The Worst Addiction Epidemic in U.S. History

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Re: The Worst Addiction Epidemic in U.S. History

Postby liminalOyster » Sat Nov 10, 2018 10:10 pm

Opioids of the Masses
Brian Snyder

In 2016, nearly 50,000 people died of opioid overdoses in the United States, and, per capita, almost as many died in Canada. From 2000 to 2016, more Americans died of overdoses than died in World War I and World War II combined. Yet even these grim numbers understate the impact of opioid abuse, because for every person who dies, many more live with addiction. The White House Council of Economic Advisers has estimated that the epidemic cost the U.S. economy $504 billion in 2015, or 2.8 percent of GDP.

This public health story is now common knowledge. Less well known is the growing risk that the epidemic will spread across the globe. Facing a backlash in the United States and Canada, drug companies are turning their attention to Asia and Europe and repeating the tactics that created the crisis in the first place. At the same time, the rise of fentanyl, a highly potent synthetic opioid, has made the outbreak even deadlier and begun to reshape the global drug market, a development with significant foreign policy implications. As a result, the world is on the cusp of a global opioid epidemic, driven by the overuse of legal painkillers and worsened by the spread of fentanyl, that could mark a public health disaster of historic proportions.

Yet in the face of this terrifying possibility, the world has remained largely complacent. Governments and international organizations urgently need to learn the lessons of the North American crisis. The first and most important of those is that the more opioids flood the market, the bigger the problem will be—and so governments must couple efforts to treat addicted individuals with efforts to curb supply. That will require them to crack down on pharmaceutical companies that abuse their positions and to take aggressive steps to regulate the sale and marketing of opioids. And the rise of synthetic opioids means that governments must rethink the role that fighting drug trafficking plays in their foreign policies.

THE PRESCRIPTION AND THE DAMAGE DONE

Opioids derived from the opium poppy have long been used successfully to relieve short-term pain from surgery and to comfort patients with terminal conditions, including cancer. Problems can arise, however, when they are prescribed for prolonged periods to treat nonterminal chronic pain. Extended use raises the risk of addiction and increases tolerance, meaning that patients need more and more of the drug to achieve the same effect. Opioids are so dangerous because the difference between a lethal dose and a normal one is only a modest multiple. Worse still, a dose that works today can kill tomorrow, especially if the patient has taken other drugs, such as alcohol or benzodiazepines (a class of drugs that includes Valium and Xanax). And because an overdose kills by depriving the body of oxygen, even those who survive risk serious organ damage.

Opioids are widely misused for three reasons. First, clinicians can’t objectively measure pain in the way they can body temperature or blood pressure, so they rely on patients’ accuracy and honesty in judging pain severity. Second, opioids are highly prized, even by healthy people, because of the euphoria they create. And third, anyone without scruples can sell prescription opioids on the black market.

The largess of manufacturers flowed to virtually every organization that should have been protecting the public.

After several epidemics involving legal medications in the nineteenth century, in 1914, the U.S. government banned most distribution of opioids. For nearly 50 years after that, North America saw few opioid-related problems besides heroin use in a few U.S. and Canadian cities. In the late 1960s and 1970s, heroin spread to more cities, but then stalled. From the 1970s to the mid-1990s, the number of dependent users was fairly stable.

All of that changed in the mid-1990s. Several pharmaceutical companies began aggressively marketing opioids to treat chronic, not just acute, pain, claiming they carried little risk of addiction. The most infamous was Purdue Pharma, the maker of OxyContin, but other companies rolled out similar products. As the New York Times journalist Barry Meier and the psychiatrist Anna Lembke have documented, their tactics were nearly as ruthless as those of any drug dealer. During the period of mostly uncritical enthusiasm for prescription opioids, the largess of manufacturers flowed to virtually every organization that should have been protecting the public, including health-care regulators, professional medical societies, medical school education programs, elected officials, patient advocacy groups, medical opinion leaders, and state medical boards.

A study by the Center for Public Integrity and the Associated Press found that from 2006 to 2015, the pharmaceutical industry spent $880 million on campaign contributions and lobbying state legislatures, 220 times as much as the amount spent by groups trying to limit opioid use. In 2013, the marketing expenditure of each of the ten largest phar-maceutical companies exceeded the entire budget of the U.S. Food and Drug Administration.

The resulting lax regulatory environment, coupled with a sincere concern that many patients were living with unacceptable levels of pain, released a tsunami of opioid prescriptions. Consumption in the United States quadrupled from 1999 to 2014, peaking at 250 million prescriptions per year. By 2010, the U.S. health-care system was dispensing enough opioids each year for everyone in the country to be medicated round the clock for a month.

A health worker treats a patient recovering from opioid addition, Boston, January 2013.
Brian Snyder / REUTERS
A health worker treats a patient recovering from opioid addition, Boston, January 2013.

In 2007, federal prosecutors secured a guilty plea from Purdue Pharma for knowingly deceiving doctors and patients. The courts fined the company $600 million and required it to more accurately describe the risks and benefits of OxyContin. Still, that fine is dwarfed by the estimated $35 billion of revenue that Purdue has earned from the drug, and the three executives who pled guilty avoided jail sentences. By contrast, someone convicted of selling 100 grams of heroin—worth between $2,500 and $15,000—faces a federal mandatory minimum sentence of five years. Other fines paid by opioid manufacturers and distributors in the United States and Canada have mostly been under $25 million—small enough that companies could treat them as just a cost of doing business.

A recent scandal reveals the extent to which the industry has captured regulators. In 2016, Eric Eyre, a determined West Virginia journalist, discovered that drug companies had shipped nearly nine million opioid pills to a pharmacy in Kermit, West Virginia, a town with fewer than 400 residents. The Drug Enforcement Administration was already investigating why the companies that distributed these opioids did not report or stop the suspicious shipments. But the opioid distributors responded by hiring away DEA officials, many of them from the division responsible for regulating the industry, and by lobbying friendly politicians. In 2016, Congress passed legislation curtailing the DEA’s ability to pursue any such cases.

One of the leaders in that effort, Tom Marino, a Republican congressman from Pennsylvania and a recipient of extensive campaign donations from the industry, was even nominated by President Donald Trump to serve as the director of the Office of National Drug Control Policy. Marino withdrew when The Washington Post and 60 Minutes broke the story of his involvement with the bill, but his nomination showed that the administration was willing to put its drug policy in the hands of a creature of the industry. And despite Marino’s withdrawal, the pro-industry policy created by Congress remains firmly in place.

SELLING NIRVANA

The liberalization of painkiller prescriptions has fueled a black market thanks to a straightforward economic calculus. The black market pays about $1 per milligram for oxycodone pills. A typical daily dose for a long-term opioid patient is 100 milligrams, or $36,500 worth of pills a year. Thus, a patient with a $30 copay for a 30-day prescription pays $1 a day for medicines that can then be sold for $100. Those skilled at working the system can obtain prescriptions for hundreds of milligrams a day, either from one doctor or by doctor shopping.

Although most patients are not criminals, many criminals pretend to be patients. Furthermore, even otherwise honest people can be tempted into crime when the payoff is that great. Just by lying about a medical condition that doctors cannot verify with any objective test, a patient can obtain prescriptions worth tens of thousands of dollars.

Even for those who truly need the drugs, the black market offers attractive opportunities. A single milligram of pure heroin usually sells for under $1, slightly less than the price that a milligram of oxycodone commands, even though heroin is roughly three times as potent. Selling prescription pills and buying heroin thus lets the user more than triple his or her opioid consumption or, alternatively, keep the same rate of consumption and buy groceries or pay the rent.

This creates a vicious cycle: addicted people obtain prescriptions, which they sell to others, who become addicted and seek their own prescriptions, which they then sell in turn, addicting still others. This process has driven a boom in demand. Heroin use, which had stayed stable for many years, surged as people who had become addicted to prescription opioids shifted to black-market alternatives.

Beginning around 2014, black-market fentanyl compounded matters. Fentanyl did not create the crisis: prescribed opioids were already killing tens of thousands of people. But it threw gasoline on the fire. Dealers began cutting heroin with cheap diluents and then adding fentanyl—which is less expensive and more potent than other opioids—to raise the strength of the mixture before selling it as heroin. Deaths in the United States from synthetic opioids other than methadone (the category that includes fentanyl) jumped from 3,105 in 2013 to 20,145 in 2016.

A WORLD OF PAIN

So far, this dynamic has been most pronounced in the United States and Canada. The United States has an unusually corporate-friendly policy environment, but Canada has a stronger tradition of state regulation. So other countries would be foolish to assume that something similar could not happen to them.

U.S. pharmaceutical companies are already working to expand foreign sales. The Sackler family, which owns Purdue Pharma, also owns Mundipharma, a worldwide network of pharmaceutical companies that is not constrained by the U.S. federal court decision against Purdue. As detailed by the Los Angeles Times, Mundipharma is active in Australia, Brazil, China, Colombia, Egypt, Mexico, the Philippines, Singapore, South Korea, and Spain and is using the same aggressive sales tactics that Purdue Pharma employed in the United States. It runs training seminars in which representatives encourage doctors to overcome their “opiophobia.” It sponsors ad campaigns that promote pharmaceutical treatment for pain. It has hired consultants, local opinion leaders, and an army of sales representatives to promote its products.

The Los Angeles Times reported that Mundipharma consultants have claimed that OxyContin presents only a small risk of addiction, the assertion for which Purdue Pharma was fined in the United States. As David Kessler, a former U.S. Food and Drug Administration commissioner, told the Los Angeles Times, Mundipharma’s strategy is “right out of the playbook of Big Tobacco. As the United States takes steps to limit sales here, the company goes abroad.”

In May 2017, a bipartisan group of 12 members of the U.S. Congress wrote to the director general of the World Health Organization (WHO) to warn against the predations of Mundipharma. But it is not clear that the world heard the message. Already, several countries appear to be falling into the trap of opioid use. In Germany, prescription rates have risen to nearly the Canadian level. In Australia, OxyContin prescriptions have increased sharply, and Mundipharma has contributed funding to the development of national pain-management strategies. In much of the developing world, where states are weaker and drug manufacturers have a freer hand, the outlook is even worse.

A NEW PRESCRIPTION

To prevent the North American crisis from growing into a global one, several steps must be taken now, before it is too late. First, jurisdictions that decide to liberalize their prescription opioid policies must plan to spend more on drug treatment and other services for those struggling with opioid addiction, rather than playing catch-up after the problem has grown. But just treating addicted people will not solve the problem. Governments must also address the incentives pharmaceutical companies have for profiting from oversupplying and overpromoting opioids.

A simple, although radical, policy would be to ban for-profit companies from selling prescription opioids for extended home use, allowing only the government or nonprofit organizations to do so. A less extreme idea would involve a ban on branding. Regulators could require pharmacies to sell only generic products or, at the least, prevent manufacturers and retailers from advertising their drugs. Although such bans are largely unconstitutional in the United States, many countries do have the power to restrict advertising. (The restrictions on promotion that have worked in the United States have come primarily from legal settlements such as those imposed on the tobacco industry, not legislation.)

A more complex alternative would be to develop a distinct and more stringent set of regulations for opioids that would recognize the unique challenges they pose. Whereas for most drugs it makes sense for regulators to consider only whether the drugs are safe and effective for patients when used as directed, that standard is woefully inadequate for drugs that are as easily and widely abused as opioids. Regulators should take all foreseeable consequences into account, not just those likely to follow from the proper use of prescribed opioids.

Tighter regulation could also include new ways of calculating fines for drug companies that break the law. There is little evidence that one-off penalties change corporate behavior. But agreements that made fines contingent on outcomes might. If opioid manufacturers faced, say, a $1 million fine for every overdose involving one of their products, they would have an enduring incentive to regulate themselves.

The WHO and the United Nations could help in two ways. Many low- and middle-income countries face the opposite problem of rich ones: they do not use enough opioids, a shortfall that leads to unneeded suffering, particularly for the terminally ill. Rather than let profit-seeking corporations exploit that opportunity and push the needle too far in the other direction, the WHO or another UN agency should provide generic morphine to patients in those countries as a humanitarian priority. The WHO and the UN should also warn their members against pharmaceutical companies with expansionist visions and questionable ethics. Just as pharmaceutical companies send their sales representatives to promote their drugs, the WHO and other public interest groups could send representatives to explain how and why the current opioid epidemic started and escalated.

Trump displays a presidential public health emergency declaration on the nation's opioid crisis in the East Room of the White House, October 2017.
Kevin Lamarque / REUTERS
Trump displays a presidential public health emergency declaration on the nation's opioid crisis in the East Room of the White House, October 2017.

TURNING OFF THE TAP

Drug policy experts often dismiss attempts to cut down on supply, arguing that governments cannot arrest their way out of drug problems. That is largely correct when it comes to street dealers. Locking up people who are easily replaced does little to stem the flow or use of most drugs. Furthermore, prisoners who depend on opioids lose their tolerance while in prison, and some then die of overdoses when they are released.

Legal drugs can bring death on a scale vastly surpassing the effects of illegal ones.

Luckily, there is a wide space between the two extremes of waging war on drug dealers and users and turning over the keys of public health and safety to rapacious companies that profit by pushing addictive drugs. Authorities can stop a doctor who prescribes illegally or irresponsibly just by revoking his or her license, no expensive prison cell needed. The tactic works because the black market cannot replace those doctors. This practice is already used, but such investigations should be given greater resources. Targeting corporations is even cheaper, since the resulting fines are often larger than the costs of investigation and prosecution. To make these investigations easier, Congress should repeal the law it passed in 2016 that restricted the DEA’s power. Other countries should make sure that their law enforcement agencies are empowered to investigate and prosecute gross corporate malfeasance.

A key lesson of the current epidemic repeats one from the history of tobacco: legal drugs pushed by corporations can bring death on a scale vastly surpassing the effects of illegal ones. Calls to legalize recreational opioids that fail to grapple with this reality do not deserve to be taken seriously.

Governments will also need to recognize a central lesson of public health research: epidemics cannot be ended simply by managing individual cases of the disease. Take Vancouver, British Columbia, which has thoroughly embraced the idea that providing health and social services can solve drug problems. Residents have access to universal health care, drug treatment programs, syringe exchanges, supervised rooms in which they can use drugs, the overdose rescue drug naloxone, and opioid substitution treatments, including government-provided heroin. The city and the province have positioned themselves as world leaders in this harm-reduction approach. Yet the overdose death rate in the Vancouver health service delivery area rose by 36 percent in 2016, reaching 53.8 deaths per 100,000 residents last year. That is similar to the rate in West Virginia, which has few services and is the U.S. state that has been the hardest hit, where 52 people died of overdoses for every 100,000 residents in 2016. Services for people addicted to opioids are essential. But the lesson of Vancouver is that expanding health and social services without addressing opioid supply is akin to emptying an overflowing bathtub with a thimble without turning down the tap.

FUEL ON THE FIRE

The rise of fentanyl is both making the North American crisis worse and complicating efforts to forestall the emerging global one. For drug traffickers and dealers, fentanyl offers many advantages and could reshape the global opioid market in ways that would have important consequences for foreign policy and international relations, not just public health. Traditional illicit drugs, such as heroin and cocaine, flow through long distribution chains that include as many as ten transactions between the farmer and the user. Parts of those chains, especially the links crossing international borders, often favor large criminal organizations that can intimidate or co-opt authorities. Fentanyl, by contrast, can be produced secretly anywhere there is a chemical industry, not just where poppies grow.

