Yesterday, I had the distinct horror of FaceTiming with a dead body.
Everyone knows that first time experiences can be difficult to prepare for, but emotional reactions are impossible to know in advance. It was not the first person I had lost at the crossroads of mental health and substance abuse - not even the first one this month. Standing in the parking lot of a department store with a cigarette dangling from my mouth, I looked into the face of an old friend in his last suit and was overcome with shame. It was the shame that these young dead Americans and the thousands before them have prompted our government to do little other than ensuring the deaths of untold more.
Until now, I would never have dreamt that my social circles would double as high-risk pools for fatal overdose. I have never joined a gang and neither of my parents drink. I live in a neighborhood where the police call me ‘sir’ and I can ride a bicycle without people assuming I don’t own a car, all despite being black. The distribution of ruined lives across my peer groups, however, suggest the cultural associations we have with fatal drug abuse are ever more outmoded. Without exception, the friends I have lost were not made in the seedy back-alleys of after-school TV PSA’s, but in the common rooms of America’s biggest and best universities.
The exponential boom of addiction and death has brought the actors of this tragedy into sharp focus. The cast of villains is wide and diverse, as with many of the systemic problems of today. In this new act, however, the characters who drive the story are not only the cartels and street gangs we are used to fearing, but the faceless name-brand juggernauts who purport to help us. Today, killers come in the classic sticky black you would expect death to wear, but mostly in a sterile white that matches the image of the medical professionals who push them. My senior year roommate didn’t drop 20 pounds and all his classes in one semester because he decided to freebase some dope one day. It began with a bottle of oxycodone he was prescribed after losing his wisdom teeth.
Opiates like heroin have always been dangerous, causing epidemics of addiction and blood borne disease around the world. Recent innovations in synthetic opioids have produced knockout drugs like Fentanyl, which is a hundred times more powerful than morphine and 40 times more potent than heroin. The increased potency has nearly doubled the rate of fatal overdose, as well as the rate of addiction. Now that there is more than one bottle of painkillers for every adult in America, more and more pharmaceutical firms are entering the addiction game.
Insys Therapeutics is one such company. After bankrolling political efforts to defeat medical marijuana in Arizona, Insys gained more notoriety last month when its CEO and senior executives were arrested for perpetrating a national drug conspiracy. Brand representatives allegedly paid pain clinic doctors around the country six-figure kickbacks in return for prescribing Insys Fentanyl to patients, even for conditions for which it was not approved, like sprains and aches. Insys would then systematically lie to Medicare, Medicaid and insurance companies who were reluctant to approve payments for Fentanyl to non-cancer patients. States from Florida to Ohio have now brought similar cases against dozens of drug companies to court in order to slow the flow of dope and bodies. According to Missouri Attorney General Josh Hawley:
“These companies knew that the drugs they sell and market are highly addictive, even life-threatening if misused. And yet they have engaged in a deliberate campaign of fraud to convince Missouri doctors and Missouri consumers otherwise. They used bogus front organizations and fake research; they used fraudulent advertising and deceptive trade practices. And they repeatedly lied about the risks and true nature of the drugs they sold. Their fraud has been devastating.”
As local and state governments struggle to respond, near-constant pill mill busts continue to expose the network of doctors, physician assistants, and nurses who keep the prescriptions moving. The number of busted drug pushers with and without lab coats pales in comparison to the incarceration rate of drug users they have created.
Even in jail, the cycle of exploitation continues. Another major benefactor of America’s addicted is United States’ second-to-none prison industrial complex. The leaders of this $4.8+ billion industry have been early and vocal supporters of (and donors too) our current administration’s lock-em-up policies, and have been promised more prisons for millions of new customers since the campaign. After Jeff Sessions was appointed attorney general, two of his former aides were hired as lobbyists by America’s largest incarceration firms. A few months later, the attorney general announced a return to the brutal drug war policies of seeking the harshest possible sentences for low-level drug offenses – a move that the industry has spent millions advocating.
The penal labor exemption in the Constitution’s antislavery amendment allows the prisons to force inmates into work or to lease them out to other companies as cheap labor. Today, prisoners of the drug war are involved in everything from defense manufacturing to Starbucks packaging. The racially skewed nature of the American drug war has ensured that in prisons across the heartland, often built on slave plantations, there is an unbroken tradition of chain-ganged black men picking crops in the southern heat while armed white men on horseback look on. They are paid $0 to <$1/hour, while industry innovators introduce cost cutting and profit-expanding policies, such as replacing family visits for $1/minute video calls.
For those with felony drug convictions, the legal discrimination they face in getting housing, employment, education, voting rights, and other securities almost ensures a future as a second-class citizen and as a repeat customer for the prison and/or drug business. For those with the social and financial resources to land in treatment instead of prison, rehabilitation still offers opportunities for exploitation. As addicts move from opiate pills to opiate addiction pills, the mode of wealth extraction remains the same. Makers of OD antidotes and addiction treatment drugs have now joined pharma industry grotesques like Martin Shkrelli and Epipen in using the current crisis to inflate their prices as high as they will go.
