Richard Eskow: Afghanistan and the Purdue Pharma Case Are Reminders That the US Is a Failed Narco-State, Too
Purdue Pharma and the Sackler family got away with the overdose murders of hundreds of thousands of Americans. (Mike Licht)
September 5, 2021
By Richard Eskow
Some commentators have taken to describing Afghanistan as a “failed narco-state.” While accurate in many ways, the description has a bitter ring when it is used by American officials. That’s like robbing someone of everything they own and then accusing them of poor money management.
Meanwhile, in a bankruptcy ruling that makes a farce out of “equal justice for all,” a judge has just granted the multibillionaire Sackler family immunity from all future lawsuits stemming from the role of their company, Purdue Pharma, in a drug overdose epidemic that has killed at least 1 million Americans. The Sacklers were not only enriched by their company’s lawbreaking. As board members, they were legally responsible for the company’s actions. They will remain free, and will remain billionaires. The people killed by their products will remain dead.
What is a narco-state? Here’s what historian Alfred McCoy wrote in 2018, as the American-backed state continued its process of collapse:
“In one of history’s bitter ironies, Afghanistan’s unique ecology converged with American military technology to transform this remote, landlocked nation into the world’s first true narco-state—a country where illicit drugs dominate the economy, define political choices and determine the fate of foreign interventions.”
That last phrase is also an apt description of the United States, with the possible exception of the word “illicit.” Thanks to regulatory and political capture, some of our most addictive narcotics were created openly. Even when they were marketed and sold illegally, their dealers escaped punishment.
This is life in the American narco-state, circa 2021.
A Million Americans Have Died From Drug Overdoses in the Last Two Decades
Official figures state that 841,000 Americans died from drug overdoses between 1999 and 2019, and that opioids caused 70.6 percent of drug overdose deaths in 2019. The CDC also reports that in 2020, overdoses spiked by about 30 percent for all drugs and nearly 37 percent for opioids, the highly predictable result of the fear and economic hardship caused by COVID-19. It reported 93,000 overdose deaths that year, which, when combined with deaths in 2021, undoubtedly takes us past the 1 million mark as a modest estimate for drug overdoses over the past two decades, and more than 660,000 deaths from opioid overdoses for the same period. (There is also good reason to believe that overdose deaths are chronically underreported.)
One million drug overdoses is more than 330 times the death toll from the 9/11 attacks—but no armies have been mobilized in response. One million deaths is more than we have lost in any war, and even more than we’ve lost in the pandemic. Of those deaths, approximately 660,000 are due to opioids, a death count that’s roughly the same as the current official death toll for COVID-19.
The role of Big Pharma in this epidemic is almost impossible to overstate. “In 2015,” writes the Commonwealth Fund, “synthetic opioids were involved in only 18 percent of all overdose deaths; in 2020, it appears to be more than 60 percent.”
The opioid epidemic is directly traceable to pharma sales practices. A 2009 article in the American Journal of Public Health by Art Van Zee, MD, “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy,” lays out some of the key facts behind this aspect of the epidemic. Although trials failed to show that OxyContin had any advantages over preexisting painkillers, Purdue Pharma spent $200 million promoting it in one year alone, as Dr. Van Zee writes:
“When Purdue Pharma introduced OxyContin in 1996, it was aggressively marketed and highly promoted. Sales grew from $48 million in 1996 to almost $1.1 billion in 2000. The high availability of OxyContin correlated with increased abuse, diversion, and addiction, and by 2004 OxyContin had become a leading drug of abuse in the United States.”
Van Zee adds, “Purdue pursued an ‘aggressive’ campaign to promote the use of opioids in general and OxyContin in particular.” He goes on to describe dozens of “national pain-management and speaker-training conferences [conducted by Purdue] at resorts in Florida, Arizona, and California,” as well as a data-driven campaign to target doctors who were high opioid prescribers across the country and blanketing them with marketing efforts to create a “database [that] would help identify physicians with large numbers of chronic-pain patients. Unfortunately, this same database would also identify which physicians were simply the most frequent prescribers of opioids and, in some cases, the least discriminate prescribers.”