Fentanyl is also far less labor-intensive to make than heroin, so its sponsors gain significantly less political capital by providing jobs than do the sponsors of illegal poppy cultivation. Disrupting fentanyl production is therefore less politically costly and has fewer negative side effects for counterinsurgency and counterterrorism efforts than eradicating drug crops. And fentanyl is so concentrated that it can be mailed a kilogram at a time. That radically reduces transportation costs and the role and power of organizations whose comparative advantage lies in smuggling large shipments across international borders.

These factors will drive down prices, raising consumption. But the consumption of opioids tends to rise in smaller proportion to the fall in prices. (A ten percent decrease in the price, for example, leads to an increase in use of less than ten percent.) Hence, fentanyl will tend to depress producers’ revenues and power. In countries that allow drug companies to market opioids aggressively, however, that effect will likely be more than offset by an intensifying demand for black-market opioids.

Fentanyl also has the potential to alter the balance of power among drug-trafficking organizations. Mexico’s Sinaloa cartel, for example, which has long dominated the distribution of heroin and cocaine in the United States, could well lose market share to its rival Jalisco New Generation, which embraced fentanyl early, back in 2014. That is not necessarily good news, because the Sinaloa cartel has traditionally been less violent than Jalisco New Generation. If that group challenges Sinaloa’s dominance north of the Mexican border, drug-related violence within the United States could well increase, both among dealers and against law enforcement and public officials.

Sinaloa has begun to adapt by moving aggressively into the distribution of fentanyl, at least on the eastern coast of the United States. It is a major supplier of the drug to New York City, for example, where drug overdose deaths last year were four times as many as homicide deaths. That’s a worrying trend, but at least Sinaloa continues to shun violence in the United States. For example, it sometimes employs nonviolent, middle-aged couples without prior criminal records to distribute fentanyl, sending them on one-time drug runs by train or car. That makes stopping them harder, but it keeps violence down.

Fentanyl’s rise could also split the global drug market. In affluent places where heroin is expensive, including Canada, the United States, and Europe, users might switch to cheaper synthetics. That would leave countries that grow poppies, such as Afghanistan and Myanmar, primarily supplying neighboring countries with high addiction rates, such as China, Iran, Pakistan, and Russia. Synthetics are less likely to make inroads in those countries because they are close to heroin production areas and have lax law enforcement and porous borders, so heroin is far cheaper.

All of this could reshape international relationships. If U.S. consumption shifts from plant-based to synthetic drugs, Washington’s interest in eradicating drug crops could wane, removing a decades-old source of tension between the United States and Latin American countries. From 2001 to 2009, U.S. programs to eradicate poppy fields in Afghanistan, where a large proportion of the economy depends on drugs, drove farmers to embrace militant and terrorist groups. Abandoning that approach, a major policy breakthrough of the Obama administration, has helped with counterinsurgency and nation building. The Trump administration should not resurrect it. If synthetic opioids replaced cocaine consumption or a synthetic cocaine analogue were developed, the coca-producing countries of Bolivia, Colombia, and Peru could see similar effects.

It will be much harder to persuade larger and more powerful synthetic-drug-producing countries, such as China and India, to crack down on manufacturers. And because U.S. and Canadian relations with China and India cover far more issues than those with South American countries, drug control efforts would have to compete against other interests.

A bifurcation in international drug markets would exacerbate splits over global drug policy, heightening differences between the interests of hawkish countries in Asia and the Middle East and those of more liberal ones in Europe and Latin America. International drug control would likely climb up the agendas of countries whose populations still relied on plant-based drugs, especially China and Russia. Russia, which is suffering from an opioid epidemic revolving around Afghan heroin, might well continue pressuring the United States to eradicate poppy fields in Afghanistan and even take it upon itself to do so. Moscow would likely view controlling drug supplies as more important than limiting the political capital the Taliban can gain from fighting to protect poppy fields. Already, Russia is courting the Taliban, perceiving the group as a lesser danger in Afghanistan than the Islamic State (also known as ISIS). Washington would be wise to engage Beijing and Moscow to educate them on the mistakes the United States has made in its fight against drugs that they should avoid and the successes they should replicate.

https://www.foreignaffairs.com/articles ... ids-masses


The Poison We Pick
This nation pioneered modern life. Now epic numbers of Americans are killing themselves with opioids to escape it.
By Andrew Sullivan

It is a beautiful, hardy flower, Papaver somniferum, a poppy that grows up to four feet in height and arrives in a multitude of colors. It thrives in temperate climates, needs no fertilizer, attracts few pests, and is as tough as many weeds. The blooms last only a few days and then the petals fall, revealing a matte, greenish-gray pod fringed with flutes. The seeds are nutritious and have no psychotropic effects. No one knows when the first curious human learned to crush this bulblike pod and mix it with water, creating a substance that has an oddly calming and euphoric effect on the human brain. Nor do we know who first found out that if you cut the pod with a small knife, capture its milky sap, and leave that to harden in the air, you’ll get a smokable nugget that provides an even more intense experience. We do know, from Neolithic ruins in Europe, that the cultivation of this plant goes back as far as 6,000 years, probably farther. Homer called it a “wondrous substance.” Those who consumed it, he marveled, “did not shed a tear all day long, even if their mother or father had died, even if a brother or beloved son was killed before their own eyes.” For millennia, it has salved pain, suspended grief, and seduced humans with its intimations of the divine. It was a medicine before there was such a thing as medicine. Every attempt to banish it, destroy it, or prohibit it has failed.

The poppy’s power, in fact, is greater than ever. The molecules derived from it have effectively conquered contemporary America. Opium, heroin, morphine, and a universe of synthetic opioids, including the superpowerful painkiller fentanyl, are its proliferating offspring. More than 2 million Americans are now hooked on some kind of opioid, and drug overdoses — from heroin and fentanyl in particular — claimed more American lives last year than were lost in the entire Vietnam War. Overdose deaths are higher than in the peak year of AIDS and far higher than fatalities from car crashes. The poppy, through its many offshoots, has now been responsible for a decline in life spans in America for two years in a row, a decline that isn’t happening in any other developed nation. According to the best estimates, opioids will kill another 52,000 Americans this year alone — and up to half a million in the next decade.

We look at this number and have become almost numb to it. But of all the many social indicators flashing red in contemporary America, this is surely the brightest. Most of the ways we come to terms with this wave of mass death — by casting the pharmaceutical companies as the villains, or doctors as enablers, or blaming the Obama or Trump administrations or our policies of drug prohibition or our own collapse in morality and self-control or the economic stress the country is enduring — miss a deeper American story. It is a story of pain and the search for an end to it. It is a story of how the most ancient painkiller known to humanity has emerged to numb the agonies of the world’s most highly evolved liberal democracy. Just as LSD helps explain the 1960s, cocaine the 1980s, and crack the 1990s, so opium defines this new era. I say era, because this trend will, in all probability, last a very long time. The scale and darkness of this phenomenon is a sign of a civilization in a more acute crisis than we knew, a nation overwhelmed by a warp-speed, postindustrial world, a culture yearning to give up, indifferent to life and death, enraptured by withdrawal and nothingness. America, having pioneered the modern way of life, is now in the midst of trying to escape it.

How Marketing — and Medicine — Spurred the Opioid Crisis
How does an opioid make you feel? We tend to avoid this subject in discussing recreational drugs, because no one wants to encourage experimentation, let alone addiction. And it’s easy to believe that weak people take drugs for inexplicable, reckless, or simply immoral reasons. What few are prepared to acknowledge in public is that drugs alter consciousness in specific and distinct ways that seem to make people at least temporarily happy, even if the consequences can be dire. Fewer still are willing to concede that there is a significant difference between these various forms of drug-induced “happiness” — that the draw of crack, say, is vastly different than that of heroin. But unless you understand what users get out of an illicit substance, it’s impossible to understand its appeal, or why an epidemic takes off, or what purpose it is serving in so many people’s lives. And it is significant, it seems to me, that the drugs now conquering America are downers: They are not the means to engage in life more vividly but to seek a respite from its ordeals.

The alkaloids that opioids contain have a large effect on the human brain because they tap into our natural “mu-opioid” receptors. The oxytocin we experience from love or friendship or orgasm is chemically replicated by the molecules derived from the poppy plant. It’s a shortcut — and an instant intensification — of the happiness we might ordinarily experience in a good and fruitful communal life. It ends not just physical pain but psychological, emotional, even existential pain. And it can easily become a lifelong entanglement for anyone it seduces, a love affair in which the passion is more powerful than even the fear of extinction.

Perhaps the best descriptions of the poppy’s appeal come to us from the gifted writers who have embraced and struggled with it. Many of the Romantic luminaries of the early-19th century — including the poets Coleridge, Byron, Shelley, Keats, and Baudelaire, and the novelist Walter Scott — were as infused with opium as the late Beatles were with LSD. And the earliest and in many ways most poignant account of what opium and its derivatives feel like is provided by the classic memoir Confessions of an English Opium-Eater, published in 1821 by the writer Thomas De Quincey.

De Quincey suffered trauma in childhood, losing his sister when he was 6 and his father a year later. Throughout his life, he experienced bouts of acute stomach pain, as well as obvious depression, and at the age of 19 he endured 20 consecutive days of what he called “excruciating rheumatic pains of the head and face.” As his pain drove him mad, he finally went into an apothecary and bought some opium (which was legal at the time, as it was across the West until the war on drugs began a century ago).

An hour after he took it, his physical pain had vanished. But he was no longer even occupied by such mundane concerns. Instead, he was overwhelmed with what he called the “abyss of divine enjoyment” that overcame him: “What an upheaving from its lowest depths, of the inner spirit! … here was the secret of happiness, about which philosophers had disputed for many ages.” The sensation from opium was steadier than alcohol, he reported, and calmer. “I stood at a distance, and aloof from the uproar of life,” he wrote. “Here were the hopes which blossom in the paths of life, reconciled with the peace which is in the grave.” A century later, the French writer Jean Cocteau described the experience in similar ways: “Opium remains unique and the euphoria it induces superior to health. I owe it my perfect hours.”

The metaphors used are often of lightness, of floating: “Rising even as it falls, a feather,” as William Brewer, America’s poet laureate of the opioid crisis, describes it. “And then, within a fog that knows what I’m going to do, before I do — weightlessness.” Unlike cannabis, opium does not make you want to share your experience with others, or make you giggly or hungry or paranoid. It seduces you into solitude and serenity and provokes a profound indifference to food. Unlike cocaine or crack or meth, it doesn’t rev you up or boost your sex drive. It makes you drowsy — somniferum means “sleep-inducing” — and lays waste to the libido. Once the high hits, your head begins to nod and your eyelids close.

When we see the addicted stumbling around like drunk ghosts, or collapsed on sidewalks or in restrooms, their faces pale, their skin riddled with infection, their eyes dead to the world, we often see only misery. What we do not see is what they see: In those moments, they feel beyond gravity, entranced away from pain and sadness. In the addict’s eyes, it is those who are sober who are asleep. That is why the police and EMS workers who rescue those slipping toward death by administering blasts of naloxone — a powerful antidote, without which death rates would be even higher — are almost never thanked. They are hated. They ruined the high. And some part of being free from all pain makes you indifferent to death itself. Death is, after all, the greatest of existential pains. “Everything one achieves in life, even love, occurs in an express train racing toward death,” Cocteau observed. “To smoke opium is to get out of the train while it is still moving. It is to concern oneself with something other than life or death.”

This terrifyingly dark side of the poppy reveals itself the moment one tries to break free. The withdrawal from opioids is unlike any other. The waking nightmares, hideous stomach cramps, fevers, and psychic agony last for weeks, until the body chemically cleanses itself. “A silence,” Cocteau wrote, “equivalent to the crying of thousands of children whose mothers do not return to give them the breast.” Among the symptoms: an involuntary and constant agitation of the legs (whence the term “kicking the habit”). The addict becomes ashamed as his life disintegrates. He wants to quit, but, as De Quincey put it, he lies instead “under the weight of incubus and nightmare … he would lay down his life if he might get up and walk; but he is powerless as an infant, and cannot even attempt to rise.”

The poppy’s paradox is a profoundly human one: If you want to bring Heaven to Earth, you must also bring Hell. In the words of Lenny Bruce, “I’ll die young, but it’s like kissing God.”


Photo-Illustration: Joe Darrow
No other developed country is as devoted to the poppy as America. We consume 99 percent of the world’s hydrocodone and 81 percent of its oxycodone. We use an estimated 30 times more opioids than is medically necessary for a population our size. And this love affair has been with us from the start. The drug was ubiquitous among both the British and American forces in the War of Independence as an indispensable medicine for the pain of battlefield injuries. Thomas Jefferson planted poppies at Monticello, and they became part of the place’s legend (until the DEA raided his garden in 1987 and tore them out of the ground). Benjamin Franklin was reputed to be an addict in later life, as many were at the time. William Wilberforce, the evangelical who abolished the British slave trade, was a daily enthusiast. As Martin Booth explains in his classic history of the drug, poppies proliferated in America, and the use of opioids in over-the-counter drugs was commonplace. A wide range of household remedies were based on the poppy’s fruit; among the most popular was an elixir called laudanum — the word literally means “praiseworthy” — which took off in England as early as the 17th century.

Mixed with wine or licorice, or anything else to disguise the bitter taste, opiates were for much of the 19th century the primary treatment for diarrhea or any physical pain. Mothers gave them to squalling infants as a “soothing syrup.” A huge boom was kick-started by the Civil War, when many states cultivated poppies in order to treat not only the excruciating pain of horrific injuries but endemic dysentery. Booth notes that 10 million opium pills and 2 million ounces of opiates in powder or tinctures were distributed by Union forces. Subsequently, vast numbers of veterans became addicted — the condition became known as “Soldier’s Disease” — and their high became more intense with the developments of morphine and the hypodermic needle. They were joined by millions of wives, sisters, and mothers who, consumed by postwar grief, sought refuge in the obliviating joy that opiates offered.

Based on contemporary accounts, it appears that the epidemic of the late 1860s and 1870s was probably more widespread, if far less intense, than today’s — a response to the way in which the war tore up settled ways of life, as industrialization transformed the landscape, and as huge social change generated acute emotional distress. This aspect of the epidemic — as a response to mass social and cultural dislocation — was also clear among the working classes in the earlier part of the 19th century in Britain. As small armies of human beings were lured from their accustomed rural environments, with traditions and seasons and community, and thrown into vast new industrialized cities, the psychic stress gave opium an allure not even alcohol could match. Some historians estimate that as much as 10 percent of a working family’s income in industrializing Britain was spent on opium. By 1870, opium was more available in the United States than tobacco was in 1970. It was as if the shift toward modernity and a wholly different kind of life for humanity necessitated for most working people some kind of relief — some way of getting out of the train while it was still moving.

