Friday, July 19, 2019

DID THE DEMOCRAT PARTY, NOW THE GLOBALIST LA RAZA SUPREMACY DEMOCRAT PARTY FINISH OFF MIDDLE AMERICA?



New York Times Op-Ed: Yes, Migration Does Spike Economic Inequality, Damage Middle Class

Migrant Caravan Crosses Into Mexico
John Moore/Getty Images
3:06

A regular columnist in the New York Times is admitting that mass migration causes inequality throughout America.

“I think our immigration policy should take into account the sharp rise in inequality over the last few decades,” David Leonhardt wrote July 17. He explained:
It’s not just a coincidence that the period of strongest income gains for middle-class and poor families — starting in the 1940s — followed, and overlapped with, a period of falling immigration. “Immigration restriction, by making unskilled labor more scarce, tended to shore up wage rates,” the great labor historian Irving Bernsteinwrote.
The economists Peter Lindert and Jeffrey Williamson have noted that the foreign-born share of the labor force fell to 5 percent in 1970, from 21 percent in 1915. Countries with “slower labor force growth” in the middle of 20th century, they note, “experienced deeper income inequality reductions.”
Since the 1970s, of course, immigration has surged, as has income inequality. Many other factors play a role in rising inequality: corporate consolidationslowing educational attainmentthe decline of unionsfalling tax rates on the rich and more. Some of these are substantially more important than immigration. But immigration belongs on the list.
Leonhardt’s column is a modest step but is notable because nearly all former liberals have remained silent about the huge economic and political consequences of their high-migration/cheap-labor economic strategy. The silence is all the more remarkable because one of the most obvious consequences has been the 2016 election of a New York real-estate entrepreneur to the White House.
But Leonhardt’s admission will likely go nowhere because his proposed fix for the current inequality is to shift the pain of cheap-labor migration from blue-collar Americans to his own influential professional class and their cosseted college-graduate children.
Instead of lowering or ending immigration, he suggests the inequality problem can be addressed by reducing, “or at least hold constant, the level of immigration by people who would compete for lower- and middle-wage jobs while increasing immigration among people who would compete for higher-wage jobs.
His column provides more evidence that elite Americans are so enamored of immigration and diversity that they would throw the college graduate class under the bus rather than give up their visions of ruling over a chaotic and fractured “diverse” society.
Amazon's Jeff Bezos & Facebook's Zuckerberg are trying to snatch a huge prize from Trump - and spike the US-India Outsourcing Economy - by quietly lobbying for a law which gives green cards to more Indians who take college-grade jobs from American grads. http://bit.ly/2LpqAmx 

Breitbart News has provided the most extensive and detailed coverage in the media of the many links between the federal economic policy of migration and the widening economic gap between investors and employees, between the few coastal states and the heartland states, and between the civic status of elitists and ordinary Americans.
Few establishment reporters can follow the money through the immigration debate, partly because their careers are risked by exposing the elites’ economic, statu, and political gains from mass migration. The major risk for journalists is the likely backlash from their own peers and customers — the progressives in the Democratic base, the business elites, and high-status university leaders who pride themselves on their self-serving support for divide-and-rule diversity.


EconomyImmigrationPoliticsimmigrationinequalitymigrationNew York Times



Is Corporate America Selling Out Our Country?



Within hours of Pearl Harbor, President Franklin Roosevelt began summoning the heads of American industry to Washington. Roosevelt knew the country would need an unprecedented buildup of planes, ships, and other war materiel. Without hesitation, American companies responded. Ford, Packard, Chrysler, 3M, Hormel, General Mills, Pillsbury, Cargill, Boeing, and many other major U.S. companies gave their all to the war effort. At Roosevelt's request, the president of General Motors even left his company to oversee the war production effort as a lieutenant general in the U.S. Army. Roosevelt's initial request for 50,000 new airplanes per year was openly mocked by the Germans as outlandishly high and impossible to achieve. But the mighty U.S. industrial base roared to life and pulled it off. By war's end, the United States was producing 100,000 warplanes a year. U.S. industry literally transformed itself to save our country. It's fair to wonder if our current CEOs would do the same.
Would American companies in a new globalized economy drop everything for their country? Do American companies even consider themselves American anymore? The Daily Caller News Foundation asked 19 of the biggest names in corporate America if they saw themselves as "American" companies. It shouldn't be a very hard question to answer. But 10 of the 19 -- including Amazon, Apple, Chevron and General Electric -- refused to answer altogether. The others mostly gave weasel answers. Only General Motors and the bank JPMorgan Chase were willing to clearly identify as American institutions. And even with them, the actual record is cause for concern.
Billionaire tech investor Peter Thiel brought this issue to light recently when he accused Google of "seemingly treasonous" behavior for cozying up to the communist Chinese government. Amazingly, Google has been working on a censored search engine: Project Dragonfly, built for the Chinese government and designed to keep the Chinese people from seeing the free flow of information. At the same time, Google refused to work with the U.S. military. Thiel suggested that the FBI and CIA should investigate Google, which seems like a good place to start. More broadly, though, can we really call Google an American company?
Google and many other U.S.-based companies have operations, sales, and customers all over the world. They think of themselves globally. They value the bottom line above all. A dollar made in China is the same as a dollar made in America.
The question for America is whether this is sustainable. Every big company has a Washington office dedicated to influencing U.S. government policy and regulation. With our increasingly powerful government and regulatory regime, it's smart for companies to do this, and there is nothing wrong with it in theory. But now that corporate America is pushing Washington for its often globalist positions instead of for policies that benefit Americans, we may have a real crisis on our hands.
We're not talking about just a few corporate offices. Washington is completely dominated by corporate America. Big companies fund the influential trade associations all over Washington and hire lobbyists all over Congress and the regulatory agencies. These lobbyists understand our increasingly complex labyrinth of regulations. And they are often writing the laws Congress enacts.
Think tanks are supposed to be independently analyzing and commenting on our policies. But who do you think funds the think tanks in Washington? Corporate America dominates in this sphere as well. When they want a new law or to stop a law or regulation they don't like, these companies go even further, hiring public relations firms and ad agencies to convince us of their positions. All of this is a multibillion-dollar business.
Lately, when senators and representatives leave Congress, they go to work for the corporate influence machine. Over two-thirds of the congresspersons who retired or lost their seats this last election cycle is now corporate lobbyists. That's a record level. A seat in Congress has become an extended tryout for a high-paying corporate influence job.
All of this would be of less concern if corporate interests still aligned with actual American interests, but those days seem to have ended sometime between the great industrial ramp-up for World War II and Google's recent siding with communist China over the U.S. military. Where does this leave the American people?