But the Perpetrators Will Never Be Punished
Despite this grim record, almost no pharmaceutical executive has done prison time for the deceptions that gave rise to this epidemic. In 2007, three Purdue executives pleaded guilty to criminal behavior for promoting opioid usage but were let off with fines and probation. The company itself acknowledged it had acted illegally, but a compliant Justice Department accepted a $600 million fine. The Sackler family, which founded the corporation, is currently using the bankruptcy courts in an attempt to insulate itself from civic action.
A multi-state settlement with Johnson & Johnson and its distributors over a wave of opioid deaths was a sweetheart of a deal. Axios notes that the $26 billion payout—if it ever is paid out—amounts to only 4 percent of the companies’ revenue for a single year. Apparently, that’s what attorneys general for a number of states thought was adequate compensation for all the lost lives, for the mothers living on the street and the children born addicted, for the grieving families, desolate neighborhoods, and dying communities.
“Distributors can easily bear this burden,” analysts at a stock market firm wrote. “We haven’t popped the champagne yet, but the bottle is definitely chilling.” Having lost a close family member to an opioid overdose, I was unable to get over my fury for days after reading this sentence.
When the people who finance the dealers of lethal drugs respond to the law by chilling the Dom, you’re dealing with a failed narco-state.
Publicly traded corporations are required to disclose risks to their business in their quarterly financials. Johnson & Johnson summarized its legal challenges from opioids, the lawsuits over its baby powder, and other challenges as follows: “In the ordinary course of business [emphasis mine], Johnson & Johnson and its subsidiaries are subject to numerous claims and lawsuits involving various issues such as patent disputes, product liability and claims that their product sales, marketing and pricing practices violate various antitrust, unfair trade practices and/or consumer protection laws.”
Killing Americans doesn’t even make the list. As for “the ordinary course of business”: sure, the phrase sounds outrageous once you know that the company has deceptively marketed a deadly drug by claiming it isn’t addictive. But, to be fair, that probably is the ordinary course of business.
The Pharma Drug Kingpins Still Hold Enormous Political Power
Like kingpins or warlords in any narco-state, the perpetrators hold enormous political influence. Not only haven’t we punished the drug executives behind this body count, we’ve rewarded them. Alex Azar, president of a corporation that jacked up the price of insulin, was given America’s top health position when he was named secretary of health and human services by Donald Trump.
When it comes to pharmaceuticals, regulatory failure isn’t usually a hindrance to career advancement, either. Janet Woodcock, the government official whom many hold responsible for botching the approval process for OxyContin, was appointed temporary head of the FDA by the Biden administration. She was considered the top candidate for a permanent appointment until a protest campaign brought up her role in the opioid crisis. If she is not nominated, however, it is likely that a different approval process (for a controversial Alzheimer’s drug) will have been her undoing.
Drug policy is shaped to please pharmaceutical executives, at the cost of countless human lives around the world. The United States government routinely develops drug patents, or finances the underlying research behind those patents, and then gives drug companies the exclusive right to use those discoveries. Those executives have no compunction about using their government-granted privilege to price their drugs out of most people’s reach. The result is an endless parade of heartbreaking deaths, most of which are untracked and undocumented.
Even the kingpins who have been publicly exposed retain extraordinary levels of entitlement, not to mention wealth. Richard Sackler continues to maintain he did nothing wrong, while family members whine about curtailment of their self-aggrandizing philanthropy—and even against minor wounds to their pride, like the removal of their names from the walls of Tufts University. Drug scion David Sackler is permitted to whine ad nauseam about the unfairness of his family’s treatment in the pages of Vanity Fair, when the only appropriate response he could make would be to dedicate his drug wealth to treatment for addicts and then disappear from public life.
Such is the arrogance of the corporate warlord.
Government Institutions Have Failed to Respond Adequately to the Crisis
Agencies haven’t been held responsible for their part in the crisis, either, but they should be. A paper in the AMA Journal of Ethics, “How FDA Failures Contributed to the Opioid Crisis,” lays out some of the FDA’s institutional shortcomings.
These broken institutions should be revamped. As one source (who chooses to remain anonymous for professional reasons) told me, “Agencies that should protect the public think their job is to help drug companies get drugs approved.”
“We need an independent entity free of regulatory capture,” the source added, “and a trustee arrangement to run [pharma] companies in the public interest.”
The fact that ideas like these aren’t even part of the political debate, even after half a million opioid deaths or more, is another sign that we are a failed narco-state.