It is tempting to wonder if, in the future, today’s crisis will be seen as generated from the same kind of trauma, this time in reverse.
If industrialization caused an opium epidemic, deindustrialization is no small part of what’s fueling our opioid surge. It’s telling that the drug has not taken off as intensely among all Americans — especially not among the engaged, multiethnic, urban-dwelling, financially successful inhabitants of the coasts. The poppy has instead found a home in those places left behind — towns and small cities that owed their success to a particular industry, whose civic life was built around a factory or a mine. Unlike in Europe, where cities and towns existed long before industrialization, much of America’s heartland has no remaining preindustrial history, given the destruction of Native American societies. The gutting of that industrial backbone — especially as globalization intensified in a country where market forces are least restrained — has been not just an economic fact but a cultural, even spiritual devastation. The pain was exacerbated by the Great Recession and has barely receded in the years since. And to meet that pain, America’s uniquely market-driven health-care system was more than ready.

The great dream of the medical profession, which has been fascinated by opioids over the centuries, was to create an experience that captured the drug’s miraculous pain relief but somehow managed to eliminate its intoxicating hook. The attempt to refine opium into a pain reliever without addictive properties produced morphine and later heroin — each generated by perfectly legal pharmaceutical and medical specialists for the most enlightened of reasons. (The word heroin was coined from the German word Heroisch, meaning “heroic,” by the drug company Bayer.) In the mid-1990s, OxyContin emerged as the latest innovation: A slow timed release would prevent sudden highs or lows, which, researchers hoped, would remove craving and thereby addiction. Relying on a single study based on a mere 38 subjects, scientists concluded that the vast majority of hospital inpatients who underwent pain treatment with strong opioids did not go on to develop an addiction, spurring the drug to be administered more widely.

This reassuring research coincided with a social and cultural revolution in medicine: In the wake of the AIDS epidemic, patients were becoming much more assertive in managing their own treatment — and those suffering from debilitating pain began to demand the relief that the new opioids promised. The industry moved quickly to cash in on the opportunity: aggressively marketing the new drugs to doctors via sales reps, coupons, and countless luxurious conferences, while waging innovative video campaigns designed to be played in doctors’ waiting rooms. As Sam Quinones explains in his indispensable account of the epidemic, Dreamland, all this happened at the same time that doctors were being pressured to become much more efficient under the new regime of “managed care.” It was a fateful combination: Patients began to come into doctors’ offices demanding pain relief, and doctors needed to process patients faster. A “pain” diagnosis was often the most difficult and time-consuming to resolve, so it became far easier just to write a quick prescription to abolish the discomfort rather than attempt to isolate its cause. The more expensive and laborious methods for treating pain — physical and psychological therapy — were abandoned almost overnight in favor of the magic pills.

A huge new supply and a burgeoning demand thereby created a massive new population of opioid users. Getting your opioid fix no longer meant a visit to a terrifying shooting alley in a ravaged city; now it just required a legitimate prescription and a bottle of pills that looked as bland as a statin or an SSRI. But as time went on, doctors and scientists began to realize that they were indeed creating addicts. Much of the initial, hopeful research had been taken from patients who had undergone opioid treatment as inpatients, under strict supervision. No one had examined the addictive potential of opioids for outpatients, handed bottles and bottles of pills, in doses that could be easily abused. Doctors and scientists also missed something only recently revealed about OxyContin itself: Its effects actually declined after a few hours, not 12 — thus subjecting most patients to daily highs and lows and the increased craving this created. Patients whose pain hadn’t gone away entirely were kept on opioids for longer periods of time and at higher dosages. And OxyContin had not removed the agonies of withdrawal: Someone on painkillers for three months would often find, as her prescription ran out, that she started vomiting or was convulsed with fever. The quickest and simplest solution was a return to the doctor.

Add to this the federal government’s move in the mid-1980s to replace welfare payments for the poor with disability benefits — which covered opioids for pain — and unscrupulous doctors, often in poorer areas, found a way to make a literal killing from shady pill mills. So did many patients. A Medicaid co-pay of $3 for a bottle of pills, as Quinones discovered, could yield $10,000 on the streets — an economic arbitrage that enticed countless middle-class Americans to become drug dealers. One study has found that 75 percent of those addicted to opioids in the United States began with prescription painkillers given to them by a friend, family member, or dealer. As a result, the social and cultural profile of opioid users shifted as well: The old stereotype of a heroin junkie — a dropout or a hippie or a Vietnam vet — disappeared in the younger generation, especially in high schools. Football players were given opioids to mask injuries and keep them on the field; they shared them with cheerleaders and other popular peers; and their elevated social status rebranded the addiction. Now opiates came wrapped in the bodies and minds of some of the most promising, physically fit, and capable young men and women of their generation. Courtesy of their doctors and coaches.

It’s hard to convey the sheer magnitude of what happened. Between 2007 and 2012, for example, 780 million hydrocodone and oxycodone pills were delivered to West Virginia, a state with a mere 1.8 million residents. In one town, population 2,900, more than 20 million opioid prescriptions were processed in the past decade. Nationwide, between 1999 and 2011, oxycodone prescriptions increased sixfold. National per capita consumption of oxycodone went from around 10 milligrams in 1995 to almost 250 milligrams by 2012.

The quantum leap in opioid use arrived by stealth. Most previous drug epidemics were accompanied by waves of crime and violence, which prompted others, outside the drug circles, to take notice and action. But the opioid scourge was accompanied, during its first decade, by a record drop in both. Drug users were not out on the streets causing mayhem or havoc. They were inside, mostly alone, and deadly quiet. There were no crack houses to raid or gangs to monitor. Overdose deaths began to climb, but they were often obscured by a variety of dry terms used in coroners’ reports to hide what was really happening. When the cause of death was inescapable — young corpses discovered in bedrooms or fast-food restrooms — it was also, frequently, too shameful to share. Parents of dead teenagers were unlikely to advertise their agony.

In time, of course, doctors realized the scale of their error. Between 2010 and 2015, opioid prescriptions declined by 18 percent. But if it was a huge, well-intended mistake to create this army of addicts, it was an even bigger one to cut them off from their supply. That is when the addicted were forced to turn to black-market pills and street heroin. Here again, the illegal supply channel broke with previous patterns. It was no longer controlled by the established cartels in the big cities that had historically been the main source of narcotics. This time, the heroin — particularly cheap, black-tar heroin from Mexico — came from small drug-dealing operations that avoided major urban areas, instead following the trail of methadone clinics and pill mills into the American heartland.

A recent shipment of fentanyl seized in New Jersey fit into the trunk of single car, yet contained more potential death than a dirty bomb or a small nuke.
Their innovation, Quinones discovered, was to pay the dealers a flat salary, rather than a cut from the heroin itself. This removed the incentives to weaken the product, by cutting it with baking soda or other additives, and so made the new drug much more predictable in its power and reliable in its dosage. And rather than setting up a central location to sell the drugs — like a conventional shooting gallery or crack house — the new heroin marketers delivered it by car. Outside methadone clinics or pill mills, they handed out cards bearing only a telephone number. Call them and they would arrange to meet you near your house, in a suburban parking lot. They were routinely polite and punctual.

Buying heroin became as easy in the suburbs and rural areas as buying weed in the cities. No violence, low risk, familiar surroundings: an entire system specifically designed to provide a clean-cut, friendly, middle-class high. America was returning to the norm of the 19th century, when opiates were a routine medicine, but it was consuming compounds far more potent, addictive, and deadly than any 19th-century tincture enthusiast could have imagined. The country resembled someone who had once been accustomed to opium, who had spent a long time in recovery, whose tolerance for the drug had collapsed, and who was then offered a hit of the most powerful new variety.

The iron law of prohibition, as first stipulated by activist Richard Cowan in 1986, is that the more intense the crackdown, “the more potent the drugs will become.” In other words, the harder the enforcement, the harder the drugs. The legal risks associated with manufacturing and transporting a drug increase exponentially under prohibition, which pushes the cost of supplying the drug higher, which incentivizes traffickers to minimize the size of the product, which leads to innovations in higher potency. That’s why, during the prohibition of alcohol, much of the production and trafficking was in hard liquor, not beer or wine; why amphetamines evolved into crystal meth; why today’s cannabis is much more potent than in the late-20th century. Heroin, rather than old-fashioned opium, became the opioid of the streets.

Then came fentanyl, a massively concentrated opioid that delivers up to 50 times the strength of heroin. Developed in 1959, it is now one of the most widely used opioids in global medicine, its miraculous pain relief delivered through transdermal patches, or lozenges, that have revolutionized surgery and recovery and helped save countless lives. But in its raw form, it is one of the most dangerous drugs ever created by human beings. A recent shipment of fentanyl seized in New Jersey fit into the trunk of a single car yet contained enough poison to wipe out the entire population of New Jersey and New York City combined. That’s more potential death than a dirty bomb or a small nuke. That’s also what makes it a dream for traffickers. A kilo of heroin can yield $500,000; a kilo of fentanyl is worth as much as $1.2 million.

The problem with fentanyl, as it pertains to traffickers, is that it is close to impossible to dose correctly. To be injected at all, fentanyl’s microscopic form requires it to be cut with various other substances, and that cutting is playing with fire. Just the equivalent of a few grains of salt can send you into sudden paroxysms of heaven; a few more grains will kill you. It is obviously not in the interests of drug dealers to kill their entire customer base, but keeping most of their clients alive appears beyond their skill. The way heroin kills you is simple: The drug dramatically slows the respiratory system, suffocating users as they drift to sleep. Increase the potency by a factor of 50 and it is no surprise that you can die from ingesting just a half a milligram of the stuff.

Fentanyl comes from labs in China; you can find it, if you try, on the dark web. It’s so small in size and so valuable that it’s close to impossible to prevent it coming into the country. Last year, 500 million packages of all kinds entered the United States through the regular mail — making them virtually impossible to monitor with the Postal Service’s current technology. And so, over the past few years, the impact of opioids has gone from mass intoxication to mass death. In the last heroin epidemic, as Vietnam vets brought the addiction back home, the overdose rate was 1.5 per 10,000 Americans. Now, it’s 10.5. Three years ago in New Jersey, 2 percent of all seized heroin contained fentanyl. Today, it’s a third. Since 2013, overdose deaths from fentanyl and other synthetic opioids have increased sixfold, outstripping those from every other drug.

If the war on drugs is seen as a century-long game of chess between the law and the drugs, it seems pretty obvious that fentanyl, by massively concentrating the most pleasurable substance ever known to mankind, is checkmate.

Watching as this catastrophe unfolded these past few years, I began to notice how closely it resembles the last epidemic that dramatically reduced life-spans in America: AIDS. It took a while for anyone to really notice what was happening there, too. AIDS occurred in a population that was often hidden and therefore distant from the cultural elite (or closeted within it). To everyone else, the deaths were abstract, and relatively tolerable, especially as they were associated with an activity most people disapproved of. By the time the epidemic was exposed and understood, so much damage had been done that tens of thousands of deaths were already inevitable.

Today, once more, the cultural and political elites find it possible to ignore the scale of the crisis because it is so often invisible in their — our — own lives. The polarized nature of our society only makes this worse: A plague that is killing the other tribe is easier to look away from. Occasionally, members of the elite discover their own children with the disease, and it suddenly becomes more urgent. A celebrity death — Rock Hudson in 1985, Prince in 2016 — begins to break down some of the denial. Those within the vortex of death get radicalized by the failure of government to tackle the problem. The dying gay men who joined ACT UP in the 1980s share one thing with the opioid-ridden communities who voted for Donald Trump in unexpected numbers: a desperate sense of powerlessness, of living through a plague that others are choosing not to see.

At some point, the sheer numbers of the dead become unmissable. With AIDS, the government, along with pharmaceutical companies, eventually developed a plan of action: prevention, education, and research for a viable treatment and cure. Some of this is happening with opioids. The widespread distribution of Narcan sprays — which contain the antidote naloxone — has already saved countless lives. The use of alternative, less-dangerous opioid drugs such as methadone and buprenorphine to wean people off heroin or cushion them through withdrawal has helped. Some harm-reduction centers have established needle-exchange programs. But none of this comes close to stopping the current onslaught. With HIV and AIDS, after all, there was a clear scientific goal: to find drugs that would prevent HIV from replicating. With opioid addiction, there is no such potential cure in the foreseeable future. When we see the toll from opioids exceed that of peak AIDS deaths, it’s important to remember that after that peak came a sudden decline. After the latest fentanyl peak, no such decline looks probable. On the contrary, the deaths continue to mount.

Over time, AIDS worked its way through the political system.
More than anything else, it destroyed the closet and massively accelerated our culture’s acceptance of the dignity and humanity of homosexuals. Marriage equality and open military service were the fruits of this transformation. But with the opioid crisis, our politics has remained curiously unmoved. The Trump administration, despite overwhelming support from many of the communities most afflicted, hasn’t appointed anyone with sufficient clout and expertise to corral the federal government to respond adequately.

The critical Office of National Drug Control Policy has spent a year without a permanent director. Its budget is slated to be slashed by 95 percent, and until a few weeks ago, its deputy chief of staff was a 24-year-old former campaign intern. Kellyanne Conway — Trump’s “opioid czar” — has no expertise in government, let alone in drug control. Although Trump plans to increase spending on treating addiction, the overall emphasis is on an even more intense form of prohibition, plus an advertising campaign. Attorney General Jeff Sessions even recently opined that he believes marijuana is really the key gateway to heroin — a view so detached from reality it beggars belief. It seems clear that in the future, Trump’s record on opioids will be as tainted as Reagan’s was on AIDS. But the human toll could be even higher.

One of the few proven ways to reduce overdose deaths is to establish supervised injection sites that eventually wean users off the hard stuff while steering them into counseling, safe housing, and job training.
After the first injection site in North America opened in Vancouver, deaths from heroin overdoses plunged by 35 percent. In Switzerland, where such sites operate nationwide, overdose deaths have been cut in half. By treating the addicted as human beings with dignity rather than as losers and criminals who have ostracized themselves, these programs have coaxed many away from the cliff face of extinction toward a more productive life.

But for such success to be replicated in the United States, we would have to contemplate actually providing heroin to addicts in some cases, and we’d have to shift much of the current spending on prohibition, criminalization, and incarceration into a huge program of opioid rehabilitation. We would, in short, have to end the war on drugs. We are nowhere near prepared to do that. And in the meantime, the comparison to act up is exceedingly depressing, as the only politics that opioids appear to generate is nihilistic and self-defeating. The drug itself saps initiative and generates social withdrawal. A few small activist groups have sprung up, but it is hardly a national movement of any heft or urgency.

And so we wait to see what amount of death will be tolerable in America as the price of retaining prohibition. Is it 100,000 deaths a year? More? At what point does a medical emergency actually provoke a government response that takes mass death seriously? Imagine a terror attack that killed over 40,000 people. Imagine a new virus that threatened to kill 52,000 Americans this year. Wouldn’t any government make it the top priority before any other?

In some ways, the spread of fentanyl — now beginning to infiltrate cocaine, fake Adderall, and meth, which is also seeing a spike in use — might best be thought of as a mass poisoning. It has infected often nonfatal drugs and turned them into instant killers. Think back to the poison discovered in a handful of tainted Tylenol pills in 1982. Every bottle of Tylenol in America was immediately recalled; in Chicago, police went into neighborhoods with loudspeakers to warn residents of the danger. That was in response to a scare that killed, in total, seven people. In 2016, 20,000 people died from overdosing on synthetic opioids, a form of poison in the illicit drug market. Some lives, it would appear, are several degrees of magnitude more valuable than others. Some lives are not worth saving at all.

