Capitalism Hits Home: Capitalism and Opioids - A Deadly Combination

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In this episode of Capitalism Hits Home, Dr. Fraad continues an ongoing critique of the for-profit health care system in the US and examines some of its deadly effects. Overdose numbers are far higher than in any other rich country and could have been avoided if it weren’t for the collusion between drug companies, pharmacies, doctors, hospitals, and insurance companies. Dr. Fraad looks at what other countries have done to mitigate the effects of their own drug epidemics, and calls for a more humane and just approach to addiction and treatment in the US, if only capitalism could get out of the way.


Transcript had been edited for clarity

 

Hello. This is Dr. Harriet Fraad from Capitalism Hits Home, brought to you by Democracy At Work. Before I begin, I want to express my gratitude, as I usually do at the end, but I want to express it correctly at the beginning, my gratitude towards Democracy At Work for helping to make this program and this podcast possible, to all our Patreon listeners and contributors who help make it possible, and to all our listeners, whether they're Patreon members or not, who tell other people about the podcast, who listen, and who are part of this podcast community. And also to Bryan Isom who produces this podcast.

Today I want to talk about addiction. The United States is a world leader in addiction. There's no question about it. There were a hundred thousand deaths between 2020 and 2021, overdoses. There have been six hundred thousand since the 1990s. That’s an awful lot. It’s more than car accidents. It’s more than cancer. It's more than AIDS. It's a serious problem in the United States.

Addiction is caused by desolate personal lives — nothing to look forward to, terrible loneliness, isolation, and general terrible disappointment with life. The United States at this point is a very lonely place. It's starting to change, as people join together to make better lives, but that’s starting now. In the last year 100,000 deaths, and they have been brought to you by a combination of players, those deaths, those deaths of despair. And what's very interesting to me is that most of the people who died of overdoses were between 44 and 55. Those are the times, and they were mainly men as well. Those were the times when when men were expected to have seniority on their jobs, be established, have family support, and have a sense of being someone in their community. That's over. Their jobs, that were unionized, paid well and gave them a sense of standing in their own eyes, gave them a sense of standing in the community, gave them the ability to support dependent wives and children so that the wives either didn’t have to work, or didn't have to work full-time, and gave them other connections — connections in their unions. In the 1950s, 35 percent of American workers were unionized. Now it's less than 10 percent. And in your unionized workplace, or your non-unionized workplace, whose wages were influenced by the unionized workers around them, there were things like bowling leagues, clubs, and other connections, as well as union work together — organizing, sustaining the union, taking up grievances, talking about them, going to union meetings. That's mainly over.

Why? What happened to bring on his level of addiction and disconnection, because really, it's about connection. There’s a book by Johann Hari — it’s h-a-r-i-, j-o-a-h-a-n-n — Johann Hari. The book is called “Lost Connections” and it's about addiction. If we look at mental health for people as a four-legged table, as i think of it and like to say it, one solid leg is really close relationships. They could be with a sex partner, they could be with a really close, intimate friend or relative. Then there's another leg of support for mental health, which is another tier of connection: connection to people who are not really close in an ongoing way, but who you can always call and talk to. Friends who you meet up with, maybe not all the time, but often, so that you feel connected to their lives and they to yours. Another is group connection: participating in the PTA, in a blood drive, in a political movement, in a social movement, in a race-based movement like Black Lives Matter, in a political party or movement like Democratic Socialists, and so on. It’s where you feel a level of solidarity, and alliance, and connection, even if it isn't intimate and emotionally personal. And then there's a fourth level of connection: connection to the world. Americans usually don’t feel too connected to the wider world, but at least the world of the United States, so that something happens here, it's important to you. So that you watch the news, you participate in helping if there's a drive because there's flooding somewhere, you join a neighborhood organization that isn’t very active, but it's a neighborhood organization that looks at what's going on in the whole neighborhood and connects it, that you feel connected to an even wider world.

So that mental health is a series of connections, from the most intimate connections, to further connections, in which you're still invested, and you're still connected. Americans have become more and more disconnected.

Thomas Putnam, in his book “Bowling Alone,” which was published in 2009, made a study which has been followed up by Altermeier and others, up to the present day (I think the last one was 2019) which says that Americans are less active in anything, anything, than they were in bowling leagues alone in 1970. Now part of it is because jobs were taken. People are working multiple jobs that are at much lower wages, and they’re emotionally and physically exhausted. Another thing is that market-driven healthcare has really immiserated the United States, so that a lot of people are sick, and don't have proper health care. Another thing is that the pharmaceutical industry has gone haywire, as capitalists went overseas, made billions of dollars, and brought those dollars home to the United States to buy our government. People are having less and less power in this country to be effective in their government. There are five lobbyists for every member of Congress. The lobbyists increasingly write the legislation that's passed, and they tweak it towards the industries for which they lobby, so that the corruption is very intense.