More fundamental than the individuals involved in these crimes is the social system that produces them. The subordination of the political establishment to the private interests of corporations is not a feature of life that will be changed through lawsuits. Rather, the solution to the opioid crisis lies in the mobilization of the working class to take ownership of the for-profit pharmaceutical companies, drug distributors and the entire healthcare industry in order to provide medical care in the interest of human need, not private profit.

Drug companies poured 76 billion opioid pills into US neighborhoods in just six years

Previously undisclosed drug company data released by the US Drug Enforcement Administration (DEA) has provided the most comprehensive look to date at the nation’s opioid crisis. The database, which traces the path of every single narcotic sold in America—from manufacturer to distributor to pharmacy from 2006 to 2012—has been analyzed in a report by the Washington Post.
The data, along with the history of its delayed release, is remarkable in many ways. First, it confirms in the most concrete terms the criminal role played by drug companies in creating the deadly opioid epidemic that now kills 70,000 people a year in the US. The prescription opioid epidemic alone resulted in nearly 100,000 deaths from 2006 through 2012.
According to the database, throughout the documented six-year period in which the drug epidemic was beginning to spin out of control, drug companies poured 76 billion oxycodone and hydrocodone pain pills into US neighborhoods.
This almost incomprehensible number meant that during these years, the companies distributed enough pills to supply every adult and child in the country with 36 pills each per year.
However, the distribution of the pills was not uniform from state to state or from city to city. The state of Kentucky, for example, was flooded with enough pills to give every person 63.3 pills each per year; South Carolina, 58; and Tennessee, 57.7.
West Virginia, the state with the highest opioid death rate during this period, received enough pills to give every person 66.5 pills each year.

Rural areas hard hit

Rural areas were among the hardest hit. In Norton, Virginia, there were enough pills to provide 306 pills per person a year; Martinsville, Virginia, 242; Mingo County, West Virginia, 203.
During the years covered by the database, 2006 to 2012, annual opioid deaths rose from under 18,000 a year to more than 23,000, with prescription drugs cited as factors in almost half the deaths. The volume of the pills handled by the companies also skyrocketed as the epidemic surged, increasing about 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012.
Since then, overall opioid deaths in the US have skyrocketed. The flooding of markets with prescription drugs, especially in economically depressed areas, spawned increased heroin use and ultimately, along with a number of other factors, led to the current fentanyl crisis that added more than 67,000 to the death toll from 2013 to 2017.
There is no doubt that the top drug 
manufacturers and distributors are guilty a 
thousand times over for the deaths of 
hundreds of thousands of innocent people; for
the incalculable pain and suffering on the 
part of those addicted, their children, and their
families; for the economic and social 
devastation the crisis has brought to large 
swaths of rural America. It has placed an 
immense strain on healthcare systems, 
social services, and the foster care system. 
These companies made billions of dollars off 
of human suffering.

Complicity of the political establishment

However, the insidious character of this massive operation extends well beyond the drug manufacturers and drug distributors. The drug manufacturers and distributors were able to carry out this operation only because of critical structural support they received from the highest level of the political establishment.
The data revealed Monday comes from an exclusive database controlled and viewable only by the DEA, a government-controlled body supposedly meant to oversee and police these companies. The information to which this body had access is highly detailed, including the name, DEA registration number, address and business activity of every seller and buyer of a controlled substance in the United States. The database also includes drug codes, transaction dates, and total dosage units and grams of narcotics sold.
It is not only the drug companies who have been fighting to keep this database secret, but the DEA along with the US Department of Justice. The database was only unveiled after a yearlong battle for access to the documents waged by the Washington Post and HD Media. What accounts for this secrecy?
The truth is, as with every major industry, the drug corporations routinely buy off politicians to secure ideal business conditions. The DEA exemplifies the fact that the federal agencies supposedly tasked with policing big business—the Securities and Exchange Commission, the Food and Drug Administration, the Environmental Protection Agency, the Occupational Safety and Health Administration—are under the thumb of the corporations and run political interference for them.
Innumerable facts support this claim. First, despite access to this overwhelming data, over the course of this entire crisis the DEA has taken only the most limited action against these companies, which has resulted in many of them paying a pittance in fees for their crimes.

BLOG: TO ESTABLISH A THIRD TERM FOR LIFE, THE MUSLIM BARACK OBAMA FIRST HAD TO DESTROY MIDDLE-AMERICA. HIS CRONY PLUNDERING BANKSTERS AND HIS SURRENDER OF OUR BORDERS TO NARCOMEX DID THAT. 
NEXT TO WAS TO WEAKEN AMERICA WITH DRUGS. 