One of the more vivid images that Americans have of drug abuse is of a rat in a cage, tapping a cocaine-infused water bottle again and again until the rodent expires. Years later, as recounted in Johann Hari’s epic history of the drug war, Chasing the Scream, a curious scientist replicated the experiment. But this time he added a control group. In one cage sat a rat and a water dispenser serving diluted morphine. In another cage, with another rat and an identical dispenser, he added something else: wheels to run in, colored balls to play with, lots of food to eat, and other rats for the junkie rodent to play or have sex with. Call it rat park. And the rats in rat park consumed just one-fifth of the morphine water of the rat in the cage. One reason for pathological addiction, it turns out, is the environment. If you were trapped in solitary confinement, with only morphine to pass the time, you’d die of your addiction pretty swiftly too. Take away the stimulus of community and all the oxytocin it naturally generates, and an artificial variety of the substance becomes much more compelling.

One way of thinking of postindustrial America is to imagine it as a former rat park, slowly converting into a rat cage. Market capitalism and revolutionary technology in the past couple of decades have transformed our economic and cultural reality, most intensely for those without college degrees. The dignity that many working-class men retained by providing for their families through physical labor has been greatly reduced by automation. Stable family life has collapsed, and the number of children without two parents in the home has risen among the white working and middle classes. The internet has ravaged local retail stores, flattening the uniqueness of many communities. Smartphones have eviscerated those moments of oxytocin-friendly actual human interaction. Meaning — once effortlessly provided by a more unified and often religious culture shared, at least nominally, by others — is harder to find, and the proportion of Americans who identify as “nones,” with no religious affiliation, has risen to record levels. Even as we near peak employment and record-high median household income, a sense of permanent economic insecurity and spiritual emptiness has become widespread. Some of that emptiness was once assuaged by a constantly rising standard of living, generation to generation.
But that has now evaporated for most Americans.

New Hampshire, Ohio, Kentucky, and Pennsylvania have overtaken the big cities in heroin use and abuse, and rural addiction has spread swiftly to the suburbs. Now, in the latest twist, opioids have reemerged in that other, more familiar place without hope: the black inner city, where overdose deaths among African-Americans, mostly from fentanyl, are suddenly soaring. To make matters worse, political and cultural tribalism has deeply weakened the glue of a unifying patriotism to give a broader meaning to people’s lives — large numbers of whites and blacks both feel like strangers in their own land. Mass immigration has, for many whites, intensified the sense of cultural abandonment. Somewhere increasingly feels like nowhere.

It’s been several decades since Daniel Bell wrote The Cultural Contradictions of Capitalism, but his insights have proven prescient. Ever-more-powerful market forces actually undermine the foundations of social stability, wreaking havoc on tradition, religion, and robust civil associations, destroying what conservatives value the most. They create a less human world. They make us less happy. They generate pain.

This was always a worry about the American experiment in capitalist liberal democracy. The pace of change, the ethos of individualism, the relentless dehumanization that capitalism abets, the constant moving and disruption, combined with a relatively small government and the absence of official religion, risked the construction of an overly atomized society, where everyone has to create his or her own meaning, and everyone feels alone. The American project always left an empty center of collective meaning, but for a long time Americans filled it with their own extraordinary work ethic, an unprecedented web of associations and clubs and communal or ethnic ties far surpassing Europe’s, and such a plethora of religious options that almost no one was left without a purpose or some kind of easily available meaning to their lives. Tocqueville marveled at this American exceptionalism as the key to democratic success, but he worried that it might not endure forever.

And it hasn’t. What has happened in the past few decades is an accelerated waning of all these traditional American supports for a meaningful, collective life, and their replacement with various forms of cheap distraction. Addiction — to work, to food, to phones, to TV, to video games, to porn, to news, and to drugs — is all around us. The core habit of bourgeois life — deferred gratification — has lost its grip on the American soul. We seek the instant, easy highs, and it’s hard not to see this as the broader context for the opioid wave. This was not originally a conscious choice for most of those caught up in it: Most were introduced to the poppy’s joys by their own family members and friends, the last link in a chain that included the medical establishment and began with the pharmaceutical companies. It may be best to think of this wave therefore not as a function of miserable people turning to drugs en masse but of people who didn’t realize how miserable they were until they found out what life without misery could be. To return to their previous lives became unthinkable. For so many, it still is.

If Marx posited that religion is the opiate of the people, then we have reached a new, more clarifying moment in the history of the West: Opiates are now the religion of the people. A verse by the poet William Brewer sums up this new world:

Where once was faith,

there are sirens: red lights spinning

door to door, a record twenty-four

in one day, all the bodies

at the morgue filled with light.

It is easy to dismiss or pity those trapped or dead for whom opiates have filled this emptiness. But it’s not quite so easy for the tens of millions of us on antidepressants, or Xanax, or some benzo-drug to keep less acute anxieties at bay. In the same period that opioids have spread like wildfire, so has the use of cannabis — another downer nowhere near as strong as opiates but suddenly popular among many who are the success stories of our times. Is it any wonder that something more powerful is used by the failures? There’s a passage in one of Brewer’s poems that tears at me all the time. It’s about an opioid-addicted father and his son. The father tells us:

Times my simple son will shake me to,

syringe still hanging like a feather from my arm.

What are you always doing, he asks.

Flying, I say. Show me how, he begs.

And finally, I do. You’d think

the sun had gotten lost inside his head,

the way he smiled.

To see this epidemic as simply a pharmaceutical or chemically addictive problem is to miss something: the despair that currently makes so many want to fly away. Opioids are just one of the ways Americans are trying to cope with an inhuman new world where everything is flat, where communication is virtual, and where those core elements of human happiness — faith, family, community — seem to elude so many. Until we resolve these deeper social, cultural, and psychological problems, until we discover a new meaning or reimagine our old religion or reinvent our way of life, the poppy will flourish.

We have seen this story before — in America and elsewhere.
The allure of opiates’ joys are filling a hole in the human heart and soul today as they have since the dawn of civilization. But this time, the drugs are not merely laced with danger and addiction. In a way never experienced by humanity before, the pharmaceutically sophisticated and ever more intense bastard children of the sturdy little flower bring mass death in their wake. This time, they are agents of an eternal and enveloping darkness. And there is a long, long path ahead, and many more bodies to count, before we will see any light.

http://nymag.com/intelligencer/2018/02/ ... demic.html
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Re: The Worst Addiction Epidemic in U.S. History

Postby liminalOyster » Sun Nov 11, 2018 6:01 pm

From poppy to fentanyl lollipops
The war on drugs in Afghanistan
By Helen Redmond
Issue #80: Features

"For god's sake, don't destroy it! We don't ave anything else....
These children have no father! How will I provide for them now?"
- An Afghan widon and poppy farmer begging a poppy eradication team not to destroy her fields

TWENTY-FIRST century Afghanistan remains a country of astonishing contradictions. It is one of the most undeveloped, technologically backward countries in the world, despite billions of dollars poured into the economy from foreign governments. The majority of Afghans turn on a radio to get information. In a country where 90 percent of women and 60 percent of men in rural areas are illiterate, radio is a necessity.1

Communication technologies are concentrated in small, urban areas. A study by the Asia Foundation estimates 88 percent of urban households have television, while only 28 percent of rural residents do.2 The digital divide in Afghanistan is a chasm; only 9 percent of the population owns a computer and most of those are in the capital, Kabul. In the Hazarajat region, there are no computer owners.3 It’s no wonder; computers need electricity. The lack of a national power grid ensures that nine out of ten Afghans have no reliable access to electricity.4Diesel generators and kerosene lamps are ubiquitous. Satellite video taken at night reveal a country plunged into medieval darkness.

Extreme poverty condemns millions to a premature death. Most Afghans live on less than two dollars a day, and the average life expectancy in Afghanistan is forty-four years.5Unemployment is endemic in most parts of the country. All the missionary zeal of the well-funded, non-governmental organizations (NGOs) that have clogged Kabul’s most secure and satellite-enabled neighborhoods, ostensibly to “help” Afghans, haven’t made a dent in the amount of suffering.

But in one economic area Afghanistan excels: the cultivation of opium. Opium is derived from the poppy plant Papaver somniferum. Afghanistan is the world’s number one grower and exporter of opium, supplying 90 percent of the drug to Central Asian and European markets.6It’s a position the country has held for an almost uninterrupted decade. Opium farmers are highly skilled experts at planting, growing, and harvesting poppy in difficult conditions, often on land where there is little irrigation and with no fertilizer or pesticides. It is organic farming out of necessity. Afghan farmers successfully grew poppy even during a seven-year drought.

About 789,000 workers, men, women, and children are responsible for growing and harvesting poppy on just 3 percent of the land.7 Harvesting is low-tech and employs two simple tools: a neshtar (lancing stick) and a rambey (scoop). The productivity of poor Afghan opium farmers is a stunning agricultural achievement. It is even more incredible when these facts are considered: the government has declared the cultivation of opium illegal; according to Islam it’s haram (forbidden); for ten years the country has been under continuous aerial bombardment, ground assault, and occupation by the United States military and NATO forces; and counternarcotics operations are increasing. As a result, the market in opium is violent and operates within an economy and country suffused with violence.

This is the backdrop to the war on drugs in Afghanistan. Two wars are being fought simultaneously: the so-called war on terror, which as this publication has argued, is an imperialist war; and a war on drugs, an assault on poor Afghan farmers and their families struggling to survive in a shattered economy.

In the post 9/11 world, terror and drugs have become conflated. Afghanistan’s designation as a “narco-state” that harbors “narco-terrorists” has become a potent justification for the United States to intervene military and to ramp up the role of the Drug Enforcement Administration (DEA). The linking of terrorists, always the Taliban, with trafficking in narcotics and using the profits to fund the insurgency allows all manner of violence to be legitimized. There is a tried and true template for the war on drugs: mendacity, hypocrisy, corruption, violence, massive profits for the few, immunity from prosecution for the kingpins and government officials at the top of the illicit drug chain, and punishment and incarceration for those at the bottom.

Past is prologue/push down pop up
Afghanistan didn’t always lead the world in poppy production.Other countries, such as India, China, and Burma (now Myanmar) have had that distinction. During the eighteenth century, the British exported large quantities of Indian opium to China. They saw the trade as a way to reduce Britain’s negative trade balance with China. The attempt by Chinese officials to ban British imports of opium resulted in two opium wars between the countries in 1839 and 1856, which ended in Britain forcibly imposing the trade, and initiating a period of colonial conquest and domination over China. As the nineteenth century progressed, China became the main producer, exporter, and a large consumer of the drug. Millions of Chinese were recreational opium smokers. After the Second World War, the Chinese government launched a massive and violent opium suppression campaign. The government arrested more than 80,000 drug traffickers, sent 30,000 to prison, held public trials, and executed hundreds.8 There was an immediate decline in opium use due to the crackdown, but since 1986 the number of narcotics users, in particular intravenous heroin users, has increased.9

The Chinese have extensive networks in the thriving opiate trade in Myanmar. From the 1960s onward, Myanmar has become a prolific cultivator of poppy. During the 1990s, it was the world’s biggest producer, but now ranks second to Afghanistan in market share.10 The crop is grown almost exclusively in the northeast province of the Shan State and in the Wa Special Region 2. Myanmar, Thailand, and Laos make up the “Golden Triangle,” but poppy cultivation has declined dramatically in the latter two countries. In 2005, the Myanmar government banned opium cultivation in the Shan State and used the military to enforce the ban. Prisons filled up with inmates shackled in leg irons, forbidden to move from the lotus position, warehoused in wooden cages, and given prison sentences of up to ten years.11 The ban failed. Production in the northern part of the Shan State simply shifted to areas in the south. Since 2006, opium cultivation has increased each year in Myanmar, and more than 1 million people depend on the crop for their livelihood.12

India, Pakistan and Iran form the Golden Crescent. Each country has deep roots in the opium trade, both legal and illegal. India is the largest supplier of licit opium gum to the world’s pharmaceutical industry. Farmers are licensed to grow opium in the states of Uttar Pradesh, Madhya Pradesh, and Rajasthan. Illicit poppy is grown in the far northeast state of Arunachal Pradesh, which shares a border with Myanmar. Researchers estimate that over 30 percent of India’s legally grown opium is diverted into the illegal market, converted into heroin, and sold on the black market.13

During the 1980s, Pakistan was a major opium cultivator and central hub for heroin manufacturing labs. The Central Intelligence Agency (CIA) worked closely with President General Zia-ul-Haq and funded the Pakistani military and the Inter-Service Intelligence (ISI). The CIA covertly encouraged Pakistani trafficking in drugs as a way to generate revenue to fight wars against a constantly changing cast of enemies. Economists estimated the annual revenue from Pakistan’s heroin industry at $8 to $10 billion.14 Both the Pakistani military and the ISI continue to be involved in the drug trade.

Opium trafficking is concentrated in three areas that border Afghanistan: the Federally Administered Tribal Areas (FATA), Khyber Pakhtunkhwa (KP) formerly called the Northwest Frontier Province (NWFP), and Balochistan.15 Two Pashtun tribes, the Shinwari in Afghanistan and the Afridi in Pakistan are central actors in the cross border opium trade. The tribes have fought attempts to eradicate their livelihood. “The government cannot stop us growing poppy,” one farmer warned. “We are one force and united, and if they come with their planes we will shoot them down.”16 In the 1990s, Pakistan, under immense pressure from the United States, initiated a campaign to eliminate poppy production. The government used a series of carrots and sticks. The threat of prison and the promise of economic infrastructure projects funded by the international community convinced many poppy farmers to either abandon farming completely or grow other crops.17 The strategies were largely successful, and, in 2001, Pakistan was declared a “poppy-free” nation. It didn’t last. The tribal areas still cultivate thousands of hectares of poppy, and the Torkham border that straddles Nangarhar province and FATA is one of the most important drug trafficking routes between Afghanistan and Pakistan.18

Iran has a history stretching back for centuries of growing opium and a deeply rooted culture of recreational opium use across economic classes. In Tehran in 1949 there were 500 public opium dens with a capacity for 25,000 smokers.19 Opium dens functioned like bars without alcohol (which was prohibited), where people socialized and got high smoking opium. The Shah imposed a complete ban on opium in 1955, but in 1969 his government re-legalized opium and created a national maintenance program for users addicted to opium and heroin.20 The Islamic Revolution in 1979 reversed the liberal drug policies of the 1960s and declared opium cultivation and narcotics use illegal. Initially, drug traffickers fought the Islamist government and killed thousands of police officers.21

Ayatollah Khomeini and subsequent ruling parties have enforced the ban with lengthy prison sentences and frequent use of the death penalty. This year alone, 126 people have been executed, many by “suspension strangulation” for drug crimes, and 300 drug-related death warrants have been issued.22 It’s estimated that 74 percent of people executed were trafficking in large quantities of opium smuggled in from Afghanistan.23 Despite the brutal crackdown, Iran continues to be both a major consumer and a critical smuggling route for opium and heroin through Baluchistan province.

Opium and its most lucrative derivative, heroin, are global commodities that cross all borders regardless of their illegality. The moment the cultivation and manufacture is outlawed in one country it crosses borders or jumps continents and sets up production in another. This phenomenon is called “push down pop up”—cultivation of an illicit drug is pushed out of one area only to pop up in another. One of the immutable laws of commodity production under capitalism is if a profitable market exists as it does for psychoactive substances like narcotics and cannabis, prohibition cannot succeed. Push down pop up acts like a broom: it sweeps poppy seeds out of one country, and they take root in another. China cracks down on poppy, Thailand and Laos ramp up production. Thailand eradicates poppy, it migrates to Myanmar. Iran and Pakistan ban poppy, and it crosses the border into Afghanistan, where within ten years the country is the number one cultivator in the Golden Crescent. Push down pop up functions like a relay race, but instead of passing a baton to another runner, it’s passed to another country.

