Like Prohibition, The Opioid Epidemic is a Social Crusade
When government substitutes its judgment for that of subject matter experts, the citizenry tends to suffer. Law rooted in compassion or concern for public welfare rarely accomplishes its desired goal, because it does not consider the diverse conditions that actually affect individual wellbeing and instead advances officials’ ideas about the social conditions that promote behaviors they deem to be in citizens’ collective bests interests. Such an attitude, though it supposedly champions citizens’ welfare, often evokes a shrug of indifference when confronted with the consequences of its ham-fisted attempts to legislate morality.
Take former Attorney General Jeff Sessions’ declaration that “the country prescribes too many opioids” and “people need to take some aspirin sometimes and tough it out a little.” (Sullum 2018) Who, one might reasonably ask, is Sessions to tell those in pain how to best manage it? Why should his assumptions be more persuasive than the expertise of doctors?
Sessions and his comrades in the rhetorical war against drugs are guilty of two sins. In the first place, they overstep the bounds of their power. When Sessions proclaims people sometimes need to settle for aspirin, he exercises his personal discretion. Yet, he seeks to deny others this same ability. This crusader complex leads do-gooding bureaucrats to believe they are best placed to judge what is in the best interests of individuals. Opioids have been deemed dangerous to the public good, so a little personal pain is a necessary sacrifice some individuals, who use prescription drugs as intended, have to make for the betterment of the social order.
And therein lies the second sin: the mantle of authority they have assumed subsumes the place of actual subject-matter experts.
In demonizing opioids Sessions and his band of paternalistic bureaucrats foment fear and distrust, which undermines the authority of doctors, who are actually best placed to understand cases in which opioid use is a legitimate treatment.
This is particularly dangerous as Sessions’ view, and those of the administration he ultimately acted to represent, are not reflective of all the medical facts. Anti-opioid crusaders often describe marijuana as a gateway drug and seek to overturn the legalization laws passed by many states. But all the available evidence suggests the opposite is true. A 2016 study conducted by researchers at the University of Michigan found a 64% drop in opioid use by chronic pain sufferers who used medical marijuana. (Boehnke et al 2016) By a similar token, a 2014 study published in JAMA Internal Medicine found that opioid deaths were on average 25% lower in states that had legalized medical marijuana. (Bachhuber et al 2014)
The science, of course, is not settled, as science never is. And correlation is not causality. But it is precisely for this reason that it is dangerous to demonize what may be the best medical solution for decreasing opioid use. Research conducted with marijuana is already hampered by the fact that the Drug Enforcement Agency lists it as a Schedule 1 drug, which means anyone interested in conducting a study must use a strain of cannabis approved (and grown) by the federal government. (Maron, 2017) This makes comprehensive studies of marijuana’s potential medical benefits and pitfalls impossible. Were bureaucrats truly interested in a solution to the opioid epidemic, their efforts would be better place facilitating medical research than demonizing something that may be a safer alternative to harder drugs.
And herein lies the real tragedy of the opioid epidemic: it is not a social or political phenomenon, but a medical one. Grim images of social decay make for good political theater and allow politicians to play the compassion hero. But they often have a tenuous relationship with the facts. It is more a matter of building a story that fits in with the broader political narrative spun by the administration. The opioid crisis, at least as far as political interests go, is just another populist front. In this regard, it is not unlike Prohibition.
Prohibition arose from a crucible of Populist fears. The Industrial Revolution seemed an existential threat to the Midwestern agrarian lifestyle. Not only were small farmers, thanks to the transcontinental railroad, suddenly competing with unknown others all across the nation, but immigrants followed the new economic opportunities, bringing with them new cultures and ideas that seemed a threat to traditional values. Alcohol was seen as a vice responsible for eroding a wholesome lifestyle; it promoted domestic abuse and poverty; it distracted honest men from righteous pursuits, like labor and the raising of god-fearing families. In the fight against alcohol, ““[u]neasy people could turn here, as they had for generations, with assurance that in attacking liquor they fought beyond question for the Lord and the sanctity of the hearth.” (Wiebe 56) Alcohol was a symbol for the oppression suffered by the everyday working. It was “the means by which the interests, in this case the “whisky ring,” fattened on the toil of the people. Drinking was pre-eminently a vice of those classes—the plutocrats and corrupt politicians and ignorant immigrants—which the reformers most detested and feared.” (Hofstadter 290)
By a similar token, modern drug companies are used as a bogeyman by crusading politicians who paint them as black and hideous vultures preying on the weak and downtrodden. The communities where media and political figures paint the opioid epidemic as most exigent is in the Midwest, in former centers of industry now gutted, supposedly, by overseas competition. It is no coincidence that many of these communities are those President Trump embraces as his base and champions when complaining about global trade imbalances. American manufacturers are the victims of predatory and unfair competition from overseas; American citizens are the victims of predatory drug companies who peddle and overprescribe dangerous and expensive drugs.