Katie Pavlich's Latest Books, Fast and Furious: Barack Obama's Bloodiest Scandal and the Shameless Cover-Up are available on Amazon
FOR EIGHT YEARS BARACK OBAMA AND ERIC HOLDER SABOTAGED HOMELAND SECURITY TO EASE MORE MEXICANS OVER OUR BORDERS AND INTO OUR JOBS AND VOTING BOOTHS.

OBAMA NEEDED THESE ILLEGALS TO FINISH OFF THE AMERICAN MIDDLE CLASS, WHAT WAS LEFT OF THEM AFTER OBAMA'S CRONY BANKSTERS' PLUNDER.


“The watchdogs at Judicial Watch discovered documents that reveal how the Obama administration's close coordination with the Mexican government entices Mexicans to hop over the fence and on to the American dole.”  Washington Times

 

 

The Obama administration’s role

However, even this minimal oversight was too much for the companies and their counterparts in Washington. As the opioid crisis was erupting, the US Congress was working to eviscerate the oversight powers of the DEA, starting in 2014 and culminating in the Ensuring Patient Access and Effective Drug Enforcement Act of 2016, which passed by overwhelming votes in Congress and was signed into law by then-President Barack Obama.
The main purpose of the legislation was to stop the DEA’s Office of Diversion Control from halting drug shipments for unusually large and unexplained sales. For example, when several Walgreens pharmacies in Florida sold more than 1 million opioid pills in a year, compared to a nationwide average of 74,000, the Office of Diversion Control could impose fines and suspend distribution, preventing the drugs from reaching the streets pending the results of an investigation.
The 2016 law effectively ended the ability of the DEA to suspend such orders. Political action committees representing the pharmaceutical industry contributed at least $1.5 million to the 23 lawmakers who sponsored or co-sponsored four versions of the bill. Overall, the drug industry spent $102 million lobbying Congress on the bill and related legislation between 2014 and 2016.
At least 46 investigators and attorneys from the DEA, including 32 directly from the Office of Diversion Control, were hired by the pharmaceutical companies after scrutiny of the drug distributors began in 2014.
The intimate connection between these gigantic corporate monopolies and the institutions of state power revealed in the case of opioid drug distributors is the relationship that prevails across-the-board throughout the capitalist system internationally.
Over the course of the last three years, various lawsuits have been brought against different drug companies. Some have been successful in bringing attention to the issues involved and in securing some monetary retribution from the companies. There are currently dozens of drug companies being sued in federal court in Cleveland by nearly 2,000 cities, towns and counties alleging that they conspired to flood the nation with opioids.
While these efforts rightfully target many of the guilty parties involved in the creation of this crisis, the results of the lawsuits, however “successful,” will ultimately do little to repair the damage done by the drug epidemic over the course of the last decade, let alone make whole the families who have suffered the trauma of losing loved ones.
More fundamental than the individuals involved in these crimes is the social system that produces them. The subordination of the political establishment to the private interests of corporations is not a feature of life that will be changed through lawsuits. Rather, the solution to the opioid crisis lies in the mobilization of the working class to take ownership of the for-profit pharmaceutical companies, drug distributors and the entire healthcare industry in order to provide medical care in the interest of human need, not private profit.


Opioid Crackdown Could Lead To More Drug Company Bankruptcies
BRIAN MANN
Two years ago, the drug company Insys Therapeutics posted a quarter-billion dollars in annual sales. But the Arizona-based firm's fortunes plummeted so far that on Monday its leaders declared bankruptcy. It was the latest fall-out from the nation's prescription opioid epidemic, which has killed more than 200,000 Americans and triggered hundreds of lawsuits against Big Pharma.
Insys marketed an opioid pain medication called Subsys that included fentanyl. It generated tens of millions of dollar in annual sales. But like other prescription opioids marketed aggressively by the drug industry, it turned out to be highly addictive.
LAW
Insys Files For Chapter 11, Days After Landmark Opioid Settlement Of $225 Million
Many of the drug industry's biggest companies are tangled up in a wave of opioid litigation, including name brand companies Johnson & Johnson and CVS. It's unlikely large firms will follow Insys' lead and seek Chapter 11 protection, but smaller firms including Purdue Pharma, the maker of OxyContin, have already floated the possibility.
Attorneys representing hundreds of communities that hoped to win compensation from Insys issued a statement Monday saying they'll work to determine whether the company is actually insolvent. "We will actively pursue full financial disclosure for Insys and any other defendant that files for bankruptcy," the plaintiff group said.

NATIONAL
New York Lawsuit Claims Sackler Family Illegally Profited From Opioid Epidemic
They added that their goal in targeting 21 other drug firms isn't to put them out of business but to "abate the current opioid epidemic and seek long-term, sustainable solutions." State and local officials hope to recoup some of the billions of dollars they've spent responding to the opioid crisis.
One major state opioid trial is underway now in Oklahoma against Johnson & Johnson, with a second consolidated trial against other firms set to begin in October in Ohio. Judge Dan Polster, who's presiding over that federal case, has urged the parties to reach a settlement so communities receive some compensation without disrupting the pharmaceutical industry.
Sources tell NPR negotiations are underway but no deal has been reached.
In all, more than 1,800 state and local governments have filed opioid-related lawsuits. Penalties and settlements could run into the tens of billions of dollars, rivaling big tobacco payouts of the 1990s. The move by Insys came a week after the firm pleaded guilty to felony charges that it bribed doctors to prescribe its Subys fentanyl medication to patients who shouldn't have been using it.
The company agreed to pay the federal government $225 million in penalties. Last month, company founder John Kapoor, once a towering figure in the drug-tech industry, was found guilty on federal racketeering charges along with four other Insys executives. The company still faced numerous other opioid-related lawsuits.
In his statement, Insys CEO Andrew Long, said in a statement those "legacy legal challenges" contributed to the firm's decision to enter bankruptcy proceedings.
He said bankruptcy proceedings would allow the company to negotiate with creditors.