The decades-long international effort to suppress the illegal opium and heroin trade clearly hasn’t worked, but that’s not a problem for US drug warriors. The goal of a drug-free world is an elaborate deception captured in the United Nations Office on Drugs and Crime (UNODC) slogan “Promoting health, security, and justice.” That the United States has declared “war” on drugs, and that the CIA has simultaneously promoted cocaine and heroin traffic for its own particular aims, show deep contradictions in US drug policy. Yet there is more of a connection between these two things than first meets the eye. There is an unelected and unaccountable multinational cabal of counternarcotics agencies led by the UNODC that have an ideological and material stake in continuing the war on drugs (and consequently, the drug trade). The United States wants and needs a nonstop war on drugs abroad as a pretext to invade or intervene in countries they seek to control for geostrategic purposes. That is the real, but hidden agenda of the international war on drugs. The consistent “failure” of the war is its success.

Opium, invasion and the mujahideen
The Soviet invasion of Afghanistan in 1979 unleashed a “scorched earth” bombing campaign in rural areas that severely disrupted agricultural production. Millions of Afghans were internally displaced and fled to the cities or refugee camps in border countries. Arable land, dams, aqueducts, and irrigation canals were blown up, destroying the export economy. Prior to the invasion, Afghanistan was self-sufficient in food production and had supplied an estimated 65 percent of the world trade in dried raisins.24 Adding to the insecurity of farming, rural areas were embedded with millions of landmines, making Afghanistan one of the most mined countries in the world. There are 10 million antipersonnel mines and unexploded ordnance (UXO) in the ground, and thousands are maimed and killed each year.25

The near total devastation of the rural economy of legal agricultural products by warfare acted as a vector for the illegal cultivation of opium. Poppy is one of the few crops that can grow in harsh conditions. The plant is relatively weather and drought resistant; it matures quickly, doesn’t rot or bruise, needs less water than other crops, and can be double cropped. Afghanistan lacks refrigeration, rapid transportation and paved roads, but opium is easily stored, transported, and conveniently sold at the farm gate. The labor-intensive nature of opium planting and harvesting also provides employment for entire families in a country where rural unemployment is persistently high. It’s survival farming and worth the risk for some farmers to grow opium because it’s the only commodity guaranteed an export market.

The economic meltdown and political instability caused by a decade of war, coupled with the loss of Russian and American funding once the war was over, set the stage for several mujahideen leaders to become major players and purveyors in the poppy trade with the backing and blessing of the CIA. Afghans were pawns in the great game that was the Cold War proxy wars, so supplying arms and cash to drug trafficking mujahideen “freedom fighters” to fight the Soviets was of no concern to Washington: the defeat of the Russians was. Narcotics production posed no serious dilemma for Islamic leaders either, despite the teachings of the Qur’an which forbid it.26 In 1981, Mullah Nasim Akhundzada, issued a fatwa (religious ruling) sanctioning poppy cultivation, and his brother Mohammed Rasul proclaimed, “We must grow and sell opium to fight our holy war against the Russian nonbelievers.”27 The superprofits from poppy make believers and hypocrites out of everyone.

During the war against the Soviets, Gulbuddin Hekmatyar, founder of the mainly Pashtun Hizb-i-Islami (Islamic Party), became the leading recipient of covert US aid from the CIA via Pakistan’s Inter-Services Intelligence (ISI) and a major drug trafficker.28 The warlord’s extreme cruelty was legendary (as an engineering student in Kabul, he was known for throwing acid in the faces of women who wore Western-style dress). Under the protection and patronage of the CIA, Hekmatyar was able to capture prime agricultural areas and dramatically boost poppy production in Helmand Province. He coerced Afghan farmers to cultivate poppy and set high production quotas with threats of punishment if they weren’t met. Local commanders collectedushr, a traditional Islamic tax on agricultural products, anywhere from 2.5 to 20 percent. Hekmatyar then moved up the poppy chain into the more lucrative manufacturing of morphine into heroin. In a cross-border alliance with Pakistani heroin syndicates, he invested in and controlled at least six heroin refineries in Koh-i-Soltan in Pakistan.29 By 1987, an estimated 100 to 200 heroin refineries were operating in the Khyber district of Pakistan’s Khyber Pakhtunkhwa territories.30

Two years later, Hekmatyar instigated a turf war with Mullah Akhundzada to seize control of opium production in the northern Helmand Valley but was repelled. Akhundzada decided to get out of the drug business and cut a deal with Robert Oakley, US ambassador to Pakistan at the time. For $2 million in “aid money” to be paid to him personally, the mullah agreed to curtail poppy cultivation. He kept his end of the bargain but Oakley reneged, invoking US law against negotiating with drug dealers.31 Large-scale poppy planting began the next season.

The leading warlords of the Northern Alliance, Ahmed Shah Massoud, Burhanuddin Rabbani, and Abdul Rashid Dostum, were involved all along the poppy chain, from taxing and transporting opium, to manufacturing it into heroin, and smuggling it across the border.32 The vast revenue from the drug trade allowed mujahideen commanders to switch from tribal warlords into drug warlords with more power, giving them the ability to control key areas of the country and allowing them to depend less on funding from external sources.

The withdrawal of Soviet forces in 1989 plunged the country into a civil war. The siege of Kabul reduced the city to dust and crushed piles of concrete; the civilian death toll was between 65,000 and 80,000.33 Rural areas were the scenes of fierce and protracted fighting. But throughout the six years of civil war the opium trade—bullet, beheading, and bomb proof—flourished despite an attempt by the newly emerging Taliban to suppress it.

When the Taliban moved in to vie for control of Helmand Province in 1995, poppy cultivation was declared haram, and production dropped by one-third. The ban caught the attention of the United States and international drug interdiction agencies who voiced support for the Taliban, believing they’d become partners in a total poppy eradication campaign.34 But the poor and war-ravaged poppy farmers in Helmand had other ideas and resisted the ban, forcing the Taliban to rescind it the following year. In order to secure the key provinces of Helmand and Kandahar—the iron lungs of poppy production in Afghanistan—Taliban commanders quickly realized they couldn’t outlaw cultivation and win allegiance to their rule.

The Taliban consolidated power in Afghanistan in 1996 and inherited an economy disintegrated by sixteen years of war. Opium export earnings powered what was left of the economy. The Taliban concocted a contradictory and self-serving edict on drugs decreeing, “The cultivation of and trading in charas (hashish) is forbidden absolutely. The consumption oftariak (heroin) is forbidden, as is the manufacture of tariak, but the production of and trading in opium is not forbidden.”35 Abdul Rashid, head of the Taliban’s counter-narcotics force gave the edict an Islamic twist, “Opium is permissible because it is consumed by kafirs (infidels) in the West and not by Afghans.”36 Exhibiting the Taliban leaders’ understanding of the politics of the drug economy, Rashid added, “We cannot push the people to grow wheat as there would be an uprising against the Taliban if we forced them to stop poppy cultivation. So we grow opium and get our wheat from Pakistan.” The Taliban collected up to 20 percent of the value of each drug shipment as a special form of zakat, an Islamic tax where Muslims give 2.5 percent of their annual disposable income and savings to the poor and needy. Regional warlords, police, and bandits imposed their own zakat to be paid in drugs or cash at checkpoints that dotted all major drug transiting routes out of Afghanistan.

Afghanistan was further isolated from the world and cut off from aid that could rebuild a more diversified economic infrastructure in 1999, when the United States introduced and passed Resolution 1267 in the United Nations Security Council. The resolution imposed sanctions on the Taliban. Flights out of the country by the state­owned airline Ariana were banned, and Taliban assets were frozen, triggering a humanitarian crisis.37 The imposition of sanctions disproportionately impacted the Afghan people, not Taliban leaders. Resolution 1267 virtually guaranteed that poppy cultivation would not only continue but increase, as the development of other agricultural crops couldn’t be financed or find markets.

The Taliban ban
Then in 2000, almost inexplicably, the supreme leader of the Taliban, Mullah Omar, declared the cultivation of opium to be un-Islamic. US Assistant Secretary of State Christina Rocca declared, “We welcome the Taliban enforcement of the ban and hope it will be sustained.”38 The imposition of sharia law and well-documented, gross human rights violations were shunted aside in American support for the new ban. The prohibition was enforced ideologically by the Ministry for the Promotion of Virtue and Prevention of Vice, and backed up in the provinces by the use of tactics that ranged from threats of destruction of property, bribery, to public lashings and death. The United States ignored this brutal aspect of the ban and gave the Taliban $43 million in humanitarian aid.39

But the Taliban had to negotiate with the powerful 400,000–member Shinwari tribe in Nangarhar province, who had a track record of resisting all attempts to eradicate poppy. The Shinwari could match the brutal violence of the Taliban if they attempted to implement a ban by force and without compensation. In 2010, the Shinwari cut a similar deal with the Karzai government against their former rulers in Kabul. The tribe agreed to back President Karzai, declared war on the Taliban, and warned they’d burn down the home of any Afghan who harbored Taliban guerrillas. For their support, American commanders agreed to give the Shinwari $1 million for development projects. No questions were asked about the tribe’s central involvement in the opium trade or what type of development projects the money would be used for.40

What led to the Taliban one-year ban on opium cultivation is still a subject of speculation. The ban was only on the cultivation of opium, not trafficking in the drug, yet another convenient contradiction that allowed a section of the drug trade to continue to operate. Taliban leaders might have been motivated to curb production in order to jettison their drug kingpin status in the eyes of the international community. Only three countries recognized the Taliban as the legitimate government of Afghanistan: Pakistan, Saudi Arabia, and the United Arab Emirates. The ban would also entitle the Taliban to $25 million per year for ten years from the United Nations Office on Drugs and Crime (UNODC) for alternative crop development.41

The more plausible motive for the ban was that it was a calculated economic decision: the price of opium was in a free fall and bumper crops from previous years had resulted in massive reserves. Captain Saif Raiaz, a Pakistani drug enforcement officer, estimated Afghanistan had “sufficient stockpiles to last at least 10 years.”42 Other estimates range from two to three years. Prohibition doesn’t allow for coordinated planning and planting of opium across regions, and the capitalist laws of supply and demand of an illegal commodity converged to “oversupply” the market. A time-limited ban should drive the price up to more profitable levels, and it did. In 2001, the total farm-gate value of opium production was $56 million. In 2002, after the ban was lifted, it shot up to $1,200 million.43

The ban on opium cultivation couldn’t be sustained for four reasons. First, there were no serious economic alternatives for the 1.6 million Afghans who work all along the poppy chain. Second, the Taliban would have faced open revolt. Mohammad Hassan Akhund, the governor of Kandahar, admitted that continuing the ban would require that “many people would have to be killed and others face starvation.”44 Third, the Taliban depended on the profits from opium to fund their regime. Fourth, their political rivals, the Northern Alliance, continued to cultivate opium. During the ban, the only source of opium production was territory held by the Northern Alliance. It tripled its production. In the high valleys of Badakhshan, an area controlled by troops loyal to the former president Burhanuddin Rabbani,―the number of hectares planted jumped from 2,458 to 6,342. The Northern Alliance fields accounted for 83 percent of total Afghan production of 185 tons of opium during the ban.45

The yearlong ban on opium cultivation led to huge profits for the Taliban and drug traffickers at one end of the poppy chain but impoverished the majority of Afghan opium farmers at the other end. Malnutrition and starvation deaths were reported. And the ban pushed poor farmers into yet more debt, forcing some to flee the country in fear of their lives because they couldn’t repay loans.46 No national banking or credit infrastructure exists in Afghanistan, so opium traders fill the role and make loans, known as salaam, to farmers at usurious rates. An opium futures market operates in the country. Typically the price paid as an advance is only 50 percent of the market price of opium on the day the agreement is finalized. The loan is an advance payment for a fixed amount of opium to be delivered at the end of the harvest season. If farmers don’t produce the agreed upon amount of opium—as they often don’t because of adverse weather conditions, the ongoing war that disrupts production, and eradication programs—they still have to repay salaam, or take more. Or they sell their daughters, known as “opium brides.”

Angiza Afridi interviewed more than 100 families about opium weddings in Nangarhar province. In two districts she studied, approximately half the new brides were given in marriage to repay opium debts. The new brides included children as young as 5 years old; they work as household servants for in-laws until they are old enough to consummate the marriage.47 Khalida Shah was 10 years old when her father Sayed Shah was forced to sell her to a 45-year-old drug trafficker because he was unable to repay a $2,000 loan. Later, he sold his 16-year-old daughter to a lender’s 15-year-old son to pay off another opium debt. “Until the end of my life I will feel shame because of what I did to my daughter. I still can’t look her in the eye.”48

Pashtun rural tradition called Pashtunwali, poppy prohibition, and the salaam system, combined with the War on Drugs strategy of eradication without compensation, maintain and reinforce the oppression of women and girls in Afghanistan. However, in yet another contradiction, poppy cultivation liberates some women. Women workers play a central role in many aspects of poppy production, from planting to the processing of by-products like soap and oil.49 The practice of purdah enforces the strict separation of women from men, and working outside the home is rare, but it doesn’t apply to poppy cultivation. Men and women work side by side in the poppy fields, and women don’t wear the burqa. Dr. Anis Aghdar, former head of the Women’s Affairs Department in Badakshan province said, “When a woman grows poppy she has a chance to earn an income and become a breadwinner like a man.”50 A woman poppy farmer in Kandahar explained, “In general, it is the only means of survival for thousands of women-headed households, women and children in our village whose men are either jobless or were killed during the war.”51

The ban on poppy was rescinded on September 2, 2001, nine days before 9/11. The next month, the United States invaded Afghanistan, toppled the Taliban regime with the help of the Northern Alliance, and installed Hamid Karzai. One of his first decrees was the banning of growing, trafficking, and consumption of opium and heroin. But the lucrative business of opium continued despite the decree, and with the Taliban decamping to Quetta in Pakistan, drug dealers aligned with the United States and the Karzai government took their place.

The United States has played its historical role as supporters and funders of murderous allies while conveniently ignoring their involvement in the illicit drug trade. The CIA gave $70 million in $100 bills to drug warlords Abdul Rashid Dostum, Ismail Khan, and Ustad Atta Mohammed.52 The Bush administration had no interest in launching an all-out war on drugs in Afghanistan for fear of alienating their drug-trafficking Northern Alliance partners. US and NATO troops ignored poppy cultivation, open-air drug bazaars, and heroin labs. One military commander said, “I don’t want my soldiers to die for the sake of a drug addict."53 It was only later that narcotics and terror were linked and the war in Afghanistan became a war against “narco-terrorists.”

