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US Society: Substance Abuse and the Opioid Epidemic

AI-generated image depicting a woman buried in prescription drugs.
Millions of Americans are caught up in the web of substance abuse and the opioid epidemic.

This week we continue our focus on the domestic issues at the heart of the American Empire, examining the causes,effects and dangers of this societal decay, illustrated this week with how substance abuse and the opioid epidemic are impacting life expectancy.

The US has the most medicated citizenry on earth; it’s estimated that 66 per cent of adults take prescription drugs regularly, compared with around 26 per cent in the UK. As this figure continues to rise, so does the number of people misusing prescription drugs – there has been an increase of 250 per cent over 20 years.

The epidemic of substance abuse has crept up on the American Empire and is now so widespread that it cannot be simply ignored as a crisis that affects only those on the margins of society. The relationship between physician and pharmaceutical company has regularly compromised the relationship between physician and patient, with none more culpable than Purdue Pharma and their opioid OxyContin. The company and the drug represent ground zero for the opioid epidemic, illustrating in microcosm the problems eating away at the core of the American Empire.

Substance Abuse and the Opioid Epidemic

Just look at the numbers.

Since 1999, almost 1 million people in the US have died from drug overdoses, and opioids are a factor in seven out of ten of overdose deaths. In 2021, there were over 106,000 deaths from drug overdoses in the US, which was up from nearly 92,000 the previous year – and of these deaths, opioids were involved in around 80,000, with fentanyl being the primary weapon of choice.

Stimulants such as cocaine, one of the biggest targets in the traditional “war on drugs”, were involved in the death of around 32,000 people in 2021. Fewer than 5,000 people died from a heroin overdose without other opioids present.

How does Purdue fit into this?

Between 1996 (when OxyContin first came on the market) and 2002 the company spent hundreds of millions of dollars to promote and distribute the drug, utilizing every single area of the supply and distribution chain to devastating effect. Doctors were wined and dined and bombarded with promotionalmaterial, using dubious claims to downplay the addictive nature of Purdue’s “miracle drug”.

At best, this led to honest doctors and pharmacists being unwitting accomplices; at worst, it created cottage industries of “pill mills” – illicit operations whereby medical professionals sold millions of tablets to those their oaths had sworn them to protect.

Purdue not only looked the other way; they actively sought to increase the quantities sold. Seventy- five per cent of their total advertising spend in this period was after the year 2000, the year that Purdue told Congress they first became aware of the growing number of cases of OxyContin abuse and resultant deaths. During this time, they pulled every available lever within the medical industry to ensure sales of $2.8 billion by the middle of 2001.

Where Purdue led, others followed, as their competitors also were named as defendants in the subsequent 1,500-plus lawsuits. By the time the fraud was discovered and prosecuted, the damage was done and millions of victims had now become addicts.

These victims, now unable to access opioids via prescription, had little choice but to turn to more dangerous replacements. Fentanyl and similar substances, dispensed not by doctors but by dealers, criminalized Purdue’s victims in the thousands. For their part, Purdue was fined $600 million in 2007, a figure that may seem large, but represents less than 25 per cent of their revenue from four years of OxyContin sales alone.

Surely the executives responsible for this fraud are in jail? Not so – fines of $34 million and zero jail time were deemed sufficient in 2007 for knowingly contributing to an opioid crisis that federal officials calculate to have cost $500 billion in 2015 alone.

In 2019, Purdue finally was forced to file for bankruptcy, and its owners, the Sackler family, reached a settlement in 2022 that will force them to pay billions towards claims by states, hospitals and individuals.

Without further examination, this may seem like justice served. However, this is not how things are done in the oligarchy of the American Empire. The Sackler family, after all, is a generous benefactor, funding all manner of institutions – their collective wealth was estimated at around $11 billion in 2021. Richard Sackler, who was president and chairman of Purdue before its collapse, is also not behind bars.

Moreover, he and his family are safe in the knowledge that the settlement all but guarantees there will be no further repercussions or public disclosures of their role in the OxyContin affair. It ensures them protection from any further lawsuits resulting from the opioid epidemic, and it assures them that the family itself is largely absolved of responsibility.

There is still hope for a reckoning, as the settlement was overturned in December 2021 by a federal judge, but in 2022 an improved offer was agreed – on the basis of future immunity.

Whatever the final outcome, a society that allows one family to cause so much damage, and still emerge with billions of dollars, is not a society that is functioning correctly.


 About the Author: British author Patrick Watts' new book, “The End of the American Empire,” warns that unless some of the issues that beset our country are resolved, the “American empire” will collapse. This is the third of a three-part series that Watts has prepared for Lean to the Left. Here are Part 1 and Part 2.

Patrick appeared on the Lean to the Left podcast February 26 and that episode can be found here: Video; Audio. To find out more, head to where you can find links to “The End of the American Empire”, podcast discussions and much more.


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The fact that the Sacklers were able to escape criminal responsibility is a travesty!

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Bob Gatty
Bob Gatty
16 jun
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