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There Is No Capitalist Solution to the Overdose Crisis

The United States has weaponized its response to the overdose crisis it helped create, using it as an excuse to further its own imperialist agenda at home and abroad.

Mike Pappas

April 21, 2023
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Overdoses are still soaring throughout the U.S. According to the National Institutes of Health, “More than 106,000 persons in the U.S. died from drug-involved overdose in 2021, including illicit drugs and prescription opioids.” From September to January 2022, almost 80,000 people died from overdose. And the epidemic goes beyond the overdose numbers. While most politicians talk about the risks of drugs laced with fentanyl, that is not the only risk. Thousands around the country are at risk of using drugs contaminated with dangerous additives such as xylazine, or “tranq,” as it spreads through the drug supply in various cities. These additives put those using drugs at an increased risk of health complications such as chronic, debilitating wounds that sometimes lead to amputation or severe infection.

Same Old Drug War Song

The drug war and the overdose epidemic could prove to be a key topic of debate leading up to the 2024 elections. Many Republican Party politicians have attempted to make this a key aspect of their discourse. As Politico reports, “Republicans suggest everything from terrorist labels to an invasion to decimate drug cartels in Mexico.” Donald Trump, for example, has openly discussed using cyber warfare or sending Special Forces, and he has asked for “battle plans” to target Mexico if he is reelected president. Republicans, such as Senator Lindsay Graham and John Kennedy, have argued that Mexican drug cartels and Chinese companies charged with producing raw materials for producing fentanyl should be labeled foreign terrorist organizations. Other Republican lawmakers, such as representative Dan Crenshaw, have argued for the use of military force to put the U.S. “at war with the cartels.”

This puts more pressure on President Biden to present himself as wanting to take action on the overdose epidemic. Biden must toe the line of making progress, enough to draw votes from the Left, but conservative enough in action, so as to not drive away more centrist voters. In March the Biden administration unveiled its “fact sheet,” claiming it plans to “save lives by disrupting the trafficking of illicit fentanyl and its precursors into American communities” while expanding “access to prevention, harm reduction where not prohibited by law.” According to the administration, it has “secured more resources for border security than any of the presidents who preceded him, deployed the most agents ever — more than 23,000 — to address the situation at the border.” The fact sheet says the administration’s budget includes $25 billion for U.S. Customs and Border Protection (CBP) and Immigration and Customs Enforcement (ICE), including

funds for CBP to hire an additional 350 Border Patrol Agents, $535 million for border security technology at and between ports of entry, $40 million to combat fentanyl trafficking and disrupt transnational criminal organizations, and funds to hire an additional 460 processing assistants at CBP and ICE.

Both parties peddle different variations on the same claims about drugs. They both blame the flow of fentanyl on China, explaining that fentanyl’s raw materials are produced there, then sent to Mexico, where they can be processed and trafficked across the border to spread throughout the U.S. They claim we just need more border security, better technology, or even military intervention, and that will “solve” the problem. They neglect that measures of this sort have been used to combat drug use, both domestically and internationally, and they never work, nor will they this time.

The ongoing criminalization of substances is exactly what creates the underground market for drug dealers — the same market that capitalist politicians claim they want to destabilize in the first place. Meanwhile, these drugs are often contaminated, which puts users at even greater risk of health complications or death. This is why we are seeing increased concentrations of fentanyl in the current drug supply (fentanyl is a stronger opioid, easier to transport, and easier to add to batches of drugs), or why we are seeing dangerous additives like xylazine in the drug supply (xylazine is a veterinary medication that acts as a sedative and extends the relatively short length of fentanyl’s effect).

Both Democratic and Republican politicians argue that they need to push back against the violence of the drug cartels, but they neglect that the vast majority of weapons owned by the cartels come from the U.S. and are produced by U.S. corporations. They claim that increased funding to ICE or the police will help combat the crisis, but the exact people politicians claim will help “regulate” the flow of illegal drugs, like the police or border control, help distribute drugs themselves.