I want to look at a particular drug here, and how it was marketed, because it's typical of the collusion of the government. Collusion is a good word that I use, but a lot of people don't know what it is. It’s the kind of willing cooperation, without acknowledging that it's cooperation. With the collusion of all parts of our market-driven health care system, the doctors, the pharmaceutical companies, and the big drug stores and, in this case also, unfortunately, the hospitals, and all aspects of health care together. I should mention also insurers, hospitals, doctors, big pharma, and big pharmacies — all together — brought he scourge of overdoses to the United States. Of the 100,000 deaths that happened just last year, most of them were deaths from opioids, and oxycontin is a primary opioid causing death.

Now what happened? What is this collusion? What am I talking about? Well, let's start with the government. The Federal Drug Administration okayed the drug oxycontin, whose claim to fame over other painkillers was that it lasts for 12 hours. and so it's slow release allows it to last for 12 hours The FDA a didn't consider how if an addict wanted to take it, it's fast release would give you a huge high. They also didn't look carefully into the research which was done in Puerto Rico and, if they'd looked carefully, they would have seen that oxycontin only lasted eight hours, after which the people who took it were desperate for more. It was passed in a very careless way, without any recognition of its potential for abuse ,or its false claims, then once it was released, it was very aggressively marketed and sold.

There’s an article that I would like to actually read most of, because it talks about the collusion of these pillars of this market-driven healthcare system that brought us addiction, because there was a lawsuit against three huge drug store chains by the state of Ohio, where small towns were taking or at least were prescribed, 400 oxy pills for every person in the little town. And somehow CVS, Walmart, and Walgreens let this through, even though they are required by law to report what looks like abuses. They didn’t, and the insurers covered the oxy prescriptions that were everywhere, and the doctors enthusiastically prescribed them, even though there was every indication that they were addictive.

Now you wonder why the United States is the leader in this area? Well, partly it's a market-driven healthcare system. It's the only country in the whole Western world, or actually in the whole world that I know of, that allows direct to consumer advertising of drugs. There is no other country that allows that. And no other wealthy country has statistics like ours where opioids are a factor in 7 out of 10 overdose deaths, and where almost a million people have been killed since 1999. And that’s, I think, partly because no other country has a capitalist health care system. All have universal health care paid for by the government to provide quality health care.

I would like to read you an article that says it all. It was in the New York Times, and it says “Big Pharmacy Chains Also Fed the Opioid Epidemic, Court Filing Says.” CVS, which operates thousands of pharmacies, worked with manufacturers to promote opioids as safe and effective. Through years of lawsuits and rising public anger over the opioid epidemic, the big American pharmacy retailers have largely eluded scrutiny. Nobody was looking at them, but a new court filing Wednesday morning asserts that pharmacies, including CVS, Rite Aid, Walgreens, and Walmart, were complicit in perpetuating the crisis as the manufacturers and distributors of highly addictive drugs. The retailers sold millions of pills, even in tiny communities. They offered bonuses for high-volume pharmacists, and even worked directly with the drug manufacturers to promote opioids as safe and effective. Specifically, the complaint they issued laid out evidence that CVS worked with Purdue Pharma, the maker of oxycontin, to offer promotional seminars on pain management to its pharmacists, so they could reassure patients and doctors about patient safety, and the safety of the drug” — all of which were lies. (That “all of which were lies” is mine; that wasn't in the article.) In partnership with EndoPharmaceuticals, CVS sent letters to patients encouraging them to maintain prescriptions of opana, a potent opioid so prone to abuse that the FDA took it off the market in 2017. From 2006 to 2014, RiteAid in Paynesville, Ohio, a population with 19 and a half thousand people, sold over 4.2 million doses of oxycodone and hydrocodone, all made by Purdue Pharma. They offered bonuses to stores with the highest productivity in selling opioids. Walgreens contract allowed, with the drug distributor AmerisourceBergen, specified that Walgreens be allowed to police its own orders, without any oversight from the distributor, because the distributors, too, are supposed to exercise oversight, which they don't do. Most of the companies for this article didn’t comment. Walgreens referred to an earlier statement responding to the litigation, and noted the “prescriptions are written by doctors based on their medical expertise, and when a patient presents a prescription, it gives no reason to question its legitimacy, the pharmacist is obligated to fill the prescription exactly as written.”