PELOSI’S OPEN BORDERS FOR MORE CHEAP LABOR

The Mexican Army made two seizures in Ensenada on August 17 (1,036 pounds of meth, heroin, and fentanyl) and August 18 (1,653 pounds of meth, fentanyl, and marijuana).

The Mexican Army discovered an active drug lab on August 25 in Tecate and seized four tons of methamphetamine.

The Mexican Federal Police seized 350 pounds of methamphetamine in an active drug lab in Tijuana on August 26.
The Mexican Federal Police seized 20,000 fentanyl pills in an active lab in Mexicali on September 10.

The Mexican Federal Police seized 550 pounds of methamphetamine in Tijuana on September 12.

The Mexican Army seized 1,055 pounds of methamphetamine near the Arizona border on September 14.

A.G. JEFF SESSIONS DEFENDS U.S. BORDERS AGAINST THE DEMOCRAT PARTY AND MEXICO’S INVASION.

"Some of the most violent criminals at large today are illegal aliens. Yet in cities where the crime these aliens commit is highest, the police cannot use the most obvious tool to apprehend them: their immigration status. In Los Angeles, for example, dozens of members of a ruthless Salvadoran prison gang have sneaked back into town after having been deported for such crimes as murder, assault with a deadly weapon, and drug trafficking." HEATHER MAC DONALD

 “Heroin is not produced in the United States. Every gram of heroin present in the United States provides unequivocal evidence of a failure of border security because every gram of heroin was smuggled into the United States. Indeed, this is precisely a point that Attorney General Jeff Sessions made during his appearance before the Senate Judiciary Committee hearing on October 18, 2017 when he again raised the need to secure the U.S./Mexican border to protect American lives.” Michael Cutler …..FrontPageMag.com 

A.G. JEFF SESSIONS DEFENDS U.S. BORDERS AGAINST THE DEMOCRAT PARTY AND MEXICO’S INVASION.
"Some of the most violent criminals at large today are illegal aliens. Yet in cities where the crime these aliens commit is highest, the police cannot use the most obvious tool to apprehend them: their immigration status. In Los Angeles, for example, dozens of members of a ruthless Salvadoran prison gang have sneaked back into town after having been deported for such crimes as murder, assault with a deadly weapon, and drug trafficking." HEATHER MAC DONALD
 “Heroin is not produced in the United States. Every gram of heroin present in the United States provides unequivocal evidence of a failure of border security because every gram of heroin was smuggled into the United States. Indeed, this is precisely a point that Attorney General Jeff Sessions made during his appearance before the Senate Judiciary Committee hearing on October 18, 2017 when he again raised the need to secure the U.S./Mexican border to protect American lives.” Michael Cutler …..FrontPageMag.com 

CJNG is one of the most powerful cartels in Mexico and the Department of Justice considers it to be one of the five most dangerous transnational criminal organizations in the world — responsible for trafficking tons of cocaine, methamphetamine, and fentanyl-laced heroin into the United States.

 

AMERICA: MEXICO’S WELFARE STATE

… and in exchange we get 40 million Mexican flag wavers, homelessness, a housing crisis, heroin & opioid crisis and jobs for legals crisis…. ALL THANKS TO THE DEMOCRAT PARTY

http://mexicanoccupation.blogspot.com/2013/08/how-cheap-is-staggering-cost-of-mexicos.html

“Thirteen years after welfare reform, the share of immigrant-headed households (legal and illegal) with a child (under age 18) using at least one welfare program continues to be very high. This is partly due to the large share of immigrants with low levels of education and their resulting low incomes — not their legal status or an unwillingness to work. The major welfare programs examined in this report include cash assistance, food assistance, Medicaid, and public and subsidized housing.”  Steven A. Camarota

THE LA RAZA MEXICAN DRUG CARTELS REMIND AMERICANS (Legals) THAT THERE IS NO (REAL) BORDER WITH NARCOMEX!

SHOCKING IMAGES OF CARTELS ON U.S. BORDERS:
“Heroin is not produced in the United States. Every gram of heroin present in the United States provides unequivocal evidence of a failure of border security because every gram of heroin was smuggled into the United States. Indeed, this is precisely a point that Attorney General Jeff Sessions made during his appearance before the Senate Judiciary Committee hearing on October 18, 2017 when he again raised the need to secure the U.S./Mexican border to protect American lives.” Michael Cutler …..FrontPageMag.com
THE MEXICAN DRUG CARTELS OPERATING IN AMERICA’S OPEN BORDERS

Overall, in the 2017 Fiscal Year, officials revealed that a record-breaking 455,000 pounds plus of drugs had already been seized. In 2016, that number amounted to 443,000 pounds. The 2017 haul is worth an estimated $6.1 billion – BREITBART – JEFF SESSION’S DRUG BUST ON SAN DIEGO

 

LOS ANGELES – GATEWAY FOR THE LA RAZA MEX DRUG CARTELS

NARCOMEX in LA RAZA-OCCUPIED LOS ANGELES – Western gateway for the MEXICAN DRUG CARTELS and MEXICO’S SECOND LARGEST CITY.


Federal agents raided Q.T Fashion and numerous other businesses in the downtown fashion district Wednesday, cracking down on a scheme that cartels are increasingly relying on to get their profits — from drug sales, kidnappings and other illegal activities — back to Mexico, authorities said.

Nine people were arrested in raids targeting 75 locations, and $90 million was seized — $70 million in cash. In one condo, agents found $35 million stuffed in banker boxes. At a mansion in Bel-Air, they discovered $10 million in duffel bags.

