel awake to fight.
After the Islamic revolution and Saddam Hussein’s murderous attack on Iran, millions of Iranians became hooked on the heroin flowing out of next-door Afghanistan, another country in agony from poverty, extremism, and foreign invasion.
The list goes on — where there is misery, there is drug addiction.
Among Canada’s First Nations, alcoholism is like pestilence. In Australia’s Northern Territory, the gasoline has an additive that makes it impossible to huff. And when America’s inner cities emptied of jobs and housing, alcohol, heroin, and later cocaine use among Black Americans skyrocketed.
Now, white working-class America is hooked. Two books, Peter Canning’s Killing Season and Anne Case and Angus Deaton’s Deaths of Despair, trace a current of pain through white America, physical and emotional pain that drives millions into the arms of opioids like Oxycodone, fentanyl, and heroin.
But unlike China, Japan or Iran, America’s pain is self-inflicted, a result not of foreign invasion but down-home class war.
Descent Into Madness
Like any good paramedic, Peter Canning wastes no time. The first sentence in Killing Season reads, “My name is Peter Canning. I am a full-time paramedic in Hartford, Connecticut, an area hard hit by the opioid epidemic and, in particular, by the synthetic opioid fentanyl, which in the summer of 2017 was in 90 percent of the city’s heroin supply.” (1)
In a fast-paced, present tense, reportorial style, Canning tells the excruciating story of Hartford’s descent into opiated madness.
Every day since the mid-’90s, he has picked up overdosed citizens of the city, revived them (or tried to), and if able, recorded their stories. In the beginning, he had little pity for the people he pulled off the streets and injected full of Narcan, viewing them as self-destructive wastrels, schoolyard “hoods” who
“end up begging for change on the street and are found overdosed or dead in their beat-up cars or in the same shooting gallery as this deceased man with drug paraphernalia by their side. I take care of them professionally, but I don’t care for them emotionally, certainly not in the same manner I care for an old woman suffering from congestive heart failure, a disabled man with diabetes, or a young woman in a car crash on the highway.” (12)
But the more Canning learns about addiction, and the more he speaks to fentanyl’s victims, the more he is convinced that these people are sick, and not in any pejorative way. Drugs have rewired their brains, and “to expect them to act rationally is akin to expecting someone with chronic obstructive lung disease to run a marathon or someone with congestive heart failure to climb Mount Everest.” (42)
Canning talks to his patients, both out in the streets and while whisking them to the local ER. He also does the research. He learns that 90 percent of heroin addicts begin with prescribed pain pills. Then the pills — codeine, Percocet, Oxycontin, and other opium preparations — are cut off.
Some people, probably most, grit their teeth through withdrawal and then continue with their lives. Many, however, find they cannot handle the withdrawal or the pain that has not subsided. They replace their doctors with street dealers, and discover in time that heroin costs less than black market pain pills.
To maximize heroin’s effectiveness, they learn to shoot it. It isn’t long before they end up in the back of Canning’s ambulance, their bag of “Skull & Bones” or “BlackJack” heroin contaminated with fentanyl “hotspots” — bits of poorly-mixed fentanyl — which they could not have known were there.
Canning has dozens of these stories. The cheerleader who broke her back when her colleague didn’t catch her; the construction worker who hurt himself lifting; the mother who had two caesareans.
All began as patients taking pain pills, and ended up addicted to heroin. Heroin addiction then expels them from their normal lives, and they end up trapped by the “three Ds of stigma: difference, danger, and discrimination.” (48)
Then there are those who learn that opium cures a different pain altogether, the psychological pain that comes from living in a hyper-capitalist, hyper-competitive world. “The pills fill a hole they didn’t know they had,” Canning writes (70). “Heroin makes people feel good; it offers relief, although temporary, from pain, stigma, shame, despair, and an uncertain or scary future.” (74)
Addicts often hate themselves and people often hate them, Canning writes. Paramedics, doctors, nurses, and especially police officers treat them like scum, leaving them with the typical warning, “‘You don’t quit, you’ll deserve your fate.’” (14)
Some do clean up, but as Canning makes clear, no one ever overcomes addiction completely. Opium’s grip is just too powerful. “‘Heroin grabs you by the ankles when you try to get away from it,’” one homeless man testifies, “‘and it pulls you back in. It makes you suffer when you try to leave it, and it never loves you again like it once did.’” (44)
Canning’s book is replete with users who go to rehab, spend months or years without using, and then fall back into opioids after something — usually more pain — pushes them back into it. This is usually where friends, relatives, and family give up on the person, leaving them to spiral back into addiction and hopelessness.
“Victory,” Canning writes, “is measured not in complete cure but in time still alive on earth.” (66)
Deaths of Despair
Case and Deaton also write about pain, but they look at an entire demographic, white Americans without college degrees.
Their argument is that opioid overdoses — along with suicide and alcohol-related liver disease — are cutting down swaths of under-educated middle-aged American whites like a sickle through wheat, resulting in, for the first time since industrialization, a reduction in life expectancy among some Americans.
They call these “deaths of despair,” and they are symptomatic of American class war, though the authors don’t call it that.
Case and Deaton are academics at Princeton University, a world away from Canning’s streets of Hartford. They work mostly from statistics, teaching us lessons like:
“After correction for inflation, the median wages of American men have been stagnant for half a century; for white men without a four-year degree, median earnings lost 13 percent of their purchasing power between 1979 and 2017. Over the same period, national income per head grew by 85 percent.”(7)
Inequality rises; the wealthy steal from the poor in a “Sheriff of Nottingham” economy; poor whites reply by voting for carnival barkers like Donald Trump, who promise they can turn things around when they have no intention of doing so. Little of this is news to those who have been following the march of neoliberalism through America.