In January, Trump took to Twitter to complain that, “Drug makers and companies are not living up to their commitments on pricing. Not being fair to the consumer, or to our Country!” (Edney 2019) The invocation of the “country” is telling, as it calls up a familiar populist dichotomy: the downtrodden everyman “us” against the conniving, manipulative “them.”
Anything that fails to appease red-hearted Americans is immediately exploitative, never-mind any consideration of how compliance with government regulations and the hefty price tag of research and development factor into the cost of drugs. The president has also spearheaded an anti-opioid campaign that promotes “true life” stories of addicts going to extreme lengths to obtain prescription opioids. Working in collaboration with the Truth Initiative, known primarily for its anti-tobacco messaging, the campaign, which aims to reach youth through “digital platforms, social media, influencers, and television,” describes the horrors of people breaking limbs and crushing their spines in order to obtain prescriptions. (Trump, 2018) According to Truth Initiative president Robin Koval, the group "’tested over 150 different message possibilities,’ focusing on whether the ads would decrease intentions of misuse, increase risk perceptions, are shareable, and make you want to learn more.” (Vazquez, 2018)
Opioid abuse is undeniably a problem, but not a political one. When it is made a political one, it becomes skewed by what amounts to political propaganda: horror stories chosen for their shock appeal. For every story of someone horrifically maiming themselves to obtain prescription painkillers, there is undoubtedly a story of someone responsibly using drugs they were prescribed and living their life in a more comfortable manner. Yet, the politicians who have decided to crusade against opioids do not tell these stories. Instead, as Koval’s statement reveals, they carefully select the most extreme stories, which foment fear and distrust of any doctor who recommends taking them.
This has the effect of undercutting the authority of doctors and other subject matter experts; it sticks the nose of government into doctor-patient relationships, undercuts the ability of individuals to make their own decisions about how to manage their health, and, by demonizing even the safe use of prescription drugs, condemns people to pain.
Prohibition was borne of a certain do-gooder class attempting to impose their will upon society. Anti-opioid political rhetoric seems to follow the same pattern. The promise to execute drug dealers makes for good political theater, painting, as it does, the politician as the social savior, but it does little to address the underlying issue of addiction, which is an individual, rather than societal, issue. Nor does painting drugs with a broad stroke as an unmitigated ill help the issue. There are legitimate uses for opioids; less-addictive drugs like marijuana may be an amenable alternative. But the research needed to determine this more authoritatively is stymied by the rhetoric of politicians like Trump and Sessions, which is devoid of nuance and facts.
Moral crusades hurt the citizens they purport to aid. They undercut the ability of individuals to have authority to make their own decisions, which is particularly troubling for those whose suffering might be eased by the drugs politicians seek to demonize. Moral crusades promote bureaucrats as the sole arbiters of societal right and wrong. This undercuts not only individual autonomy, but the place of subject-matter experts like doctors, who are best placed to provide help where it is truly needed.
Bachhuber, Marcus A.; Saloner, Brendan; Cunningham, Chinazo O.; and Barry, Colleen L. “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010. JAMA Internal Medicine. 2014;174(10):1668–1673.
Boehnke, Kevin F.; Litinas, Evangelos; and Clauw; Daniel J. “Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain.” The Journal of Pain. 2016;17(6):739-744.
Edney, Anna. January 5, 2019. “Trump Goes After Pharma on Twitter as Companies Increase Prices.” Bloomberg. https://www.bloomberg.com/news/articles/2019-01-05/trump-goes- after-pharma-on-twitter-as-companies-increase-prices
Hofstadter, Richard. The Age of Reform. New York: Vintage Books, 1955.
Maron, Dina F. June 14, 2017. “Science Calls Out Jeff Sessions on Medical Marijuana and the “Historic Drug Epidemic.” Scientific American.https://www.scientificamerican.com/
President Donald J. Trump. June 7, 2018. “President Donald J. Trump Is Taking Action to Stop Youth Opioid Abuse.” whitehouse.gov. https://www.whitehouse.gov/briefings- statements/president-donald-j-trump-taking-action-stop-youth-opioid-abuse/
Sullum, Jacob. January 8, 2018. “Jeff Sessions’ Advice to Pain Patients: ‘Take Some Aspirin’ and ‘Tough It Out’. Reason.com. https://reason.com/2018/02/08/jeff-sessions-advice-to- pain-patients-ta/
Vazquez, Maegan. June 7, 2018. “White House launches multimillion dollar ad campaign to combat opioid addiction.” CNN. https://www.cnn.com/2018/06/07/politics/white-house- opioid-advertisement-campaign/
Wiebe, Robert H. The Search for Order 1877-1920. New York: Hill and Wang, 1967.