British troops were initially tasked with drug eradication. British Special Forces handed out millions in cash to Afghan officials, village elders, and to farmers to not grow poppy, and, for a limited time, destroyed poppy fields.54 Neither the carrot nor the stick worked to decrease poppy production. The US State Department and the Drug Enforcement Administration (DEA) then stepped in and escalated the war on poppy farmers. DynCorp, the notorious American mercenary corporation, provided training and security for Afghan eradication teams. DynCorp received $1 billion for their failed efforts.55

Eradication teams were met with fierce resistance in some areas: snipers, roadside bombs, rockets, and farmers ready to fight. In 2002, poppy farmers in Helmand province marched on Lashkar Gah to protest eradication, and in the ensuing clash with police, thirty-five farmers were killed and eight wounded.56 When the Afghan Special Narcotics Force moved in with tractors to plow over poppy fields in the Maiwand district of Kandahar, farmers set the tractors on fire, patrolled their fields with AK-47s, and blocked the highway with burning tires. Two protesters were killed, and four police were injured.57 The biggest protest was in Nangarhar province. Up to 10,000 farmers blocked roads and attacked eradication teams.58 In Farah province, three members of an eradication team were killed when an IED exploded.59 Public protests and confrontations with authorities were vital to maintaining the livelihoods of Afghan farmers and their families. Hassan Khan, a poppy farmer said, “The government can’t destroy poppy fields as it has not done a single thing for us. We will defend our poppy fields with our lives.”60

The Obama administration suspended poppy eradication programs in 2009 at the urging of Richard Holbrooke, the former US envoy to Afghanistan, who stated, “The United States alone is spending over $800 million a year on counternarcotics. We have gotten nothing out of it. It is the most wasteful and ineffective program I have seen in 40 years.”61 And they finally figured out that poppy eradication forced Afghans to seek the Taliban’s protection and convinced them to join the insurgency.

But the war on drugs in Afghanistan is far from over. It continues under the Karzai government with the increased involvement of the DEA. Governor-led eradication teams (GLEs) destroy poppy fields, and DEA agents target drug labs and traffickers. US counternarcotics programs have become increasingly militarized under the Obama administration. For all intents and purposes, the DEA operates as a division of the US military. DEA agents train with US Navy SEAL and special operations units, and they share intelligence and conduct joint operations.62The goals of the DEA and the US military bleed into one another: Capture or kill high-value drug traffickers suspected of supporting and financing the Taliban. DEA teams called Foreign-Deployed Assistance and Support Teams (FAST), largely funded by the Department of Defense, carry out drug raids.63 The FAST partner with Navy SEALS and the Counternarcotics Police of Afghanistan (CNPA) to carry out these raids, which are similar to the “night raids” conducted by US and NATO forces.

Bombs are dropped on land where counternarcotics agencies suspect that drugs are buried, and compounds are destroyed in the search for drugs and weapons. In 2008, FAST teams were deployed to Spin Boldak and burned bricks of hashish in areas under Taliban control. In 2009, US troops engaged in direct support of a forced eradication mission as part of a security detachment for Afghan counternarcotics forces in the Nadi-Ali district in Helmand province.64 During drug raids, Afghans are routinely beaten, humiliated, killed, and imprisoned.

The DEA doesn’t plan on leaving Afghanistan anytime soon. Michelle Leonhart, head administrator of the DEA, bragged, “We don’t get bogged down with the question of how long we’re going to be there. Someone has to go after the biggest and the baddest, someone has to put these traffickers in jail, someone has to stop the flow of terrorist financing and it’ll be the DEA.”65

Corruption and the drug-terror nexus
For years, Afghan and US officials promised compensation for eradication of poppy and consistently reneged or provided insufficient payment to farmers. Rebuilding an economic infrastructure with agriculture wasn’t a priority or even a part of the government’s “Afghan Stabilization Program.” It defined key infrastructure as: police barracks, a prison, a post office, and a mosque.66 A collection of NGOs led by USAID promised reconstruction projects, alternative agricultural development, and work opportunities, but failed to deliver for a raft of reasons. Over $35.4 billion in aid has been pumped into Afghanistan since 2002, yet the nation still ranks as the second poorest on the planet.67 Where did all the money go?

Staggering levels of corruption exist in Afghanistan. Thousands of officials in the Karzai government, from Kabul to Kandahar, engage in extortion, stealing, and embezzlement of public money and humanitarian assistance. Billions earmarked for economic development have disappeared into the pockets and foreign bank accounts of warlords and drug lords, now legitimate government representatives, while the vast majority of Afghans continue to live in abject poverty.

Corruption in the Afghan drug trade follows a predictable pattern with baksheesh, bribery, deeply entrenched and accepted as business as usual. Drugs and bribes are estimated to be the two largest income generators in Afghanistan, accounting for $2.8 billion and $2.5 billion per year, respectively.68 It was an open secret that President Hamid Karzai’s brother, Ahmed Wali Karzai (known by his initials, AWK), was centrally involved in the drug trade in southern Afghanistan. He ruled like a Mafia don, and much of his wealth and power derived from the opium trade. The “King of Kandahar,” as he was dubbed, was assassinated in July of this year. Numerous WikiLeaks documents corroborate AWKs role. In one communiqué, US ambassador to Afghanistan Karl Eikenberry stated Ahmed Karzai is “widely understood to be corrupt and a narcotics trafficker.”69 Prior to WikiLeaks, German intelligence provided information to the Americans in 2005 that AWK headed a drug smuggling ring. He was also a valuable CIA asset and worked both as a paid informant and a go-between.70 The CIA and U.S special military forces contracted his private paramilitary, the Kandahar Strike Force, to hunt down suspected Taliban cells, and Strike Force soldiers regularly operated outside the law.71

Other WikiLeaks cables reveal that the CIA believed Muhammad Fahim, the former Defense Minister and current First Vice President, is involved in the drug trade. His predecessor, Ahmed Zia Massoud, was. On a “capital flight,” he flew into Dubai with $52 million in cash.72 General Mohammed Daud Daud, the former deputy minister of the interior and the head of the Counternarcotics Police of Afghanistan (CNPA), provided protection for drug smugglers and accepted bribes.73 General Daud was killed in a suicide bombing attack in May of this year. Not to be outdone, President Karzai has pardoned and placed in positions of power dozens of accused and convicted drug traffickers.

The Bush administration, seeing the need to further demonize the Taliban to justify an increasingly unpopular war, began to whip up the notion of “narco-terrorism.” In 2005, Congress passed the Narco-Terrorism Enforcement Act as an amendment to the USA PATRIOT Act. The law permits criminal prosecution against any person in any country that traffics in illicit drugs and uses the proceeds to fund “terrorist” activities. US lawyers are concerned the law can be interpreted so broadly that it could ensnare anyone the government wants.74 The law has been used almost exclusively against Afghan drug traffickers accused of supporting the Taliban. Khan Mohammed was the first person charged and convicted under the new law. Prosecutors argued he was “closely aligned with the Taliban” and had “supported the Taliban’s efforts to forcibly remove the United States and its allies from Afghanistan.”75 He is serving a life sentence.

The DEA set up Afghan drug traffickers Hajji Bashar and Hajji Juma. Bashar was lured to the United States under false pretenses, and Juma was extradited from Indonesia. The men were informants for the CIA and the DEA and had provided intelligence on Taliban and drug smuggling activity. At clandestine meetings with American officials, they received large amounts of cash in exchange for information.76 The formerly fêted and well financed drug kingpins were now cast as “narco-terrorists,” the dangerous heads of “narco-cartels.” Both were accused of supporting and funding the Taliban. In 2009, Bashar was sentenced to life in prison.77

But trafficking in opium isn’t a terrorist activity—it’s agribusiness, no different than the trade in tobacco or grapes, save for its illegality. Opium is a crucial commodity that keeps the Afghan economy financially solvent, and the crop makes up an estimated 35 percent of Afghanistan’s GDP.78 If Juma and Bashar were the CEOs of tobacco or alcoholic beverage businesses—legal drugs that addict, disable, and kill far more people—they wouldn’t be rotting in prison. They’d be free to sell their products worldwide.79

In Afghanistan, the United States is reprising a role it has played before: backing one group of drug traffickers against another for its own political gain. Currently, it’s the Karzai government against the Taliban. Counter-terrorism officials consistently link terrorism and narcotics with the Taliban. The reality is the “drug-terror nexus” includes other armed insurgent groups and the Karzai government. They all profit from the drug trade, which by Washington’s definition makes them all “narco-terrorists.” And the Taliban aren’t funded exclusively from the sale of opium but from a variety of sources including the taxing of wheat and other crops, Muslim charities, and religious institutions outside the country.80

The solution: licensing and legalization of narcotics
The solution to the so-called poppy problem is to license poppy production. Afghan farmers should be licensed to grow and manufacture poppy into morphine for domestic use and to sell to the international community just as farmers in seven other countries are. Overnight, the most productive opium cultivators in the world would become legal producers of much-needed pain-relieving drugs. The need for opiates is great; 80 percent of the world’s population faces an acute shortage of opiate-based medicines.81 The World Health Organization (WHO) maintains a list of essential medications: morphine is number one (in combination with medications used in anesthesia) and number two.82 Narcotics are vital to human health and are used to manage chronic pain, pain in childbirth, end-of-life care, and during surgery. The average person in the United States has seven surgeries.83

Incredibly, in Afghanistan, a country saturated with opium, there is a shortage of opiate-based medicine. The burn unit in Herat Hospital offers only cream, bandages, and IV saline to patients.84 Bost Hospital’s pediatric unit in Lashkar Gah has no narcotics. Patients with extensive burns are given acetaminophen for pain, though morphine is the gold standard to control the pain from burn wounds. Similarly, Mirwais Hospital in Kandahar lacks access to medication needed for sedation and pain control.85 In 2010, NATO opened a $40 million state-of-the-art hospital at Kandahar Airfield with a pharmacy well-stocked with narcotics. And in theaters of war all over Afghanistan, Army medics carry morphine and fentanyl lollipops to administer to wounded soldiers.86

Poppy cultivation in Afghanistan is not the problem, the prohibition of poppy cultivation is. The International Narcotics Control Board (INCB) licenses countries to legally supply narcotics raw material to the pharmaceutical industry to process into a variety of pain medications. The countries include: Australia, France, Hungary, India, Poland, Spain, and Turkey. The contradictions in current global drug policy mean the same drug that generates income for farmers and workers and profits for the pharmaceutical industry in rich countries, criminalizes poor people in Afghanistan who cultivate poppy for an illegal market in order to survive. Afghanistan should be allowed to join these nations and provide raw materials to the legal market.

There will always be a market for morphine. An Afghan pharmaceutical industry anchored by the production of morphine for domestic use and for international export retains the profits that accrue to a minority and spreads them further down the poppy chain to the farmers, seasonal laborers, and workers in laboratories. Licensing the cultivation of poppy would end the salaam system that keeps farmers in a perpetual cycle of debt and crucially, the sexual slavery of women and girls sold as opium brides. Licensing farmers to grow poppy recognizes the obvious reality that a thriving narcotics industry exists, and with legal status, the expertise of Afghans involved in the poppy chain from cultivation to the manufacture of morphine is turned into a positive instead of a negative.

Legalization of narcotics for personal use has to accompany the licensing of poppy production in Afghanistan. It is the only way to control prices and undercut the development and diversion of narcotics to the black market. Harm-reduction policies can simultaneously be put into place to help those with addiction: syringe exchange, safe injection sites, and heroin prescription.87

The International Council on Security and Development (ICOS), a policy think tank based in London, has developed Poppy for Medicine (P4M), a project that offers an alternative to poppy prohibition in Afghanistan.88 It has been roundly criticized as unworkable given the dysfunctional dynamics on the ground. P4M proposes to legally manufacture poppy into morphine tablets in factories located in poppy-farming communities and sell it to countries under special licensing agreements.89 P4M’s pilot project is modest in scope and embedded at the village and district level to test the waters. ICOS recognizes the enormous challenges that exist but argues, “We simply cannot put on hold economic development projects because we feel that Afghan institutions lack the necessary capacity to carry them out.”90

Unfortunately, the politics of ICOS are right-wing and undermine the viability of P4M. ICOS is an NGO that doesn’t believe in conflict-neutrality or the right of nations to self-determination.91ICOS wholeheartedly supports US imperialism, endorsed the troop surge, and opposed the US drawdown in troops. ICOS recommends maintaining the surge for another year.92 That puts the NGO in direct opposition to what the majority of Afghans want: foreign troops out. Their support of the occupation actually jeopardizes the implementation of P4M by setting up Afghan communities involved in the project as targets for the Taliban, the very people ICOS purports to help.

If Afghanistan licensed poppy cultivation, it wouldn’t be the first country to do it. In 1974, Turkey made the transition. Although there are key differences between Turkey and Afghanistan, it provides important lessons for how a country can move from illegal production of poppy to legal production.93 The United States transitioned from 13 years of alcohol prohibition back to legalization and regulation of the drug with the repeal of the Volstead Act in 1933. The rich and powerful booze barons, bootleggers, and the massive corruption of organized crime syndicates determined to stay in business had to be confronted and put out of business. And over time, they were.94 If the United States was truly interested in a solution, American pharmaceutical companies could import poppy raw materials from Afghanistan as they do from India and Turkey for manufacture into legal narcotics.95 Another solution is to buy the entire poppy crop. In 2002, MI6, Britain’s secret service, asked for permission to do exactly that. The idea was rejected by the government for reasons of cost and appearance.96

Licensing narcotics production and legalizing consumption in Afghanistan confronts huge challenges and powerful entrenched interests. Key state actors in the Karzai government, provincial drug kingpins, and counterinsurgent forces benefit from the illegal drug trade. These three groups have the power to sabotage reforms to retain their profits. But it’s also true that a layer of them would benefit from the creation of a legal pharmaceutical infrastructure which would create profits, confer legitimacy in the international community, and end Afghanistan’s designation as a “narco-state.” The outlaw Afghan drug dealers of today could be transformed into “respectable” CEOs of legal narcotics manufacturing businesses. There’s no doubt there would still be corruption, but it’s better and easier to deal with the problems of corruption under conditions of legality than the conditions of violent illegality. Poppy farmers have consistently fought to grow and sell poppy. Thousands of farmers have demonstrated their power for years by halting the eradication of their fields by both the Karzai government and the Taliban when they held power. Poppy farmers play a crucial role in the illegal drug trade and if they took up the fight for licensing and legalization it could be a game changer. Afghan poppy farmers have everything to gain from transitioning from criminals with no rights, into legal growers with rights who are viewed as rebuilding Afghanistan’s economy, not destroying it.

It’s not possible to predict with complete certainty the future of Afghanistan except for one thing: As long as poppy cultivation and narcotics consumption is illegal, the drug trade will continue to reward and enrich a minority of drug lords and punish and impoverish the majority of poppy farmers, low-level drug trade workers, and the drug addicted.

I dedicate this article to the people of Afghanistan, who are as tenacious as Papaver somniferum. Props to the following people for assistance in writing this article: Jorrit Kamminga, Director of Policy Research at ICOS for debate and discussion about Poppies for Medicine (P4M); David Whitehouse for critical comments; Anand Gopal for consultation; John Shuler & Anne Armstrong, UIC librarians extraordinaire, for finding the sources when I couldn’t.

