The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided Struggle

Abstract

The opioid/overdose crisis in the United States and Canada has claimed hundreds of thousands of lives and has become a major field for research and interventions. It has embroiled pharmaceutical companies in lawsuits and possible bankruptcy filings. Effective interventions and policies toward this and future drug-related outbreaks may be improved by understanding the sociostructural roots of this outbreak. Much of the literature on roots of the opioid/overdose outbreak focuses on (1) the actions of pharmaceutical companies in inappropriately promoting the use of prescription opioids; (2) "deaths of despair" based on the deindustrialization of much of rural and urban Canada and the United States, and on the related marginalization and demoralization of those facing lifetimes of joblessness or precarious employment in poorly paid, often dangerous work; and (3) increase in occupationally-induced pain and injuries in the population. All three of these roots of the crisis-pharmaceutical misconduct and unethical marketing practices, despair based on deindustrialization and increased occupational pain-can be traced back, in part, to what has been called the "one-sided class war" that became prominent in the 1970s, became institutionalized as neo-liberalism in and since the 1980s, and may now be beginning to be challenged. We describe this one-sided class war, and how processes it sparked enabled pharmaceutical corporations in their misconduct, nurtured individualistic ideologies that fed into despair and drug use, weakened institutions that created social support in communities, and reduced barriers against injuries and other occupational pain at workplaces by reducing unionization, weakening surviving unions, and weakening the enforcement of rules about workplace safety and health. We then briefly discuss the implications of this analysis for programs and policies to mitigate or reverse the opioid/overdose outbreak.

Keywords: despair; one-sided class war; opioids; overdose; pain; social conflict.

Figure 1

A brief sociohistorical model of upstream processes and pathways through which they helped generate the opioid/overdose epidemic*. *As is discussed in the text, Items on the left seem to contribute causally to items to their right. A degree of reverse causation and of causal influence on items higher or lower in this diagram also seems to take place.

Figure 2

Overdose deaths in the United States, 1999−2017. Source: Centers for Disease Control and Prevention (26)*. *All material in the MMWR series is in the public domain and may be used and reprinted without special permission; citation as to source, however, is appreciated.