In October, 35 states and the District of Colombia brought a lawsuit against drug firm Reckitt Benckiser for operating a multi-pronged scheme using patent laws and fake safety concerns to dominate the market and maintain an artificially high price for its opiate addiction drug Suboxone. This drug is so critical to kicking the habit and enduring withdrawal, friends of mine in treatment became just as ill and desperate for it as with the opiates themselves. Some drug companies have begun testing other techniques, like using profits to lobby and donate to politicians to include their products by name in new laws aimed at combatting addiction, staking out new monopolies for themselves.
Rehab clinics are getting in on the action as well. Billion-dollar private equity firms like Mitt Romney’s Bain Capital have seen the crisis as a signal to “roll up” the rehab industry. These companies purchase clinics hundreds at a time, then squeeze them for profits through cost-cutting and streamlining. Too often this means investing heavily in profitable rehab and detox while neglecting prevention and long-term programs that prevent repeat customers and unsatisfied guests, like the friend I buried this week. For them, the devastation of today is a favorable industry tailwind that entices the potential of even bigger revenue.
We are living through a time in which the concert of profiteering has accelerated the killing beyond our institutions’ ability to cope. In the American heartland, morgues are overflowing with the dead. Since March, some have been forced to rent cold storage trailers to keep the excess bodies from rotting in the summer heat. A year ago, I interviewed my small Indiana college town law enforcement when the department first started distributing Narcan to his deputies. I asked him the price point at which he wouldn’t supply it anymore. It remains the only question I have ever asked as a journalist to which I was refused an answer. In the year since increasing prices have squeezed the ability of first responders and law enforcement to deploy lifesaving overdose drugs as the epidemic spreads.
This year, the emergence of the “Grey Death,” a synthetic cocktail so potent it can cause overdose from skin contact with an amount less than half a grain of rice, has already hospitalized one first responder and spooked thousands more. I have several friends who have been resuscitated by that college town police department in the past, but as rescue drug prices rise, its deputies must now make the grim choice at every OD call between aiding the dying with their single dose and protecting themselves from the monster. This week, they responded to a record 10 calls in a 24 hour period.
This crisis is devastating, but not insurmountable. Study after study has shown that medication and counseling is generally an effective treatment for drug addiction. Unfortunately, the reframing of the drug epidemic as a disease and public health issue is a question of politics, not science. Outlooks on this issue have become polarized between a shrinking group of moralists who believe drug addiction is a personal deficiency and the swelling crowd of the mourning. From the words and deeds of our Congress and President, the future of this ongoing massacre is largely being decided by the ignorant-at-best.
The GOP Senate Healthcare Bill released this week is a prescription for accelerated killing. Today, roughly 10% of addicts receive treatment. Republican lawmakers in hard-hit states who have requested more than $40 billion to close this gap and fight the epidemic will get $2 billion, insufficient funds to run the substance abuse programs of Pennsylvania alone. Medicaid, the largest provider of addiction treatment in America, is set to be gutted, pulling the floor out from under the poorest Americans and their families who receive treatment under its Obamacare expansion. It would give states the ability to cut addiction treatment from the list of benefits it requires insurance providers to offer, or even let them designate it as a disqualifying pre-existing condition.
In terms of suffering and loss, the United States drug crisis is the human meat grinder of our generation as the Vietnam War was to our parents. Apart from being wildly profitable, the major difference is the former will kill more of us in just this year than the latter did for its entire duration. Mangled in this grinder’s teeth, Americans of all kinds are mechanically separated from their money, their worth, and their lives. Untouchable-class economic powers like insurance firms, drug companies, and private prisons scurry about its base, competing and cooperating to simultaneously fill its funnel, turn its cranks, and frantically suckle at the profit that dribbles from its spout. The remainder that is extruded back into society from its waste-nozzle is merely the byproduct – a piling slurry of anguish and spent corpses we experience with our screens and increasingly, without.
How can the United States, The Greatest Country on Earth™, tolerate a monster that consumes 59,000 of its citizens every year? Three thousand people died on 9/11, and the United States has bombed 7+ countries, invaded 2 of them, spent roughly $2,000,000,000,000, and killed over 1,000,000 people in response, with no end yet in sight. If there is a similar threshold of unacceptability for the death toll of the drug epidemic, we haven’t found it- we only know that it must be above the more than 200,000 lives it has already claimed if it exists at all.
Underneath that department store flagpole today, I faced the “American Carnage” our commander-in-chief presented to us as his first priority. In response, he is preparing fresh tax cuts for the same brave job creators who slurp its juices, and more fodder to feed the machine. If history is any teacher for us, we will see more of our loved ones in boxes before we will see any better.