USAID Afghanistan. 2011, afghanistan.usaid.gov/en/programs/education.
Mohammed Osman Tariq, Najla Ayoubi, Faxel Rabi Haqbeen. Afghanistan in 2010: A Survey of the Afghan People. The Asia Foundation, 155. http://www.asiafoundation.org. The survey is extensive, but some of the key findings are dubious. The survey polled Afghans across all 34 provinces on issues ranging from the economy, to corruption, to women’s issues. In-person interviews were conducted in Dari and Pashto with 6,467 men and women from different social, economic, and ethnic communities (Pashtun, Tajik, Uzbek, Hazara, Turkmen, Baloch) in rural and urban parts of the country. However, there were problems with sampling due to the high levels of violence and insecurity in areas outside of Kabul. Interviewers weren’t able to get into twenty-one districts. The reason referred to in the survey was, “The district is under control of Taliban.” This skewed the results. Also, the study shows the Taliban control all major opium producing provinces. Among them: Helmand, Kandahar, Nirmroz, Farah, Balkh, and Sari-i-Pul. See Appendix 2: Methodology, 161-181.
Ibid, 153.
“Afghanistan electricity: After years of rebuilding, most Afghans lack power,” Huffington Post, July 19, 2010, huffingtonpost.com.
World Health Organization (WHO). Afghanistan: health profile, 2008, http://www.who.int/gho/countries/afg.pdf.
Citha D. Maass, “Afghanistan’s drug career: Evolution from a war economy to a drug economy,” Afghanistan Analysts Network, March 31, 2011, 1, http://aan-afghanistan.com/uploads/2011 ... rug_Career—FINAL.pdf.
Letizia Paoli, Victoria A. Greenfield & Peter Reuter, The World Heroin Market: Can Supply Be Cut?(New York: Oxford University Press, 2009), 118-119. I’ve combined 309,000, the number of estimated households involved in opium growing with 480,000, the number of itinerant workers engaged in various aspects of poppy cultivation. Estimating the numbers of people involved at each level of the drug trade is notoriously difficult because it is illegal. If all the workers engaged in all the aspects of the drug trade are added together, the number rises to 1.6 million. These statistics are from the United Nations Office on Drugs and Crime (UNODC.) They are imprecise and rough estimates only.
Paoli, Greenfield & Reuter, 33. China continues to execute people involved at all levels of the drug trade.
Wei Hao, Shuiyuan Xiao, Teiqiao Liu, Derson Young, Shanmei Chen, Diran Zhang, Chao Li, et al., “The second national epidemiological survey on illicit drug use at six high-prevalence areas in China: prevalence rates and use patterns, Addiction,” V. 97, 10, September 20, 2002.
Paoli, Greenfield & Reuter, 111. See also, “Myanmar: UN reports ‘worrisome’ rise in opium cultivation,” UN News Center, December 14, 2009. http://www.un.org/apps/news/story.asp?C ... wsID=33236.
Matthew Brzezinski, “Heroin: The sleek new business model for the ultimate global product,” New York Times Magazine, June 23, 2002, 26. The vast majority of people put in prison for drug crimes are “low-level” workers and earn small amounts of money. The women in this article were each paid about $20 for transporting a kilo of heroin that is worth between $4500-$9500.
UN News Centre, “New UN survey reveals surge in Myanmar’s opium production,” October 10, 2007, http://www.un.org/apps/news/story.asp?N ... 7&Cr=&Cr1=.
Paoli, Greenfield & Reuter. 144. The Central Bureau of Narcotics (CBN) negotiates with licensed farmers to determine how much opium they’ll grow each year using a system called minimum qualifying yield (MQY.) Disagreements over MQY led poppy farmers to strike. In 1997, 30,000 cultivators went out on strike demanding reductions in MQY. The CBN replaced most of the striking farmers but the harvest in 1998 was one of the smallest ever recorded.
Alfred W. McCoy, The Politics of Heroin: CIA Complicity in the Global Drug Trade, Afghanistan, Southeast Asia, Central America, Colombia (Chicago: Lawrence Hill Books, 2003, Revised Edition), 483. McCoy’s seminal work exhaustively and conclusively documents in 680 pages the CIA’s sinister role in the world drug trade.
FATA and Balochistan are populated and essentially governed by fiercely independent tribes that have engaged in consistent armed conflicts with the Pakistani army. In 2002, after Pakistan and the United States sent forces into the region to hunt down Osama bin Laden but instead killed civilians, an insurgency erupted in Waziristan. Balochs have repeatedly fought for independence from Pakistan and have been brutally crushed. As a result, the Pakistani government can’t easily intervene in the cross-border drug trade.
Kathy Evans, The Tribal Trail, Newsline (Karachi), December 1989, 24.
“Illicit drug trends in Pakistan.” United Nations Office on Drugs and Crime, (UNODC) Country Office, Pakistan, April 2008, 6. http://www.unodc.org/documents/regional ... n_rev1.pdf.
Iqbal Khattak, “Increase in poppy cultivation in Pakistan in 2003,” http://www.mamacoca.org/FSMT_sept_2003/ ... 003_en.htm. See also David Macdonald, Drugs in Afghanistan: Opium, Outlaws and Scorpion Tales (London: Pluto Press, 2007), 78.
Garland H. Williams, “Opium Addiction in Iran,” report to H. J. Anslinger, Commissioner of Narcotics, February 1, 1949, 1-12. (Historical Collections and Labor Archives, Pennsylvania State University.) It’s important to note that many writers on the drug war refer to all drug use as addiction when in fact there is a continuum of drug use, and the vast majority use drugs recreationally and are not addicted.
“Epidemiology of drug use in Iran,” United Nations Office on Drugs and Crime (UNODC), February 6, 2011, http://www.unodc.org/iran/en/epidemiology.html. The opiate maintenance program was restricted to users 60 years and older. Users were given “opium tablets” or methadone, a synthetic opiate.
“Iran, Pakistan on frontline in war on drugs,” Tehran Times, November 27, 2010. Over 100,000 Iranians have been injured in the War on Drugs. http://www.tehrantimes.com.
Matthew Cardinale, “Iran executing hundreds in war on drugs,” IPS, June 27, 2011, http://www.ipsnews.net In 2010, Iran executed 590 people for drug offences.
Ibid.
Macdonald, 61.
International Campaign to Ban Landmines. “Afghanistan: Landmine Fact Sheet,” http://www.afghan-network.net/Landmines/.
UN Office for the Coordination of Humanitarian Affairs, “In-depth: Bitter-sweet harvest: Afghanistan’s new war, opium and ­alternative livelihoods, August 2, 2004, http://www.irinnews.org/InDepthMain.asp ... rtId=63020.
McCoy, 484-485.
Vanda Felbab-Brown, Shooting Up: Counterinsurgency and the War on Drugs (Washington, DC: Brookings Institute Press, 2010), 116.
Barnett R. Rubin, The Fragmentation of Afghanistan: State Formation and Collapse in the International System (New Haven: Yale University Press, 1995), 183.
Amir Zada Asad & Robert Harris, The Politics and Economics of Drug Production on the Pakistan-Afghanistan Border (Surrey: Ashgate, 2003), 147.
Macdonald, 89.
Felbab-Brown, 120. The CIA continued to fund Massoud through the 1990s. See Steve Coll, Ghost Wars: The Secret History of the CIA, Afghanistan and Bin Laden, from the Soviet Invasion to September 10, 2001 (New York: Penguin Press, 2004).
Malalai Joya, A Woman Among Warlords (New York: Scribner, 2009), 26.
Felbab-Brown, 125.
Michael Griffin, Reaping the Whirlwind: The Taliban Movement in Afghanistan (London: Pluto Press, 2001), p. 153.
Quoted in Ahmed Rashid, Descent into Chaos: The United States and the Failure of Nation-Building in Pakistan, Afghanistan, and Central Asia, (New York: Viking, 2008), 317. This isn’t true. Thousands of Afghans of all ages use opium. It’s used medicinally to treat a range of health problems and to treat pain, especially in rural areas where there is no health care or access to non-narcotic pain medication. Afghans also smoke opium recreationally and inject heroin. In Kabul, the World Health Organization estimates there are 150,000 heroin injectors. There is a dearth of drug treatment programs across the country.
Sonali Kolhatkar & James Ingalls, Bleeding Afghanistan, (New York: Seven Stories Press, 2006,) 32-33.
James Bovard, “Bush’s opium boom,” Future of Freedom, May 28, 2003, http://www.fff.org/freedom/fd0304d.asp.
Ibid.
Dexter Filkins, “Afghan tribe vowing to fight Taliban to get U.S. aid in return,” New York Times, January 27, 2010.
Macdonald, 79.
Christian Caryl, “The new ‘silk road’ of death,” Newsweek, September 17, 2001,
“Summary findings of opium trends in Afghanistan,” UNODC http://www.unodc.org/pdf/afghanistan_20 ... -09-09.pdf.
Quoted in Felbab-Brown, 131.
Paul Harris, “Victorious warlords set to open the opium floodgates,” Observer, November 25, 2001.
David Mansfield, “The impact of the Taliban prohibition on opium cultivation in Afghanistan,” May 25 2001, http://www.davidmansfield.org/all.php.
Sami Yousafzai, “The opium brides of Afghanistan,” Newsweek, March 29, 2008.
Ibid. See also, Elaheh Rostami-Povey, Afghan Women: Identity & Invasion (London: Zed Books, 2007), 55-59.
David Mansfield, “The economic superiority of illicit drug production: Myth and reality. Opium poppy cultivation in Afghanistan,” August, 2001, http://www.davidmansfield.org/all.php.
“In-depth: Bitter-sweet harvest: Afghanistan’s new war. Afghan women and opium,” 2004, http://www.irinnews.org/InDepthMain.asp ... rtId=62950.
Ibid.
John Pilger, “Breaking the silence: Truth and lies in the war on terror, a special report,” 2003, http://www.bullfrogfilms.com/guides/breakguide.pdf.
James A. Nathan, “Poppy blues: The collapse of poppy eradication and the road ahead in Afghanistan,” Defense & Security Analysis, Vol. 25, Issue 4, 2009, 334.
Ibid, 332.
Ibid, 333.
Joel Hafvenstein, Opium Season: A Year on the Afghan Frontier, (Connecticut: Lyons Press, 2007), 211. The title of the book is a misnomer. It’s not about opium, it’s about the challenges and dangers of an inexperienced project manager/missionary in rural Afghanistan who works for Chemonics, an international development consulting firm. Hafvenstein is no expert on opium in Afghanistan although he portrays himself as such.
Ibid, 257.
Felbab-Brown, 140.
Arman-e-Milli, “The people of Nangarhar oppose the campaign against poppy,” Afghanwire, February 20, 2007, http://www.afghanwire.com/article.php?id=4201.
Arman-e-Milli, “People clash with security officials,” Afghanwire, April 3, 2007, http://www.afghanwire.com/article.php?id=4995.
David Charter and Tom Baldwin, “Obama changes tactics in ‘disastrous’ war against Afghanistan’s heroin producers,” Sunday Times, March 23, 2009.
Chuck Holton, “DEA agents target Afghanistan’s ‘narco-insurgency’,” CBN News, April 27, 2010, http://www.cbn.com/cbnnews/world/2010/A ... nsurgency/.
Richard P. Kaufman, “America’s opium war: How the wrong approach to counternarcotics is undermining state-building in Afghanistan,” June 9, 2008, http://www.sais-jhu.edu/bin/w/a/KAUFMANFinal.pdf.
Ibid.
Holton.
Seth G. Jones, In the Graveyard of Empires: America’s War in Afghanistan (New York: Norton, 2009), 173.
“Afghans wealthier, remain among the poorest,” Killid Correspondents, Asia Times Online, January 29 2010, http://www.atimes.com/atimes/South_Asia/LA29Df04.html.
“Corruption widespread in Afghanistan, UNODC survey says,” January 19, 2010, http://www.unodc.org/unodc/en/frontpage ... -says.html.
Ryan Harvey, “The Afghan war: spreading democracy (and heroin),” December 10, 2010, Truthout.org, http://www.truth-out.org.
Peter Goodspeed, “Ahmed Wali Karzai: From waiter to ‘King of Kandahar’,” National Post, May 28, 2010, http://www.rawa.org.
Anand Gopal, “When personalities trump institutions: Two assassinations in Afghanistan,” Foreign Policy, July 18, 2011.
Jonathan Steele and Jon Boone, “Wikileaks: Afghan vice-president landed in Dubai with $52m in cash,” Guardian, December 2, 2010, http://www.guardian.co.uk Ahmed Zia Massoud is the son of deceased Northern Alliance warlord Ahmed Shah Massoud, who was also involved in the drug trade.
Graeme Smith, “Afghan officials in drug trade cut deals across enemy lines,” Globe and Mail, March 11, 2009, http://www.militaryphotos.net.
John E. Thomas, Jr., “Narco-terrorism: Could the legislative and prosecutorial responses threaten our civil liberties?” Washington and Lee Law Review, 2009, http://www.law.wlu.edu/deptimages/Law%2 ... asNote.pdf.
Ibid.
James Risen, “Propping up a drug lord, then arresting him,” New York Times, December 11, 2010,
Benjamin Weiser, “Afghan linked to Taliban sentenced to life in drug trafficking case,” New York Times, May 1, 2009. Bashar’s arrest was a classic DEA set-up. Agents promised he wouldn’t be detained if he came to the United States. They lied. After 11 days of meetings with federal agents, Bashar was arrested. Juma was arrested in Jakarta and extradited to New York under the 2005 international narco-terrorism law.
William Byrd, “Afghanistan: State building, sustaining growth and reducing poverty,” 2005, http://elibrary.worldbank.org/content/b ... 0821360958.
Hajji Bashar was given a life sentence. Hajji Khan is awaiting trial.
Peter Kenyon, “Exploring the Taliban’s complex, shadowy finances,” National Public Radio, March 19, 2010, http://www.npr.org/templates/story/stor ... =124821049.
“Availability of internationally controlled drugs: Ensuring adequate access for medical and scientific purposes,” International Narcotics Control Board, 2010, http://www.incb.org/pdf/annual-report/2 ... Supp_E.pdf. See also, International Council on Security and Development, Poppies for Medicine Project, http://www.poppyformedicine.net/.
“WHO model list of essential medications,” 16th list, March 2009, http://www.who.int/selection_medicines/ ... ist_en.pdf.
Atul Gawande, The Checklist Manifesto: How to Get Things Right (New York: Metropolitan Books, 2009), 31.
“Army request for burn unit & maternity ward in Herat,” June 2007, Spirit of America, http://www.spiritofamerica.net/cgi-bin/ ... est_id=133.
Case study: “War zone hospitals in Afghanistan: A symbol of willful neglect,” The International Council on Security and Development, February, 2007, http://www.icosgroup.net/static/reports ... Report.pdf.
Fentanyl is a synthetic opioid that is 100 times more potent than morphine. The fentanyl lollipop is put under the tongue which is super vascular, and the opiate is absorbed rapidly into the bloodstream. Pain is relieved within minutes. Fentanyl lollipops are given to wounded soldiers in the battlefield to treat acute pain and to cancer patients.
See the Drug Policy Alliances’ website on harm reduction interventions around the world, including heroin-assisted treatment, http://www.drugpolicy.org.
“Poppy For Medicine: Licensing poppy cultivation for the production of essential medicines: on an integrated counter-narcotics, development, and counter-insurgency model for Afghanistan,” 2007, http://www.poppyformedicine.net/.
P4M proposes to sell finished poppy-based medicines to less developed countries that lack access under a two-tier system. According to P4M, “A second tier system of product supply is most useful where a significant sector of consumers are disconnected from the overall market for that product having been priced out, or ignored altogether.” This is a nice way of saying the drug companies have no interest in selling medicine to poor people in poor countries. There’s no profit in that. The international HIV/AIDS crisis put a spotlight on the criminal and monopolistic pricing practices of the pharmaceutical industry. See Elizabeth Terzakis’s article, “The global AIDS crisis,” International Socialist Review 25, September–October 2002.
Romesh Bhattacharji & Jorrit E.M. Kamminga, “Poppy for medicine: An essential part of a balanced economic development solution for Afghanistan’s illegal opium economy,” Journal of Drug Policy Analysis, Vol. 3, Issue 1, Article 3, 2010, 7.
Ashley Jackson, “Nowhere to turn: The failure to protect civilians in Afghanistan,” A joint briefing paper by 29 aid organizations working in Afghanistan for the NATO heads of government summit, Lisbon, November 19, 2010, Oxfam International, Afghanistan. The guidelines for the Interaction of Civilian and Military Actors in Afghanistan state, “Maintaining a clear distinction between the role and function of humanitarian actors from that of the military is a determining factor in creating an operating environment in which humanitarian organizations can discharge their responsibilities both effectively and safely.” ICOS is not a signatory to the Joint Briefing Paper.
Noreen MacDonald, Alan Jackson, & Jorrit E.M. Kamminga, “Afghanistan transition: Dangers of a summer drawdown,” January, 2011, 31, http://www.icosgroup.net/static/reports ... awdown.pdf. Despite all evidence to the contrary, ICOS stubbornly believes that the surge worked and write in their report, “It is clear that the additional US forces in southern Afghanistan are making progress.”
Jorrit E. M. Kamminga, “Opium poppy licensing in Turkey: A model to solve Afghanistan’s illegal opium economy?, International Council on Security and Development, January 2011, http://www.icosgroup.net.
Ethan A. Nadelmann, “Thinking seriously about alternatives to drug prohibition,” Daedalus, Vol. 121:3, 1992, 114.
Paoli, Greenfield & Reuter, 260. The United States is the largest importer of opiates. In 1981, the DEA began enforcement of a policy that the pharmaceutical industry could only import narcotics raw materials from an approved list of source countries. It’s called the 80/20 rule. It dictates that India and Turkey must be the source of at least 80 percent­­­ of all opiates.
Nathan, 331-332.