"Los Angeles has become the epicenter of narco-dollar money laundering with couriers regularly bringing duffel bags and suitcases full of cash to many businesses," said Robert E. Dugdale, the assistant U.S. attorney in charge of federal criminal prosecutions in Los Angeles.



LOS ANGELES: MEXICO’S SECOND LARGEST CITY AND  GATEWAY FOR THE LA RAZA HEROIN CARTELS          





Every CEO in every company sees the business opportunity: Will I earn higher profits by replacing my American staff with cheaper H-1B workers? The answer is an obvious yes.
The Washington-imposed economic policy of economic growth via mass-immigration shifts wealth from young people towards older people by flooding the market with foreign labor. That process spikes profits and Wall Street values by cutting salaries for manual and skilled labor offered by blue-collar and white-collar employees. The policy also drives up real estate priceswidens wealth-gaps, reduces high-tech investment, increases state and local tax burdens, hurts kids’ schools and college education, pushes Americans away from high-tech careers, and sidelines at least 5 million marginalized Americans and their families, including many who are now struggling with opioid addictions.
A NATION DIES OF OPIOID ADDICTION
AMERICAN BIG PHARMA, RED CHINA and NARCOMEX PARTNER FOR THE BIG BUCKS
“The drug epidemic is the product of capitalism and the policies of the capitalist parties, both Democrats and Republicans. There is, first of all, the role of the pharmaceutical companies, which have amassed huge profits from the deceptive marketing of opioid pain killers, which they claimed were not addictive. Prescriptions for opioids such as Percocet, Oxycontin and Vicodin skyrocketed from 76 million in 1991 to nearly 259 million in 2012. What are the numbers and profits now?

OPIOID MURDERS BY BIG PHARMA

“While drug distributors have paid a total of $400 million in fines over the past 10 years, their combined revenue during this same period was over $5 trillion.”

“Opioids have ravaged families and devastated communities across the country. Encouraging their open use undermines the rule of law and will do nothing to quell their continued abuse, let alone the problems underlying mass addiction.”

 

Opioid Nation

Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic (Expanded and Updated Edition)