As our comrades in Mexico note in their recent piece,

Imperialist hypocrisy consists of filling their mouths talking about public health care when the drug business is not attacked, which not only involves its production and distribution, but also the generation of capital itself, since drug traffickers do not keep money under the mattress, they keep it in banks as a way of accumulating capital, as Columbia University academic Edgardo Buscaglia pointed out more than a decade ago.

On the other hand, the responsibility of pharmaceutical companies in promoting the excessive consumption of addictive substances is excluded, the result of which is to individualize the blame, transferring it to the impoverished masses, to those who carry out problematic or occasional consumption and to foreigners. …

So even though imperialism claims that it seeks: “to further protect the U.S. financial system from the use and abuse by drug traffickers,” what it actually does is protect the business for the millionaires who get rich from this activity, it is say financial capital and the owners of the means to produce drugs.

Drug War as Politics by Other Means

Politicians still make the same old claims about how best to address the overdose epidemic, but why? To look at the capitalist approach to the drug war in the current global geopolitical context, it’s helpful to refer to the great military theoretician Carl von Clausewitz, who famously said war is the continuation of politics by other means. Through the lens of the current approach to the drug war, we see how politicians use those suffering from addiction to advance a political strategy that is already underway. They do this while a proxy war is being waged between the imperialist states of the U.S. and NATO on one side, and an emerging alliance between Russia and China on the other. This proxy war has allowed them to prepare for a coming military conflict with China. Capitalist politicians push changes in drug policy, pressuring the Mexican government, attacking immigrants, and supporting reactionary governments throughout Latin America.

In this context, it’s clearly advantageous to blame the U.S. opioid crisis on China and Mexico. Both Republicans and Democrats cry crocodile tears for those lost to a drug war that continues to be an utter failure. Yet it is a war they helped create and continue to wage to advance their own politics and policies. As we see through the examples of dialogue around China or Mexico’s role in the opioid epidemic, politicians also look for ways to weaponize the results of this drug war to expand imperialist policy around the globe. This focus on combating the flow of drugs can then be used to further justify increases in military budgets (such as Biden’s recently proposed $880 billion military budget). It can be used to further attacks on Latin America, as well as maintaining imperialist control in the area using the “war on drugs” as a pretext.

This wouldn’t be the first time the drug war was used to advance politics around other measures. These efforts have been underway since Nixon launched the first war on drugs in the 1970s. John Ehrlichman, Nixon’s White House counsel and assistant to the president for domestic affairs, tells us all we need to know about the policies of the 1960s around drugs:

The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin. And then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders. raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.

The war on drugs was originally used to attack the antiwar movement and Black people while at the same time attacking and destabilizing politicized Black communities incarcerating participants in the Black Power struggle. Politicians used cocaine that was brought into Black communities — the CIA participated indirectly in this distribution — to finance the counterrevolutionary in Central America and then criminalize that cocaine use. This later led to uneven levels of sentencing for users of crack and powder cocaine. These sentencing laws targeted Black and brown communities and led to millions being incarcerated. The legacy of the drug war continues today.

Addiction Isn’t Even about Drugs

If politicians cared about those suffering from addiction or felt for those who have died or lost loved ones to drug use, they would approach the problem with compassion, love, and respect, not violence, policing, and surveillance. Though capitalist politicians would love the public to believe it, the origins of drug addiction don’t even lie in this or that “evil” substance. It would be hard to discuss this at length in this piece, but several articles and books have been published on this topic, including In the Realm of Hungry Ghosts, Chasing the Scream, or High Price, to name just a few. Research shows there is a confluence of factors at play — the substance itself is often the least important component. Often at the center of substance addiction is a person self-medicating some sort of ailment that is rarely addressed under capitalism.