Canning and Dean make a persuasive case that the four-year Bachelor’s degree is what makes the difference. Those with the degrees continue to live longer, generally happier lives, though they may struggle. (Canning and Dean make little mention of the $1.5 trillion student debt bomb, except to say they don’t want it canceled.)
For those with only a high school education — an education that is mostly geared towards preparation for college — there isn’t the work there used to be. Those jobs that cannot be sent abroad — services like cleaning, food preparation, and driving — have become devalued and outsourced to contractors, so these workers “are no longer invited to the holiday party.”
Once, the CEO and janitor could brag of being part of some “great enterprise” — now only the CEO can, as janitorial services are contracted out. Their jobs stink or are non-existent, paychecks dwindle, health and housing costs soar, families disintegrate, and the result — just as in Canning’s Hartford — is increase in pain.
This is common throughout the country, but especially in places like the West, Appalachia, the South, Maine, and northern Michigan, where education is lower, unemployment higher, and people poorer.(72, 86)
This pain, both physical and psychological, is treated with the opioids devastating America, as well as with alcohol, leading to large rises in liver cirrhosis deaths among the middle aged — and for those for whom opiates and alcohol are not quick enough, there is suicide.
Taken together, these “deaths of despair” killed 158,000 Americans in 2017 alone, “the equivalent of three full 737 MAXs falling out of the sky every day, with no survivors.” (94; Italics in original.) Compare that with 40,100 traffic fatalities that year, and 19,510 homicides. (97)
Although these conditions mostly affect Americans without college degrees, Case and Deaton predict that those with college degrees could be next, just as today’s devastation of white working-class America was preceded by the devastation of Black working-class America in the 1970s and 1980s.
Big Pharma and Corporate Healthcare
So, who’s to blame? Some villains are obvious. Both Canning and Case and Deaton call out Purdue Pharmaceuticals, who developed, marketed, and lied about the painkiller Oxycontin, claiming that fewer than one percent of its users became addicted. In fact, it was closer to eight to 12 per cent, and the $600 million fine the U.S. Justice Department hit them with barely dented their $30 to $50 billion in profits.
Case and Deaton fault the U.S. healthcare system above all. They describe it as “rent-seeking” of the worst kind, a system that funnels billions from working people into the hands of private equity firms and investors.
“If a fairy godmother were somehow to reduce the share of healthcare in American GDP,” Case and Deaton write, “not to the average of rich countries but, less ambitiously, only to the second highest, Switzerland, 5.6 percent of GDP would be available for other things, freeing up more than a trillion dollars.” (194; italics in original)
They deplore the power of Washington lobbyists, and the health care industry’s ability to force a for profit racket on sick Americans.
They’re not wrong. As a Canadian, I regularly view U.S. healthcare debates as a dialogue of lunatics. Canadians know their system isn’t perfect. But we often look south of the border and say, good God, at least it isn’t that.
But Case and Deaton seem content to stop at health care reform. Capitalism, they insist, is not to blame, and is likely to form part of the solution. On the very first page of their preface, a few paragraphs before listing the number of the national Suicide Prevention Lifeline (1-800-273-8255), they announce, “We believe in capitalism, and we continue to believe that globalization and technical change can be managed to the general benefit.” (ix)
The solutions that Case and Deaton don’t want overwhelm what they do want. They advocate against a universal basic income, student loan forgiveness and free college, or measures to reduce inequality and improve the social safety net. Capitalism, they insist, is only a problem in health care provision, as when they write:
“In the markets for tuna fish, for automobiles, for houses, and for airplane trips, consumers can soon learn which products suit them and which do not, and competition among providers will remove those products that are defective or that suit no one. But try to find out who is the best orthopedic surgeon.” (208)
This is an absurd statement. Their examples of “good” capitalism causes dead dolphins, gas guzzling global warmers, foreclosure, and the agony of long-haul Coach.
Meanwhile, Google reveals the best orthopedic hospital in America is the Hospital for Special Surgery in New York. It is because you can choose and pay for the best doctors that American health care is so popular among the wealthy.
Canning’s policy prescriptions are more street-focused. He has little to say about capitalism, and nothing about the healthcare system he is a part of. But he excoriates the War on Drugs, viewing it as a wasteful and stupid enterprise that prevents America from using the one method that works to save users’ lives, at least in the short term — harm reduction.
Needle exchanges, free naloxone, supervised injection sites, fentanyl test strips, gas chromatography machines that can tell you what is inside your drugs — these do not solve the opioid crisis, but they keep people alive. “‘The people who use drugs are members of our community,’ [Canning says], ‘and they need to be welcomed back home rather than’ dispersed.” (263)
There is no single “solution” to drug use. People have used drugs since the dawn of time, and since then, some people have been prone to using them too much — even in a paradisical, socialist Eden, there will be a few obnoxious stoners.
But mass addiction, what we are seeing now in the United States, is a sign of a society that does not work, or at least does not work for most people. When the rich steal from working people, cause working people to become addicted to its products, and then jails them for using similar products once legitimate supplies have been cut off — that’s not rent-seeking, it’s class war.
The best policy option is to create a legal supply of heroin (or a reasonable substitute — not methadone) to provide addicts, along with support should they wish to drop their habits.
The current policy just unveiled in Canada, allowing users to carry 2.5 grams of drugs without fear of prosecution, is the kind of window-dressing that progressive governments like to display to show they’re dealing with the problem.
Canning would likely be the first to note that limiting drug possession 2.5 grams does nothing to keep it free of fentanyl, and it is drug users themselves who have pointed this out in Canada. It sounds like the sort of half-measure that Case and Deaton would approve.
While reform in Washington remains extremely difficult, community organizers and activists remain the best hope for the millions of Americans in pain.
July-August 2022, ATC 219