Empire of Pain is an all-American story. It’s about fast-paced ambition and the depths of misery, about psychiatric neglect, and about the twisted, tangled rope that connects culture, capital, callous disregard for life, and commercialized health care in the American dream.
It can seem like a world away from the day-to-day professionalism of our own national health service. But in examining our own conscience in relation to drug deaths, the book tackles two crucial issues that transcend national borders: greed and pain.
The Sacklers are notorious for their role in the development of Oxycontin, the starting point of America’s opioid epidemic. Recently her company, Purdue Pharma, was ordered to pay over $1 billion in compensation for Oxycontin-related damages, part of a deal some believe will protect the Sackler family personally from criminal charges.
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It was marketed as a non-addictive pain management solution and was in fact twice as potent as morphine, highly addictive and very often fatal. Generations of Americans, literally entire families, were wiped out by a legal pill that was regulated by the Food and Drugs Administration (FDA), prescribed by professionals, and available in pharmacies.
There is no such obvious villain in Scotland. Responsibility for our shameful record of drug deaths rests with all political parties. There is a general admission of national guilt and official apologies from politicians that obscure the apparent vacuum of individual responsibility and accountability.
Over a twenty year period around fifteen thousand people have died in Scotland from drug-related causes. That’s a big number, but also a confusing one. People, our own loved ones, have become statistics. Statistics become structural problems. Structural problems are then everyone’s and nobody’s fault, making it seem impossible to find solutions.
Oxycontin was a legal drug that often acted as a pipeline to harder substances. Too many people in Scotland still tend to think of our own drug-related deaths simply as an epidemic of heroin overdoses. Still, many of our deaths are related to the prescription of perfectly legal drugs – in some cases methadone, but also a range of benzodiazepines (temazempan, diazepam) which were at some point prescribed by doctors to relieve everyday suffering and symptoms of alienation in various forms.
Deindustrialised, post-Thatcher Scotland was a bottomless well of existential pain; Legal and illegal tranquilizers were the simple and often inexpensive answer. And that story takes us back to Sackler, who himself spearheaded the marketing of Valium as “mother’s little helper” before professionals realized the true ferocity of these calming little pills.
Scotland’s drug crisis will not be solved in one term or by manifest promises. It won’t be solved by pasting slogans on Party leaflets or yelling declarations about the failed war on drugs.
It will take decades to manage and resolve the crisis. To pretend otherwise is dishonest and our politicians know it. Electoral politics does not lend itself to long-term planning, but a cross-party, cross-generational, long-term commitment to tackling drug-related deaths in Scotland could be part of the solution.
There are some signs of progress. Harm reduction is the buzzword of the hour, and there are benefits. By refocusing the issue on health rather than crime, harm reduction will save lives. On the fringes, it will lower the shameful stats.
But I’m not convinced that decriminalization or overdose prevention programs or needle exchanges alone will do what needs to be done: eradicate the scourge of addiction. Because addiction alone is a different kind of death. It’s something that tears the soul apart and replaces it with an insatiable longing, where relationships become purely transactional, where the body is devalued and the mind enslaved to the nagging, groaning frenzy of need and desire.
After reading Empire of Pain I thought about the safe consumption rooms that sort of already exist here in Scotland. There are pharmacies where people queue outside to get their (legal) heroin substitute administered by a professional.
I’ve met people who, after recovering, weaned off heroin only to be on a prescription for methadone for almost 20 years of their lives. Imagine what you have seen and done in 20 years. Others have had their lives stolen through a medicated solution to addiction without further intervention or support, with no reward in terms of actual deliverance or freedom. Repelling death does not automatically bring life.
Almost every addiction study today, whether in Scotland or the US, agrees that poverty is a key factor in drug-related deaths. That much is undeniable. But I worry that it’s some kind of oversimplification.
The glamor of anti-poverty radicalism can mask an uglier streak of paternalism that treats poor people as victims, more prone to addiction or violence, rather than as people with agency.
And the danger of such simplification is that it distracts us from the underlying political causes of alienation. My grandparents’ generation was materially poorer than many of the poorest people today; But they also had communal institutions that built collective resilience and protected them from the harsh exploitation of their time. Whether it was socialist politics, mass unions or the church, they had a sense of choice and a way out.
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Drug deaths in particular are a class issue and not just a product of poverty. It is about what has been stolen from working class people with the violent destruction of organized collectivism and the promise of democracy as a sensible choice.
Genetically, as a species, we are all prone to addiction. And the atomization of life, the sense of a constant race to the death, affects almost everyone; The misery of alienation is evident throughout the middle class.
But being middle class means having choices; And it means that at a young age you have the space to make stupid decisions that don’t have to haunt you for the rest of your life. There are only about 400 in-patient rehabilitation places in Scotland: criminally few. But if you find the money, there are other options.
There are people far more qualified on the subject than I am, but I believe until we can reckon with the notion that no pills, liquids or powders provide a quick fix to the trauma of atomized living, then I, you and them People We Love There’s always a danger that it’s just another statistic.