The drug crisis is hard to ignore in the South – and not just in the rural areas. People keel over waiting for buses or lie slouched and zoned out in cars, as if some zombie-inducing viral contagion out of a horror flick suddenly descended. Overdosing has become such a part of the fabric of everyday life here that, like the weather, taxes and homelessness; it no longer elicits a reaction, โit is what it is.โ Last year on the job, an elderly woman fell and broke her hip. The ambulance crew apologized for coming so late, but said they had been dealing with one OD after another all night, including a man who had fatally ODโd in a nearby Walmart parking lot. Alabama has the highest opioid prescription rate in the country and for every 100 people in the state, 121 prescriptions are written (1).
Oxycontin (Iโm going to leave crystal meth, which is still the Southโs preferred drug of choice, to the side) is not only a drug of abuse, but also a form of alternative currency, which is yet another reason for its stubborn persistence. It works like this. People on low income, many times elderly or disabled, get a script filled for chronic pain. They need extra money; SSI or Social Security isnโt enough to survive. Supplementing their insufficient incomes, they then hawk pills by word of mouth for extra cash. Some, depending on their pain levels, sell their whole allotment; others just part. For a long time, it was possible for those, mostly younger or middle-aged, with ambition or voracious habits needing to be fed to transition from dipping and dabbling in informal pill-selling by word of mouth to extended family members and friends into more lucrative pill markets. Although mostly shut down now, for a long time, there was a veritable diaspora of โpill millsโ in the South, especially in strip-mall Florida, set up by sketchy doctors fleeing more intense northern regulatory scrutiny.
In these โpill mills,โ masquerading as pain centers, someone hopping from one to another, a budding pharmaceutical entrepreneur as it were, without much effort could rack up scripts sometimes for hundreds of pills. Since black market street rates for Oxys run roughly a dollar a milligram, selling pills on the black market made rational economic sense; a perfect example of the homo economicus so beloved by bourgeois economists. I heard of a couple who did just this. Both were on SSI and heavily strung-out. To feed their habits, they would make bi-weekly runs to Florida strip-mall clinics to stock up on pills both for sale and personal use (they eventually broke up over mutual accusations of stealing each otherโs โcapital.โ)
I knew a woman who had been kicked off social services because she was too high to keep the appointments and, as a result, temporarily without income. She instead used her Oxy scripts to trade for food stamps and to pay for child-care in the interim (I shudder to think about the quality of the child care if the babysitter was paid in Oxys and Xanax). While her case of pharmaceutical barter might be an outlier, it is undeniable that Oxy derived income streams unacknowledged in the formal economy
Because Oxycontin is obtained legally โ unlike heroin and cocaine, thereโs no real street corner drug trade; itโs all done covertly and discretely with willing sellers and buyers โ I think, except for the black market rates, the trade in Oxycontin and other opioid derivatives roughly approximates what a real-life drug decriminalization policy might look like. Yet while decriminalizing now illegal drugs would stop the tremendous waste of lives left in the wreckage of a decades long failed War Against Drugs, harms such as mass incarceration, destruction of families and community bonds, I believe, from personal observation, that decriminalization would just shift the problem elsewhere.
Just because Prohibition ended, alcohol didnโt stop being a โproblemโ because it now was legal. On the contrary, many still drink in ways that hurt themselves and others. Contrary to libertarian dogma, alcohol and unwise drug use is not a victimless crime, a consensual act between a buyer and a seller : the families and children involved are always victims, the unacknowledged collateral damage, a damage measured in intimate partner violence, child abuse and neglect, and constant financial stress, if not actual homelessness, to list just some of the many non-consensual harms visited on the families of hard-core addicts.
In narrowing drug use to a legal or public health problem, as many genuinely concerned about the legal and social consequences of addiction will argue, I believe a larger politics and political critique gets lost (This myopia is not confined to drug issues. From what Iโve seen, much of the โsocial justiceโ perspective in the professional care industry is deeply conservative; what gets argued for amounts to little more than increased funding for their own services and endless expansion of non-profits). Drug use, broadly speaking, doesnโt take place in a vacuum. It is a thermometer for social misery and the more social misery, the greater the use. In other words, itโs not just a matter of the properties of the drug or the psychological states of the individual user, but also of the social context in which such actions play out.
If we accept this as a yardstick, then itโs no accident then that the loss of the 1984-1985 U.K. Minersโ Strike, with the follow-on closure of the pits and destruction of pit communitiesโ tight-knit ways of life, triggered widespread heroin use (2). What followed the defeat of the Minersโ Strike only telescoped into a few years the same social processes that in much of the U.S. were drawn out, more prolonged, insidious, and harder to detect. Until, that is, the mortality rates โ that canary in the epidemiological coalmine -sharply rose to everyoneโs shock.
US doctors have coined a phrase for the underlying condition of which drug use and alcoholism is just part: โshit-life syndrome.โ As Will Hutton in the Guardian describes it,
โPoor working-age Americans of all races are locked in a cycle of poverty and neglect, amid wider affluence. They are ill educated and ill trained. The jobs available are drudge work paying the minimum wage, with minimal or no job security. They are trapped in poor neighborhoods where the prospect of owning a home is a distant dream. There is little social housing, scant income support and contingent access to healthcare. Finding meaning in life is close to impossible; the struggle to survive commands all intellectual and emotional resources. Yet turn on the TV or visit a middle-class shopping mall and a very different and unattainable world presents itself. Knowing that you are valueless, you resort to drugs, antidepressants and booze. You eat junk food and watch your ill-treated body balloon. It is not just poverty, but growing relative poverty in an era of rising inequality, with all its psychological side-effects, that is the killerโ(3).
This accurately sums up โshit-life syndrome.โ So, by all means, end locking up non-violent drug offenders and increase drug treatment options. But as worthwhile as these steps may be, they will do nothing to alter โshit-life syndrome.โ โShit-life syndromeโ is just one more expression of the never-ending cruelty of capitalism, an underlying cruelty inherent in the way the system operates, that canโt be reformed out, and wonโt disappear until new ways of living and social organization come into place.
(As a closing aside, I should say I tried crack several times in the 1990s โ or rather I should more accurately say, was treated to it, because I am too cheap to spend money on illegal โescapeโ drugs of any sort. It brought on a pleasant, transient high, but nothing I was going to give up what I was doing in my life to chase. On the other hand, I knew many people that went on crack runs so severe that they wasted away to near-skeletons; it was only getting locked up that forced an unwilling pause in their run. You could always tell when someone like this had been to jail; they came out with a healthy glow and increased weight. Itโs a sad comment on U.S. society to note that jail is less detrimental to many than โfreedomโ on the outside)
Notes
1) National Institute on Drug Abuse (NIDA) Alabama Opioid Summary. Downloaded fromhttps://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/alabama-opioid-summary
2) BBC (2002). Mining Towns Hit Hard By Heroin. Downloaded from http://news.bbc.co.uk/2/hi/uk_news/england/2338623.stm
Will Hutton (2018).The Bad News Is Weโre Dying Earlier In Britain โ And Itโs All Down To Shit-Life Syndrome. Downloaded from https://www.theguardian.com/commentisfree/2018/aug/19/bad-news-is-were-dying-earlier-in-britain-down-to-shit-life-syndrome