https://isreview.org/issue/80/poppy-fentanyl-lollipops
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Re: The Worst Addiction Epidemic in U.S. History

Postby Cordelia » Tue Nov 13, 2018 5:26 pm

Recent article doesn't directly address the tariff repercussions cited by liminal up-thread, but more on the China Connection...which, if the data reported is correct, and if the Zheng organization (referred to in past-tense) has reorganized and/or has competitors, the epidemic's future is assured and can only grow w/no fix in sight. By furthering the 'trade' war with China, the U.S. is sacrificing growing numbers in a population it must care little to nothing about.

Updated November 10

Labs in China brazenly sell fentanyl online


The U.S. is pressuring Beijing to shut down labs that produce, sell and smuggle the drug that's 'killing Americans.'


By Del Quentin Wilber

The Zheng drug trafficking organization was hardly clandestine. The Shanghai-based network sold synthetic narcotics, including deadly fentanyl, on websites posted in 35 languages, from Arabic and English to Icelandic and Uzbek.

The Chinese syndicate bragged that its laboratory could “synthesize nearly any” drug and that it churned out 16 tons of illicit chemicals a month. The group was so adept at smuggling, and so brazen in its marketing, that it offered a money-back guarantee to buyers if its goods were seized by U.S. or other customs agents.
.

Over the last decade, federal officials say, the Zheng group mailed and shipped fentanyl and similar illicit chemicals to customers in more than 25 countries and 35 U.S. states. U.S. officials say the syndicate’s success, laid bare in a recent federal indictment, partly helps explain America’s skyrocketing death toll from drug overdoses.

Fentanyl – 50 times more potent than heroin – and related laboratory-crafted drugs have become the No. 1 cause of opioid-related overdose deaths. And rogue chemical companies in China – operating openly and outside the reach of U.S. authorities – are the largest single source of the deadly drugs, law enforcement officials say.

A REAL CRISIS

“People in labs in China are producing this substance that is killing Americans,” Deputy Attorney General Rod Rosenstein said in an interview. “This is a real crisis. The Chinese government has the ability to stop this if they want to. We believe they should want to do that.”

U.S. officials have pushed Beijing to shut down the labs, and say Chinese authorities have taken steps to police chemical makers. The push comes even as relations with Beijing have grown acrimonious amid an escalating trade war and U.S. unease over China’s increasing economic and military clout.

Nearly 29,000 people died last year in the United States from overdoses linked to synthetic opioids, a category that experts say is dominated by fentanyl and its chemical cousins – a staggering surge from the 3,100 such deaths reported in 2013.

One reason for the increase: The drug is so powerful that a sugar-packet-sized bag of it can contain 500 lethal doses. That also means it can be smuggled through the mail in what officials call micro-shipments, which are far harder to identify and interdict than bulkier loads of heroin, cocaine or marijuana.

Chinese companies send fentanyl in small quantities to dealers in the United States or Canada, but ship the drugs in bulk to criminal cartels in Mexico. The cartels then mix the synthetics into heroin and other substances, or press them into counterfeit pills. The product is then smuggled across the border.

While total fentanyl seizures more than doubled last year, to 1,196 pounds, officials say far more of the illicit drug is getting through. Some of the biggest fentanyl busts have been in California because of the Mexican connection.

In September, for example, U.S. Customs and Border Protection agents seized 52 pounds of powdered fentanyl at the Pine Valley checkpoint near San Diego – and that wasn’t a record. In December, officers discovered nearly 80 pounds in a college student’s car.

This summer, authorities discovered 20,000 fentanyl pills in a hidden compartment of a Mini Cooper at the San Ysidro checkpoint – a week after confiscating 11,500 pills in another vehicle.

U.S. drug dealers also purchase directly from China with a few clicks of a computer mouse on company websites or in so-called dark web drug bazaars, where communications are encrypted and dealers often pay with cryptocurrencies or gift cards that are difficult to trace.

GOOGLE IT


The ease with which dealers can buy fentanyl from China “is a challenge because it’s creating traffickers who are not affiliated with larger organizations or with cartels,” said Paul Knierim, a top Drug Enforcement Administration official.

It isn’t hard to find fentanyl and similar drugs on the Internet, and sales tactics rival those of online retailers, according to federal investigators.

“A simple Google search of ‘fentanyl for sale’ returned a number of potential sellers,” according to a Senate Homeland Security Committee report released in January.

It said investigators, “posing as a first-time fentanyl purchaser,” had contacted six online sellers overseas, and each offered to ship purchases to the United States – sometimes with aggressive salesmanship.

The sellers “actively negotiated … to complete a deal by offering flash sales on certain illicit opioids and discounted prices for bulk purchases,” the report said. When investigators “failed to immediately respond to an offer, the online sellers proactively followed up, sometimes offering deeper discounts to entice a sale.”

Fentanyl was developed decades ago as an ultra-powerful painkiller – 100 times more potent than morphine – for use in surgery. It is still used to help hospice-level cancer patients.

https://www.pressherald.com/2018/11/10/ ... ug-online/


Since I'm more visually oriented, I needed to see what one ton of 'chemicals' could look like ...

Image

x 16 tons/month x 12 = just shy of 200 tons a year (almost 400,000 lbs). :shock:

The drug is so powerful that a sugar-packet-sized bag of it can contain 500 lethal doses. That also means it can be smuggled through the mail in what officials call micro-shipments, which are far harder to identify and interdict than bulkier loads of heroin, cocaine or marijuana.


So, packets of Fentanyl could look like...

Image
Fentanyl-laced heroin
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Re: The Worst Addiction Epidemic in U.S. History

Postby Grizzly » Tue Nov 13, 2018 8:44 pm

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If Barthes can forgive me, “What the public wants is the image of passion Justice, not passion Justice itself.”
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Re: The Worst Addiction Epidemic in U.S. History

Postby Cordelia » Thu Nov 15, 2018 12:09 pm

In the funeral industry, the spike in business due to overdose deaths is not appreciated by most and, (in my area at least) I've heard it taking a very high emotional toll on funeral home employees.

Opioid crisis creates new concerns for funeral homes


CLEVELAND – The opioid crisis in Northeast Ohio is changing how those who provide afterlife care do their jobs.

Not only are they seeing more overdose deaths, but each one brings its own unique challenges that could leave funeral home staff and their guests at risk.

From accidental exposure to powerful drugs to fights breaking out during a service, it’s the new reality for those who consider themselves the last responders to this deadly problem.

Funeral homes are now forced to change with the times.

The National Funeral Directors Association is recommending that its members across the country train their staff on how to recognize signs of an overdose and make sure they’re also prepared to administer naloxone.

For so many, the search for that next high costs them everything.

“We see the end result here at the funeral home. It’s shattering families,” said Mark Busch.

Busch, co-owner of Busch Funeral Home, sees nearly a half dozen overdose deaths every month.

“It’s heartbreaking,” said Busch.

Right now, some funeral homes are not taking chances and are implementing a naloxone protocol.

“It is something we are considering and evaluating at this time,” said Busch.

Busch said there’s growing concern in his line of work as he watches this crisis escalate.

“I’ve had colleagues of mine that have had overdoses occur within their funeral homes,” said Busch.

Guests at memorial services for a friend or family member who overdosed may turn to the same drugs that killed their loved one.

“That’s the unbelievable power and grip of this drug that it can’t be broken by someone just seeing they’ve had the death of their friend,” said Busch.

Busch said the ruthless cycle of overdoses knows no bounds.

“We’ve not only buried and or provided services for one member of a family, but we’ve provided services for another member of the same family,” said Busch.

Exposure to dangerous drugs is not the only safety threat surfacing. Those who are among the mourners could also lead to trouble.

“It’s a different dynamic that I would not expect a funeral home to be faced with during the course of my career,” said Busch.

In many overdose deaths, Busch sees angry, divided families, leaving funeral home staff in the middle as tensions rise.

“We become an arbitrator, a mediator. One side of the family over here – the other side of the family over here,” said Busch.

As a steady stream of grief-stricken families come in, Busch has grown frustrated.

“It is a crisis that I still do not believe is being adequately addressed,” said Busch.

http://greaterthanheroin.com/opioid-cri ... ral-homes/


Heroin epidemic so severe that many funeral homes can’t keep up with demand

Image

https://www.naturalnews.com/2017-03-11- ... emand.html



There's also additional fallout for other professionals, inc. coroner's office employees:

...Across the country, the opioid epidemic is putting a strain on already stressed county medical examiner and coroners’ offices — “busting the cracks wide open,” said Andrew Baker, M.D., chief medical examiner for Hennepin County, Minn.

“Whether you know it or not, the bottom is about to fall out of our death investigation system in America,” he warned NACo members July 15. Baker was part of a panel discussion on “The Opioid Crisis: Supporting County Medical Examiners and Coroners Offices.”

https://www.naco.org/articles/opioid-cr ... rs-offices


And so forth and so on...

:(
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Re: The Worst Addiction Epidemic in U.S. History

Postby Grizzly » Fri Nov 16, 2018 12:06 am

^^^ JESUS! ...
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Re: The Worst Addiction Epidemic in U.S. History

Postby Cordelia » Fri Nov 16, 2018 11:56 am

I remember reading this NYT article from October 2017; I wonder if the areas addressed have improved or worsened in a year's time (I hope that the career/spiritual changes on Dr. Andrew's path improve his life and the lives of those he works with :praybow ).


As Overdose Deaths Pile Up, a Medical Examiner Quits the Morgue

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Dr. Thomas Andrew, the chief medical examiner of New Hampshire, retired last month. Bodies from overdose deaths have overwhelmed medical examiners across the country.CreditCreditTodd Heisler/The New York Times

By Katharine Q. Seelye

Oct. 7, 2017

CONCORD, N.H. — In the state morgue here, in the industrial maze of a hospital basement, Dr. Thomas A. Andrew was slicing through the lung of a 36-year-old woman when white foam seeped out onto the autopsy table.

Foam in the lungs is a sign of acute intoxication caused by an opioid. So is a swollen brain, which she also had. But Dr. Andrew, the chief medical examiner of New Hampshire, would not be certain of the cause of death until he could rule out other causes, like a brain aneurysm or foul play, and until after the woman’s blood tests had come back.

With the nation snared in what the government says is the worst drug epidemic in its history, routine autopsies like this one, which take more than two hours, are overtaxing medical examiners everywhere.

“It’s almost as if the Visigoths are at the gates, and the gates are starting to crumble,” Dr. Andrew said. “I’m not an alarmist by nature, but this is not overhyped. It has completely overwhelmed us.”

As Dr. Andrew, an energetic man of 60 who, with his close-cropped gray beard, resembles the actor Richard Dreyfuss, has watched the drug toll mount, he is no longer content simply to catalog it. He wants to try, in his own small way, to stop it.

After laboring here as the chief forensic pathologist for two decades, exploring the mysteries of the dead, he retired last month to explore the mysteries of the soul. In a sharp career turn, he is entering a seminary program to pursue a divinity degree, and ultimately plans to minister to young people to stay away from drugs.

“After seeing thousands of sudden, unexpected or violent deaths,” Dr. Andrew said, “I have found it impossible not to ponder the spiritual dimension of these events for both the deceased and especially those left behind.”

This is especially true in New Hampshire, which has more deaths per capita from synthetic opioids like fentanyl than any other state. Last year the overdose death toll here reached nearly 500, almost 10 times the number in 2000.

Some medical examiners, especially in hard-hit Ohio, have had to store their corpses in cold-storage trailers in their parking lots. In Manatee County, Fla., Dr. Russell Vega, the chief medical examiner, said that when he reaches “overflow” conditions, he relies on a private body transport service to store the bodies elsewhere until his office can catch up.

With 64,000 overdose deaths last year nationwide — a staggering 22 percent jump over the previous year — it is little wonder that overdoses, the leading cause of death among Americans under 50, are reducing life expectancy. They are also straining the staffs and resources of morgues, and causing major backlogs.

In Milwaukee, Dr. Brian L. Peterson, the chief medical examiner, said that apart from the “tsunami” of bodies — his autopsy volume is up 12 percent from last year — the national drug crisis has led to staff burnout, drained budgets and threats to the accreditation of many offices because they have to perform more autopsies than industry standards allow.

At the same time, severe staff shortages unrelated to the drug crisis are crippling the profession, said Dr. Peterson, who is president of the National Association of Medical Examiners, which oversees accreditation. Few people go into forensic pathology in the first place, he said, largely because of low salaries, and as more forensic pathologists retire, fewer are replenishing the supply.

The result, Dr. Peterson said, is a national crisis that has already cost at least four offices their accreditation, which can undermine public confidence and lead to court challenges over a medical examiner’s findings.

For Dr. Andrew in New Hampshire, where a backlog of autopsies has put the state at risk of losing accreditation, that prospect is particularly distressing. He spent the first eight of his 20 years here professionalizing the office and earning its accreditation. Despite the caseload, the office has one of the most timely and transparent surveillance and reporting systems in the country.

MORE... https://www.nytimes.com/2017/10/07/us/d ... miner.html
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