by Barry Meier
Random House, 223 pp., $27.00

Dopesick: Dealers, Doctors, and the Drug Company That Addicted America

by Beth Macy
Little, Brown, 376 pp., $28.00

American Overdose: The Opioid Tragedy in Three Acts

by Chris McGreal
PublicAffairs, 316 pp., $27.00

American Fix: Inside the Opioid Addiction Crisis—and How to End It

by Ryan Hampton, with Claire Rudy Foster
All Points, 290 pp., $27.99
Jerome Sessini/Magnum Photos
A man who has just taken heroin, Philadelphia, April 2018
The National Institute on Drug Abuse estimates that 72,000 Americans died from drug overdoses in 2017, up from some 64,000 the previous year and 52,000 the year before that—a staggering increase with no end in sight. Most involved opioids.
A few definitions are in order. The term opioid is now used to include opiates, which are derivatives of the opium poppy, and opioids, which originally referred only to synthesized drugs that act in the same way as opiates do. Opium, the sap from the poppy, has been used throughout the world for thousands of years to treat pain and shortness of breath, suppress cough and diarrhea, and, maybe most often, simply for its tranquilizing effect. The active constituent of opium, morphine, was not identified until 1806. Soon a variety of morphine tinctures became readily available without any social opprobrium, used, in some accounts, to combat the travails and boredom of Victorian women. (Thomas Jefferson was also an enthusiast of laudanum, one of the morphine tinctures.) Heroin, a stronger opiate made from morphine, entered the market later in the nineteenth century. It wasn’t until the twentieth century that synthetic or partially synthetic opioids, including fentanyl, methadone, oxycodone (Percocet), hydrocodone (Vicodin), and hydromorphone (Dilaudid), were developed.
In 1996 a new form of oxycodone called OxyContin came on the market, and three recent books—Beth Macy’s Dopesick, Chris McGreal’s American Overdose, and Barry Meier’s Pain Killer—blame the opioid epidemic almost entirely on its maker, Purdue Pharma. OxyContin is formulated to be released more slowly and therefore lasts longer. The company claimed that the drug’s slow release would make it less addictive than ordinary oxycodone, since the initial euphoria—the high—would be muted. Based on this theory and little else, the FDA permitted OxyContin to contain twice the usual dose of oxycodone and carry on the label this statement: “Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.” (The FDAofficial who oversaw OxyContin’s approval later got a plum job at Purdue Pharma.)
The company launched an extraordinarily aggressive and successful marketing campaign to convince physicians that they had the holy grail of a nonaddictive opioid. It sent hundreds of sales representatives to doctors’ offices to tout OxyContin, and offered doctors dinners and trips to meetings at luxury resorts. And it paid more than five thousand doctors, pharmacists, and nurses to train as speakers to tour the country promoting OxyContin. But like all opioids, OxyContin is addictive. And soon enough, users found that they could crush the pills or dissolve the coating, then snort the drug like cocaine or inject it like heroin. Each pill would then become essentially an instantaneous double dose of oxycodone.
OxyContin almost immediately became a blockbuster—that is, a prescription drug with annual sales of more than $1 billion. It was widely used not just by those for whom the prescriptions were written, but by their relatives and friends. The pills were also sold or stolen or otherwise diverted to street use. In addition, “pill mills” sprang up, where unethical physicians wrote innumerable prescriptions for OxyContin and refilled them automatically without ever seeing the patient. McGreal describes “one of the most productive pill mills in the country,” which operated in the small town of Williamson, West Virginia—known locally as “Pilliamson.” The town, he says, “was awash in pills,” and people came by car and bus to line up at the clinic and cooperating drugstores. “Investigators calculated that in 2009 alone, the clinic pulled in $4.6 million in a town with a population of little more than three thousand people.”
It’s impossible to know how many new prescriptions were obtained in each of these ways, but one way or another, OxyContin addiction grew into an epidemic. The epicenter was central Appalachia, and its victims were mainly white people in small, economically depressed coal-mining communities in southern West Virginia and parts of Kentucky, Tennessee, and southwestern Virginia.1
The three books that focus on Purdue Pharma are in a sense the same book. Barry Meier first published Pain Killer in 2003. The new edition (released by a different publisher) is much the same, with some updating and re-arrangements. The two new books, Dopesick and American Overdose, cover the same story as it unfolded in the same region of the country. Both Macy and McGreal refer to the 2003 edition of Meier’s book (but not the new edition, probably because they could not have known of it at the time their books were written). All three books are gripping and well written, with detailed accounts, one after another (perhaps too many), of families decimated by the epidemic. And they all tell the story of Art Van Zee, a physician in southwestern Virginia, who in 2000 became aware of the growing epidemic of OxyContin there and tried heroically to get Purdue Pharma and the FDA to take responsibility for it.
Purdue Pharma and the Sackler family that founded it are very hard to defend. By aggressively marketing OxyContin, even after they knew it was being widely abused, the family became enormously wealthy. But the FDA was also guilty. It permitted OxyContin to be sold as a relatively nonaddictive opioid without good evidence to support that claim, and it should have been obvious that the pills might be crushed or dissolved to make them even more addictive. Van Zee, along with Beth Davies, a nun who ran the local substance abuse clinic, saw Lee County, Virginia, blanketed with OxyContin prescriptions and watched the deaths mount, particularly among young people. They informed Purdue, which simply stonewalled. Over the following year, Van Zee devoted himself completely to the cause, meeting with company and FDAofficials and testifying before a Senate committee, trying to get Purdue to reformulate the drug or even withdraw it from the market.
In 2007 Purdue pled guilty to criminal charges of fraudulently marketing OxyContin and settled for $600 million in fines and penalties. Three executives pled guilty to misdemeanor charges and were sentenced to four hundred hours of community service and lesser fines. The company’s fine was trivial in comparison with its profits from OxyContin. In fact, almost every other major pharmaceutical company has had to settle both civil and criminal charges of fraudulent marketing for much more (the record settlement is now GlaxoSmithKline’s $3 billion, for a variety of violations, including falsely promoting drugs and failing to report safety data). These kinds of fines are just the cost of doing business. And so it was for Purdue Pharma, although the fraudulent marketing stopped and a warning was added to the label.
The problem with these three books, and it’s a big one, is that they treat the Purdue story as though it were the whole story of the opioid epidemic. But OxyContin did not give rise to opioid addiction, although it jump-started the current epidemic. Heroin has been a common street drug ever since it was banned in 1924. Morphine has also been widely abused.
Nor would taking OxyContin off the market end the epidemic. The overwhelming majority of opioid deaths are caused not by OxyContin but by combinations of fentanyl, heroin, and cocaine, often brought in from China via Mexican cartels, and frequently taken along with benzodiazepines (such as Valium or Xanax) and alcohol. These drugs are cheaper and stronger, particularly fentanyl. Fentanyl was first synthesized in 1960, and soon became widely used as an anesthetic and powerful painkiller. It is legally manufactured and highly effective when used appropriately, often for short medical procedures such as colonoscopies. The illicit production and street use is relatively new, but it is now the main cause of most opioid-related deaths (nearly 90 percent in Massachusetts).
