The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided Struggle.

Samuel R Friedman,Georgios Nikolopoulos,Danielle C Ompad,Pedro Mateu-Gelabert,Magdalena Cerdá,Leah Hamilton,David C Perlman,Honoria Guarino,Noa Krawczyk

doi:10.3389/fpubh.2020.540423

Abstract

The opioid/overdose crisis in the United States and Canada has claimed hundreds of thousands of lives and has become a major field for research and interventions. It has embroiled pharmaceutical companies in lawsuits and possible bankruptcy filings. Effective interventions and policies toward this and future drug-related outbreaks may be improved by understanding the sociostructural roots of this outbreak. Much of the literature on roots of the opioid/overdose outbreak focuses on (1) the actions of pharmaceutical companies in inappropriately promoting the use of prescription opioids; (2) “deaths of despair” based on the deindustrialization of much of rural and urban Canada and the United States, and on the related marginalization and demoralization of those facing lifetimes of joblessness or precarious employment in poorly paid, often dangerous work; and (3) increase in occupationally-induced pain and injuries in the population. All three of these roots of the crisis—pharmaceutical misconduct and unethical marketing practices, despair based on deindustrialization and increased occupational pain—can be traced back, in part, to what has been called the “one-sided class war” that became prominent in the 1970s, became institutionalized as neo-liberalism in and since the 1980s, and may now be beginning to be challenged. We describe this one-sided class war, and how processes it sparked enabled pharmaceutical corporations in their misconduct, nurtured individualistic ideologies that fed into despair and drug use, weakened institutions that created social support in communities, and reduced barriers against injuries and other occupational pain at workplaces by reducing unionization, weakening surviving unions, and weakening the enforcement of rules about workplace safety and health. We then briefly discuss the implications of this analysis for programs and policies to mitigate or reverse the opioid/overdose outbreak.

Highlights

Much of the literature on roots of the opioid/overdose outbreak focuses on [1] the actions of pharmaceutical companies in inappropriately promoting the use of prescription opioids; [2] “deaths of despair” based on the deindustrialization of much of rural and urban Canada and the United States, and on the related marginalization and demoralization of those facing lifetimes of joblessness or precarious employment in poorly paid, often dangerous work; and [3] increase in occupationally-induced pain and injuries in the population. All three of these roots of the crisis—pharmaceutical misconduct and unethical marketing practices, despair based on deindustrialization and increased occupational pain—can be traced back, in part, to what has been called the “one-sided class war” that became prominent in the 1970s, became institutionalized as neo-liberalism in and since the 1980s, and may be beginning to be challenged
We describe this one-sided class war, and how processes it sparked enabled pharmaceutical corporations in their misconduct, nurtured individualistic ideologies that fed into despair and drug use, weakened institutions that created social support in communities, and reduced barriers against injuries and other occupational pain at workplaces by reducing unionization, weakening surviving unions, and weakening the enforcement of rules about workplace safety and health
A National Academy of Sciences report made a related point [13]: While increased opioid prescribing for chronic pain has been a vector of the opioid epidemic, researchers agree that such structural factors as lack of economic opportunity, poor working conditions, and eroded social capital in depressed communities, accompanied by hopelessness and despair, are root causes of the misuse of opioids and other substances and SUD

Summary

WHICH HELPED GENERATE THE

It has been proposed that we are in a fourth phase, characterized by polysubstance use, as overdoses involving both opioids and stimulants such as methamphetamine and cocaine have seen an increase, this may be a continuation of trends in polysubstance use that began after the 2008 economic crisis [29, 34] It is not clear whether the three proximal partial causes of the overall epidemic that we focus on in this paper—pharmaceutical industry activities, community despair, and pain—were differentially important in these three phases, it is likely that the pharmaceutical corporate contribution was greatest in the first phase. After 2013, the introduction of fentanyl into the illegal drug market, and the adulteration of heroin with fentanyl contributed greatly to the rise in heroin overdose deaths

COMMUNITIES OF DESPAIR

Workplace Sources of Pain

Findings

IMPLICATIONS FOR ACTION