Now of course, federal law demands that manufacturers, drug realtors, and suppliers report high orders that don't make sense, high orders to the DEA, the Drug Enforcement Administration, but the chains didn't do that. They just continued to sell outsized quantities of opioids, only very rarely sounding alarms, which was true of the drug distributors as well. Walmart devised a workaround to that reporting requirement, the complaint says. It fixed a hard limit on opiate quantities it would distribute to its stores
foreclosing the need for pharmacists to repeat excessive orders. Yet Walmart simply allowed its stores to make up the difference in buying the reminder of their large opioid supplies directly from distributors. Until now, the focus of thousands of lawsuits across the country has been on drug manufacturers and distributors. A handful have settled. However, they're continuing to sue. The first case to advance against retailers in Ohio was scheduled for November. Those counties are only suing the chains in their capacity as distributors. However, there are also suits on their capacity to recommend and to reassure doctors of the legitimacy of these opioids that are highly addictive, and cause overdose deaths. It’s so dramatic that in a little town or a little county in Ohio, Trumbull County, 28 pharmacies sold 68 million doses to a population of 20,000 people, 322 pills for everyone.

Now, how did this get by? What happened? Well, first the government allowed the oxycontin to continue, and then oxycodone to continue, a later similar product, even though it had proved highly addictive in the tests. Secondly, a very aggressive marketing process by Mackenzie went all over the country, to every little town, to meet with doctors, and pay other doctors, to reassure those doctors that these are safe and effective drugs, far superior to the other drugs on the market. Then the pharmacies also cooperated, and reassured the patients and the doctors that these were safe, as they distributed millions upon millions of pills to addicts across this country.

Now what's going on here? What's going on is capitalist collusion to kill people. These are killer drugs, and yet it wasn't picked up. It’s not picked up that the doctors were paid, bribed, to give seminars to other doctors on the marvels of oxycodone and oxycontin, and a drug rep was always present. The minimum they got was 30 grand a year, but that was a minimum; The maximum was far higher, into the millions. And the representative of the Purdue Pharma Company was there, serving the wine, and the cheese, and noting if anything negative were said by the doctor, then he'd be off the gravy train. So that you had a collusion of the doctors, the pharmaceuticals providers, pharmaceutical manufacturers, the marketers, the drug stores, and the insurance that paid people for repeated doses that they could never have needed. The Sackler family that owns Purdue Pharma, although they are implicated in seven out of ten deaths, have had no jail time. They have had to pay out millions of dollars in settlements, but all they've done with that is make more money by shifting their marketing overseas, like the tobacco companies did. The head of the marketing genius was the child of the person who marketed Valium to Americans, in previous times called “mother’s little helper,” and not considered to be addictive which, of course, it was. The Sacklers did have some damage; the Sackler wing at the Guggenheim Museum in New York is no longer called the Sackler wing, because hundreds of people had a die-in at the Guggenheim Museum, showing how many people died of overdoses thanks to Purdue Pharma, owned by the Sackler company. The Louvre, the big museum in France, had to give up its Sackler wing because of demonstrations at the Louvre. Certain Sackler chairs in various medical schools had to be renamed, because the Sacklers killed people, but they retain billions, and have never seen a day of jail time, whereas someone who steals one prescription serves jail time, especially if he or she is a person of color.

And so there is this collusion. The addiction crisis, which is much worse in the United States than any other developed country, could have been prevented. A country that’s a larger country that we all know about, like Portugal, was really afflicted with heroin. They had been under Salazar, a dictator, for a long time — 30 years, as I recall. People felt hopeless, and disconnected, and the situation was so terrible that one percent were addicted. Then they got through a program which reduced addiction by 75 percent, which is all drugs were sold by the government, legally sold by the government, so if you wanted any kind of drug you went to the vans that were in every neighborhood, and came every day, and you bought your drugs. That made the population healthier, because people weren't injecting concrete and other mixers into their arms. And in this van there were also people to help you if you wanted to get off your addiction. If you didn’t, nobody bothered you; you could buy your drugs. And with the money for safe drugs, they set up a huge chain of treatment for people who wanted that treatment. It was a wild success.

The same thing happened in a poor little country, Uruguay, in South America. When they finally won their revolution, their leader (who had plenty of time to think, because he was imprisoned in a well for 20 years) realized that Uruguay was on the supply chain between Mexico and the United States, and it would be afflicted by the drug trade. He was a Socialist, and when he became the head of Uruguay — and just to show you what kind of person he was, he moved back into the shack where he and his wife had lived before, called the presidential shack — and they passed a drug policy similar to Portugal’s, that all drugs are controlled and sold by the government, which offers treatment, and finances that treatment well, through the drug money that it gets. They too escaped the kind of crime wave that has happened in every nation between Mexico and the United States, and other drug producers like Colombia and the United States.