The steady increase in opioid deaths after OxyContin came on the market has been supplanted by a much faster increase starting around 2013, when heroin and fentanyl use increased dramatically. We now have two epidemics—the overuse of prescription drugs and the much more deadly and now largely unrelated epidemic of street drugs. By concentrating on the first, we are closing the barn door after the horse is long gone.
Efforts to deal with the epidemic have been all over the map—literally. Possession of illegal drugs (and legal drugs illicitly used) is still a federal crime, and prisons are still full of people whose only crime was that. But many states, counties, and cities have begun to regard opioid addiction as a public health issue, not a police issue. They are opening centers in which people who seek help are shifted to less powerful opioids like methadone and buprenorphine (Subutex)—a method known as “medication-assisted treatment,” or MAT. Naloxone (Narcan), the antidote for an opioid overdose, is now sold over the counter in almost all states. If used immediately, it can prevent an otherwise inevitable death from a drug overdose. And drug courts, which may drop criminal charges in return for an agreement to submit to treatment and monitoring, are becoming more common.
Nan Goldin/Marian Goodman Gallery
Nan Goldin: Withdrawal/Quicksand, Berlin/NY, February 2016, 2016
Most controversial are facilities called “safe injection sites,” or SIFs, where drug users can come to use drugs without fear of arrest. The staff provides clean needles to reduce the risk of HIV and hepatitis C infections, and is prepared to resuscitate addicts who overdose. This approach is called “harm reduction.” The problem is that addicts must still buy drugs illegally, and it’s almost impossible to know exactly what is in them.
In a recent New York Times Op-Ed, the deputy attorney general, Rod Rosenstein, came down hard on SIFs. He warned that “it is a federal felony to maintain any location for the purpose of facilitating illicit drug use,” and that “cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action.” He was referring to plans to operate SIFs in San Francisco, New York City, and Seattle, and similar options now being considered by Colorado, Maine, Massachusetts, and Vermont. Later in the same article, however, he softened, saying we should “help drug users get treatment and aggressively prosecute criminals who supply the deadly poison,” suggesting that perhaps he doesn’t believe simple possession is so bad, after all.
But the proposed solutions to this epidemic range from the extreme of “lock ’em up” to “drug abuse is no less a disease than cancer or diabetes” and should therefore be met with the same solicitude. Ryan Hampton exemplifies the latter view in his angry book, American Fix. A former drug user himself and now an impassioned advocate and activist, he insists that drug abuse should be regarded like other diseases. He doesn’t acknowledge that for most users there was a moment of choice in becoming addicted that is not the case for people with cancer or diabetes. After receiving Dilaudid for a painful ankle, Hampton decided to ask for more, and then more. I think one can make the argument for sympathy with drug users and for understanding how the quest for drugs ceases to be under their control without claiming an analogy to diseases like cancer or diabetes.
Hampton paints a vivid picture of the downward spiral of addiction. When he “leveled up to IV heroin,” he explains, “it was cheaper than pills, easier to get hold of, and a quarter the cost. More important, nobody was tracking us in a database.”
Where Hampton is at his best is in his exposure of the profiteering and corruption in the burgeoning addiction industry—what he calls “the treatment industry swamp.” In the swamp, he found
lack of effective treatment, exorbitant costs, and ridiculous twenty-eight-day vacations disguised as medical help, fed by patient brokers who run a completely legal, high-end human trafficking cartel to push tens of thousands of patients through the broken system.
He was referring to the panoply of treatment centers, both residential and outpatient, and detox facilities, where users are supposed to be weaned from drugs before entering “sober living houses.” As in so much of American medicine, even nonprofit insurers like Medicaid outsource the actual delivery of care to for-profit companies that charge whatever the market will bear. According to Hampton, “one of the most expensive treatment centers in America, Passages Malibu, costs more than $60,000 per month.” Costs are settled by a crazy quilt of payers, including state and local governments, Medicaid, other federal programs, private insurers, and often by desperate families. Not surprisingly, only a minority of users are ever treated.
In 2017 the Aspen Institute’s Health Strategy Group, led by two former secretaries of health and human services, Tommy Thompson and Kathleen Sebelius, and consisting of twenty-four members from various health-related fields (I am among them), met for three days to examine the opioid epidemic. The deliberations were preceded by four presentations by experts in the field. In the final broad and comprehensive report, the group made a strong case for decriminalizing drug addiction and instead regarding it as a public health issue. Among the five major recommendations was a call for more research into nearly all aspects of the epidemic. It’s startling how little we know, given the immensity of the problem and the media attention it receives.2
We need to know, for instance, how effective opioids are for different kinds of pain, including long-term treatment for chronic pain. We need to know how opioids compare in effectiveness and side effects with acetaminophen (which can cause liver failure) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (which can cause gastrointestinal bleeding). We need to know how the death rate in the opioid epidemic compares with the rate of use. We know the death rate is soaring, but does that mean the rate of use is, too, or is it simply a result of the lethality of the drug mixtures obtained on the street? We need to know how much diversion there is now from legitimate treatment to abuse. That includes diversion of methadone and buprenorphine, which are also opioids and can be sold on the street or added to the user’s illicit intake. According to Macy, “Buprenorphine is the third-most-diverted opioid in the country, after oxycodone and hydrocodone.”
We need to know how many addicts want to quit, since most don’t seek treatment. Why don’t they? And finally, we need to know the best approach to treatment. There is concern, for example, that detox might be dangerous, because the first dose after a relapse can be deadly if the user is no longer tolerant to the drug’s effects. Is providing methadone or buprenorphine indefinitely, even for life, the best treatment among bad choices? There is plenty of speculation about all of these questions, and suggestive findings about some of them, but little solid evidence.
We also need to remember an essential and crucial fact: opioids do have a legitimate purpose, and it’s an enormously important one. They treat severe pain, often when no other treatment is effective. Patients suffering from cancer are sometimes completely dependent on opioids for relief, as are some patients with other forms of severe pain. As the authors of the books acknowledge, pain was systematically undertreated throughout most of the twentieth century. After centuries of free and easy use of opioids, there was a sudden reaction in the United States at the start of the twentieth century, which had much to do with anti-immigrant sentiment, particularly animus toward Chinese immigrants who were widely assumed to be opium addicts. (It also paralleled the growing reaction against alcohol that resulted in Prohibition.) The 1914 Harrison Narcotics Tax Act imposed strict regulations on the use of opioids; they had to be prescribed by physicians, and then only for patients not already taking them. Prohibition lasted for only thirteen years, but the dread of opioid addiction stayed with us until the 1980s and caused cruel suffering for generations of patients.