We Are Promoting a Global Narcotics Crisis Across the Planet
In a science-fiction-like scenario, Johnson & Johnson (of whom a judge said, “The facts show Defendants engaged in false and misleading marketing of both their drugs and opioids generally”) invented a breed of “super poppy” and then introduced it to the island of Tasmania, where they offered generous bounties to Tasmanian farmers willing to grow their product to meet U.S. demand. As the Washington Post reports:
“Tasmanian farmers grew the novel plants, enticed by flashy incentive prizes—a Mercedes, a Jaguar, a BMW—that a Johnson & Johnson subsidiary awarded for growing the best crop.
“As… officials would later boast in a 2003 internal company presentation introduced in the Oklahoma trial: The ‘patented, high-thebaine poppy was a transformational technology that enabled the growth of oxycodone.’”
Our military and intelligence services are equally adept at serving the American narco-state. The U.S. government supported drug kingpins in Southeast Asia. In his groundbreaking books The Politics of Heroin in Southeast Asia and The Politics of Heroin: CIA Complicity in the Global Drug Trade, Alfred McCoy documents the role of U.S. intelligence in promoting the global trade in illegal drugs. In the latter, McCoy cites Dr. David Musto, head of President Jimmy Carter’s council on drug abuse, who found that the CIA blocked the council’s access to any of the classified information it needed to do its work.
Musto described saying this when he was told that Carter would back the Afghan mujahideen against the Soviets: “I told the council that we were going into Afghanistan to support the opium growers… Shouldn’t we try to avoid what we had done in Laos [during the Vietnam War]?”
As McCoy notes, DEA agents soon noticed the influx of Middle Eastern heroin in uptown New York City, and from there to Philadelphia and Baltimore. McCoy adds:
“In 1979, the Soviets invaded Afghanistan and the Sandinistas took power in Nicaragua, prompting two major CIA operations with some revealing similarities. These covert wars would play a significant role in stimulating narcotics trafficking and drug source regions that later emerged, during the 1980s, as major suppliers for the United States… the CIA’s covert war in Afghanistan transformed Central Asia from a self-contained opium zone into a major supplier for the world market.”
Heroin addicts, whether in America’s cities or the streets of Europe, were now collateral damage in the American narco-state’s covert wars. As for Afghanistan, the United States had made it a drug-dependent nation. From that point on, it did what addicts always do: whatever it takes to survive.
Counternarcotics operations became part of the grift surrounding the U.S. occupation. Opium production, as Matt Taibbi writes, was at “an all-time low of 7,606 hectares of opium production” when we invaded, “ironically thanks to a short-lived, Taliban-imposed ban. By 2017, however, the country had reached all-time highs of 328,000 hectares of production.” (I assume Taibbi’s use of “highs” here is unironic.)
That’s what we got for $8.62 billion in counternarcotics spending.
At the same time, however, we were currying favor with warlords and drug kingpins who were deeply involved in opium cultivation and smuggling. As the Naval Postgraduate School’s Program for Culture and Conflict Studies puts it, with distinct understatement, “corruption does exist. Eradication missions, carried out by anti-narcotic personnel, are alleged to have been targeted away from the fields of generous poppy-growers and towards those of growers who failed to render their ‘due.’”
The program adds, “The corruption has included members of parliament, police, governors, border security forces, and a host of other positions… [including] in some cases, those officials with particularly low salaries (such as Afghan National Police at… $70 per month).”
These are the people we put into power. What we fought with one hand, we encouraged with the other. The military contractors made money from each.
This, then, is life in the American narco-state. The dealers in Big Pharma go unpunished and continue to wield enormous political and economic power. The illicit drug trade in this country has grown and flourished as we have helped establish new sources of heroin throughout the world. We are incapable of holding either our drug executives or our military and intelligence leaders accountable. Meanwhile, the death toll continues to rise.
The Sacklers said they wanted “global peace” from future lawsuits, and they got what they wanted. Meanwhile, in the failed narco-state they helped create, the war goes on.
Richard “RJ” Eskow is senior adviser for health and economic justice at Social Security Works. He is also the host of The Zero Hour, a syndicated progressive radio and television program.
This article was produced by Economy for All, a project of the Independent Media Institute.
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