Addictions don’t even always need to be related to substances. As physician Gabor Maté discusses, “Addiction has little to do with illicit substances. It’s just not about drugs. Or gambling, or shopping, or porn or whatever behavior happens to incinerate the lives of millions. Instead, addiction is about the emotional pain behind the behavior.” Yet certain addictions, such as those that involve illegal substances, are an easy scapegoat, since those with severe addiction have trouble being efficient producers in the capitalist system (this is obviously not everyone, many with substance use addiction function efficiently from day to day). But other, arguably much more damaging “addictions,” such as addictions to power, wealth, consumerism, etc., are not just criminalized but often lauded under capitalism. This is no surprise under a system that consistently needs to expand, concentrating wealth in the hands of a few. Why wouldn’t those who exemplify such values — those who serve the central tenets of capitalism — be celebrated?

Care about Overdose? Do What Actually Works

If capitalist politicians cared about overdose deaths, they would work to enact policies that actually work to save lives. Such policies often center around approaching individuals with love, compassion, and respect. For example, a center in New York City where I serve as a staff physician called OnPoint NYC is the nation’s first overdose-prevention site. People using drugs can obtain safe use supplies, overdose reversal kits, medical care, substance use treatment, and social services without stigma or judgment. The center also has a space where people can come, test their drugs to make sure they are safe, and even use them under supervision. Participants of OnPoint are treated with love, kindness, and respect, regardless of their histories or social situations.

Since its opening in November 2021 OnPoint has prevented over 700 overdoses and had over 55,000 visits. The concept of an overdose-prevention site is not new — the first site opened in Switzerland in 1986 — but it is telling that despite the proof that these measures work, the first center opened only in November 2021 (and this site operates in a legal gray zone, since allowing people to use illegal substances on site is still federally illegal but permitted by the city government). Although OnPoint has shown that this model can work in the U.S., there have been few measures on the state and federal level to expand this model across the U.S. Governments would rather discuss using settlements from opioid lawsuits to increase budgets for police departments to terrorize communities than open centers similar to OnPoint.

And there are other models that have worked around the world that the U.S. still refuses to use, largely because of the legacy of the ongoing drug war. For example, heroin-assisted treatment (HAT) is an option that is part of the national health system of Switzerland, Germany, the Netherlands, Canada, and Denmark. This allows healthcare workers to prescribe medical grade heroin to individuals with opioid use disorder so that those with opioid use disorder to not have to risk their health or well-being using a substance they buy off the street that could be contaminated. This option is still unavailable to healthcare workers like myself in the U.S.

Other countries have decided to decriminalize or legalize drugs altogether, attempting to take a more health-oriented approach to drug use. For example, in 2001, Portugal decided that possessing drugs for personal use would no longer be treated as a crime, which would often include police interaction, possible arrest, a criminal record, and associated stigma. Instead, they decided to invest in public health measures to combat substance use, such as increased substance use treatment and healthcare. Data from these changes show that “drug-related deaths have remained below the EU average since 2001, the proportion of prisoners sentenced for drugs has fallen from 40 percent to 15 percent, and rates of drug use have remained consistently below the EU average.” Legalization of all drugs and investment in public health measures would also destabilize the underground market that criminalization creates in the first place — destabilize a market that capitalist politicians claim to care so much about combating.

Going Beyond

It goes beyond these measures, though. We need a society that allows people to flourish, where they are not treated as expendable tools for capitalist exploitation. Where everyone has access to free housing and free healthcare, and can pursue their dreams and passions without the threat of poverty or homelessness. Instead, we have a society that sends people off to imperialist wars to fight their working-class brothers and sisters, only to return to a society that does not care for them or their internalized trauma or suffering and leaves them to self-medicate untreated physical or emotional pain. We want a society where those who are suffering from substance use addiction are not condemned or vilified, but treated as humans who deserve love, kindness, and respect. But this society cannot be achieved under capitalism, a system that creates and exacerbates poverty, inequality, suffering, and illness. While substance addiction and overdose may never be eliminated, they can be mitigated. The illness and death often caused by those using substances today do not have to exist. Every overdose death today could be prevented, but that can’t happen with capitalist politicians peddling the same old responses. It can’t happen with capitalist politicians weaponizing overdose deaths to further advance political measures that create the exact situation they claim to be trying to solve.

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Mike Pappas

Mike is an activist and medical doctor working in New York City.

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