Even in hospitals where cancer patients lay dying in agony, opioids were administered reluctantly, in small doses, and at infrequent intervals. When I was in training in a teaching hospital in the 1960s, there was an awful ritual to it. The drugs were administered according to a pro re nata (prn) regimen (ostensibly “as needed”) that required the patient to wait out a four-hour interval, no matter how severe the pain, and then request the next dose. Those who badly wanted the drug had to keep track of the time and have the strength and endurance to summon a nurse if one was nearby. Patients were sometimes inhibited in asking for the next dose by a desire to please the medical staff and not be a nuisance, or by their own belief that taking morphine was somehow wrong or reflected weakness. The extent to which nurses and physicians shared the common fears of addiction influenced their readiness to respond. Desperate patients would count the minutes toward the end of the interval, hoping they could flag down a nurse. Many doctors and nurses interpreted the anxiety and clock-watching as a sign of growing addiction, not inadequate pain relief. These patients were labeled “drug-seeking” and often punished for it by being denied the very help they needed.
During the 1980s there was a welcome change in that attitude, partly due to the hospice movement that had begun in the United Kingdom. The prn system became more flexible, or was eliminated altogether. There was a realization that because pain is entirely subjective, there is no way to measure or verify it, and even patients with the same condition could differ in their experience of pain. Instead of having to flag down nurses, patients were asked at shorter intervals whether they needed pain relief, and how much. In 2001 the Joint Commission on the Accreditation of Healthcare Organizations proclaimed pain the fifth vital sign, to be assessed in every patient, along with heart rate, respiratory rate, temperature, and blood pressure. Although the motivation for this move was laudable, it presented problems, since, unlike the other four vital signs, pain can’t be objectively quantified.
The authors of the books under review recognize the history of inadequate treatment of pain throughout most of the twentieth century, but they don’t give it its due. They concentrate instead on the reaction of the 1980s, which they consider excessive and an underlying cause of the opioid epidemic. In 1982 I wrote an editorial in The New England Journal of Medicine, which began, “Few things a doctor does are more important than relieving pain.” I still believe that. I ended with these words: “Pain is soul-destroying. No patients should have to endure intense pain unnecessarily. The quality of mercy is essential to the practice of medicine; here, of all places, it should not be strained.”
The opioid epidemic, while horrifying, is still outweighed by alcohol deaths, which are also increasing, according to the Centers for Disease Control. Hampton writes, “If my first drug of choice came with a prescription, the second one, alcohol, was culturally embedded and used to celebrate at every turn of events.” In 2016, when there were 64,000 deaths in the US from the drug epidemic, there were 90,000 from alcohol (including accidents and homicides caused by inebriated people, as well as direct effects, mainly cirrhosis of the liver). Cigarette smoking is estimated to cause 480,000 deaths a year. I do not intend to minimize the opioid epidemic. Far from it. What I want to underscore is the differences in these three epidemics. Alcohol and cigarettes have no medical or practical uses of any kind. Yet we permit their use if regulated. In contrast, opioids do have medical uses, and they are important.
The opioid epidemic is usually seen as a supply problem. If we can interdict the supply of prescription opioids, the thinking goes, we can stanch the epidemic. But that is unlikely to work for two reasons. First, as I pointed out, this is no longer mainly an epidemic of prescription drugs but of street drugs. And second, it creates an onerous obstacle for doctors and outpatients who require pain treatment. More and more, they have to satisfy regulations expressly designed to restrict access to prescription opioids. Some make sense. For example, it’s reasonable to monitor opioid prescriptions to detect pill mills. It’s also reasonable to flag users who “doctor-shop,” that is, see several doctors at once to try to get multiple doses of opioids.
But other requirements are meant simply to inconvenience both doctors and patients until they give up. For example, in Massachusetts doctors must limit their first-time opioid prescriptions to seven days. That can be more than an inconvenience for ill patients in pain. Macy quotes a letter from a friend with severe back pain from scoliosis. “‘My life is not less important than that of an addict,’ my friend wrote,…explaining that her new practitioner requires her to submit to pill counts, lower-dose prescriptions, and more frequent visits for refills, which increase her out-of-pocket expense.” Even more serious is a new shortage of opioids for injection in cancer centers.
For physicians, who are already weighed down by innumerable bureaucratic requirements, these restrictions present one more hoop to jump through, and many simply won’t do it. Instead, they’ll send the patient away with some Advil and hope it does the trick, even though they know it probably won’t. The regulations are having their intended effect. In Massachusetts, opioid prescribing has decreased by 30 percent. Meanwhile, the epidemic of street drugs continues apace. McGreal raises the possibility that reducing access to prescription opioids might feed the demand for heroin. Macy quotes an addiction specialist who laments that “our wacky culture can’t seem to do anything in a nuanced way.”
I believe the modern opioid epidemic is now more a demand problem than a supply problem. Three years ago, the Princeton economists Anne Case and Angus Deaton published an explosive paper about the surprising rise in mortality, starting at the turn of this century, among middle-aged white non-Hispanic men and women. The increase was greater in women than in men. They found three main causes: drug and alcohol overdoses, suicide, and alcohol-associated liver disease. They later called these “deaths of despair,” because they were most common among workers in tenuous jobs, with only a high school education or less, who were struggling to stay afloat in isolated regions of the country. Dragged down by these deaths, in the past three years overall life expectancy in the United States has started to drop.
It’s not hard to see reasons for the despair. Most working-class Americans have not benefited from our booming economy, the fruits of which have gone almost entirely to the richest 10 percent. For the bottom half of the population, income has scarcely budged since the 1970s, while expenses for necessities like housing, health care, education, and child care have skyrocketed. In Appalachia, where the opioid epidemic first took hold, many coal miners were unemployed and would probably remain so. People expected they wouldn’t live as well as their parents had, and had little hope for their children. It is true that African-Americans still have higher overall mortality rates than whites, but that gap is closing rapidly for people under the age of sixty-five, particularly for women. By 2027, white women will have higher mortality rates than African-American women. Mortality for African-American men is falling even faster than for African-American women; it is projected to be equal to that of white men by 2030. But the epidemic has extended to all parts of the country and to all ethnic groups, so it’s unclear how the effects will be distributed in the future.
By the middle of this decade, the grotesque inequality in this country began to get the attention it deserves. And the growing awareness of that inequality fed the populist passion that, when twisted and distorted, produced the election of Donald J. Trump. It’s probably not coincidental, then, that the opioid epidemic got its second wind at about that time. It certainly marks the time when the opioids of choice changed from prescription drugs to the witches’ brew of street drugs. Did the epidemic explode because people were becoming aware that the American Dream was no longer theirs to dream?
As long as this country tolerates the chasm between the rich and the poor, and fails even to pretend to provide for the most basic needs of our citizens, such as health care, education, and child care, some people will want to use drugs to escape. This increasingly seems to me not a legal or medical problem, nor even a public health problem. It’s a political problem. We need a government dedicated to policies that will narrow the gap between the rich and the poor and ensure basic services for everyone. To end the epidemic of deaths of despair, we need to target the sources of the despair.


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