So that, of course, is possible. It's been done. It could be done in the United States, so we wouldn't be outstanding, not only in being the only market-driven and most expensive health care system (though I should say, not the best) in the world. We could solve the addiction problem by legalizing drugs, and decriminalizing all drugs that aren’t sold through the government's sales vans in every neighborhood, and using that money to treat people, and in addition, to create political and social services, and social movements that link people. Portugal, although Americans don't really know it (even though we all know the name Portugal) has been ruled by a coalition of the Socialist Party, the Communist party, and the Green Party, and it didn't suffer from the kind of austerity that the United States and many other nations suffered. And it has resolved its drug problem. Uruguay, similarly.

So of course, the United States, instead of declaring a war on drug users, and making their lives miserable and unhealthy, could have that policy, have all drugs sold by the government at prices that are reasonable prices, and raise enough money for treatment, because in our for-profit system not only do we have our legitimate doctors making a mint, so highly paid, and extra money from bribes for the marketing associates for drugs like oxycontin, we have them in collusion with the insurance companies, who pay for the drugs, the pharmaceutical companies who make the drugs, the government which lacks oversight, the drug stores that push the drugs, and the whole health system, the whole market-driven health system, is implicated. Basically, the things we need for life are proper food, clean water, clean breathable air, proper health care, places to live, and temperature control, to protect us from extreme heat and cold. None of those things, of course, including health care, should be commodified. What's the point of making a commodity out of a life necessity, so some people can accumulate billions, while other people die? The same thing is true across the board. The EpiPen went up 400 times in price when it was bought by a new pharmaceutical company. The EpiPen is needed for extreme allergic reactions, it keeps people from dying, and it made a huge profit. These are criminal activities of a capitalist government, and people say, “Well, the problem is it's not regulated enough.” Well, if some people have many billions, and other people don't have anything, you can always buy the regulators. That’s what you could see in every field where there's danger.

I remember the discussion of Zyprexa, a drug that was supposed to be only given to psychotic adults, but a Dr. Biederman at Harvard, who was the head of the Harvard Child Psychiatry Department, and also the Journal Child Psychiatry, recommended Zyprexa for children as well. All it does is give them diabetes, but I remember hearing a representative of Johnson and Johnson, which made Zybrexa, and Johnson and Johnson, which also rewarded Dr. Biederman with the 3.2 million dollar complex for his laboratory at Harvard, which did not oversee these funds, at any rate this representative was asked, “How could you push a drug that made children obese, diabetic, and didn't help them? How could you do that to them?” And he said, in true capitalist fashion, “Hey, if you're racing towards a billion dollars, or 17 billion in this case, you pay the traffic ticket.” The traffic ticket was a couple of million in fines.

So if you have a capitalist-driven, market-driven health care system, you will have corruption. Every other rich country has recognized this, and has universal health care, which takes away the scourge of corruption, because profits aren't made there. We have to join those countries, and we won't join them unless there's a united movement, and all those people who want drug addiction and drug crime to stop, have to change it from a war against drug users, to a war against drugs and the profit from drugs. And in the United States, the most deadly drugs, the ones that caused 600,000 deaths, and then in the last year a hundred thousand, our thanks are given to you by the pharmaceutical industry, which is still a legitimate industry, hardly overseen by the largely compromised Federal Drug Enforcement Administration. This is a crime against all of us. We need a Socialist movement .we need to take capitalism totally out of the basic needs of our lives. And the reason so many people are addicted is they're alone, and a way of fixing that is creating a mass movement where we all together realize we need each other, and connect to change that. Connect to force a universal, quality, public health care system and a Socialist system like they have in Portugal.

And it's interesting to me that in this latest COVID epidemic, where the United States is once again a world leader with the most dead, the United States has 800,000 dead and climbing, we are a third of the population — well China has four times, actually, more people than we do — but they have one twentieth of the deaths, something so wrong. They're a combination of capitalism and socialism, a highly regulated capitalism and a dominant socialism, with offenses it is true, as every country does, but they created the Sinovac which they have liberally distributed. Everyone has to be vaccinated, and boosted, and safe. And when there was another epidemic recently in one city, they found 59 cases, they closed the whole city down, and tested, and treated everyone. That's what you need. You need big government, like FDR — the most popular president in history — had, so that people know they're taken care of. Big government the way Jacinda Ardern, of the Labour Party in New Zealand, has, but also has a tiny, tiny portion of deaths, because they trust their leader, because they have a fair society, because the economic discrepancies are not outrageous. We need that. We need Socialism here. We need it for a lot of things, but one of them is to stop addiction. Thank you.

Goodbye for now, and thanks to Bryan Isom who produces this show, and also to Democracy At Work, and to all of you who contribute, and who listen. Thanks so much. Goodbye.

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References: https://bookshop.org/books/lost-connections

https://bookshop.org/books/bowling-alone

https://www.nytimes.com/2021/11/23/health/walmart-cvs-opioid-lawsuit-verdict.html


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