In her final guest post for Points, Siobhan Reynolds asserts that the oft-repeated claim that the War on Drugs has failed should be reassessed from the point of view of those who profit from its outcomes. Looked at from that perspective, Reynolds sees opiate regulation as central to the drug war’s astonishing success.
Drug policy reformers have rallied for an end to drug prohibition calling it a dismal failure. To my mind, however, in order to understand this thing that has taken on a life all its own and to ultimately change course, if that is possible, one has to stop looking at the drug war as a failure and instead regard it as a spectacular success. There’s no denying that drug war policies and practices have turned physicians against the interests of their patients, been wildly expensive, destroyed the criminal justice
system, and facilitated the incarceration of people in the United States to a degree that would make Stalin or the Chinese envious. People who value civil liberties above all other social goods undoubtedly consider such developments evidence of failure. But these chilling outcomes do benefit some. A mature view would necessitate that we look at who profits under drug prohibition in order to truly judge what it has become.
A good friend of mine and former Pain Relief Networkboard member, James Stacks, makes the excellent point that the stellar pharmacological power of opioids was in essence harnessed by the medical profession in the early part of the twentieth century, back when doctors were widely known as jumped-up barbers and generally unable to do anything about most illnesses. At the advent of drug prohibition, medicine had not yet employed antibiotics, average life expectancy for a male in the United States was 48 years, surgery was performed in unsterile theaters, and people died of whatever came their way.
As a result of the criminalization of all derivatives of the opium poppy, perhaps the most miraculous of natural substances, doctors managed to corner the legal market in their dissemination and so enhance their healing and palliative prestige among the general public. Says Stacks,
[Perhaps it was] Siobhan who mentioned that doctors, given a scenario where they could only have one drug to use in their practice, would likely choose an opioid. I think the profession of medicine was an early player in this game, and a large part of the growth of their profession in the twentieth century was based in getting opioids off the free market and under their exclusive control. […] Opioids solved many problems for medicine, and the medical profession was able to make use of this powerful tool to effect a very broad range of interventions. The breadth of these interventions had the natural effect of leaving the uninformed and uneducated with the impression that entire ranges of problems had been solved independently. That is, it made the profession appear much more competent than it really was, sort of in the same way a scatter gun makes a single person appear to be a “better shot,” unless the judge understands why the person with the scatter gun never misses.
As government control became more and more absolute, physicians were increasingly required to go the extra mile to prove that the pain patients they were seeing were in fact people in pain rather than addicts seeking maintenance. Physicians were and are required to see patients regularly and order all kinds of tests in order to document a “legitimate medical relationship,” a situation that the medical profession and tertiary professions have exploited handsomely.
People in pain who would be quite satisfied with picking up their prescriptions every six months are now required to go to the doctor every month, sometimes every two weeks. The general unavailability of prescribed opioids due to fear of official sanction puts patients into the unenviable position of having to capitulate to the demands of orthopaedic surgeons who insist that they try any and all surgeries in order to prove that they don’t want the medications to get high. The pharmaceutical industry makes all kinds of money it wouldn’t otherwise because doctors prescribe anti-inflammatories, anti-anxiety medications, anti-depressants instead of the tried and true opioids.
Additionally, tens of millions of Americans see their health deteriorate due to untreated pain, the physical consequences of which include the development of obesity, diabetes, heart disease and many other complications. This creates perhaps the largest area of inflated profit. As the modern system has all kinds of expensive interventions at the ready as treatments for these conditions, the unavailability of pain medicine has turned all of us into a herd of cash cows for the mega hospital/insurance industry.
Patients complain that their quality of life should be put before profits, but no one is there to hear them. Congress now works to shield these corporate interests from the complaints of the patients and their families. And the mainstream press will not publish patient accounts of what it is like to live in this pariah state, knowing that one is not being helped by the medical machine but is rather being fed to it.
“After World War II, the United States, along with Britain and France, recurrently used both drug networks and terrorist groups as assets or proxies in the Cold War,” Peter Dale Scott writes in his painstakingly documented book American War Machine (one in a long line of scholarly works probing the deeper motives for the War On Drugs). As Scott shows, drug prohibition became intertwined with the CIA’s efforts to dominate the globe over the last sixty-odd years. Were pain medications to become actually legal and readily available through medical practice, the very fabric of American foreign policy would unravel.
When seen in this context, it isn’t difficult to understand why opium prohibition is such a sacred cow, its elimination “off the table” even amongst leading drug law reform organizations. The profits from illegal drugs have become a second economy throughout the world–and of course a significant source of income for America’s political class–in such a way that it no longer makes sense to talk about the War on Drugs as something we as a nation do. The drug war forms the structure of our political system both domestically and abroad. It is, rather, what we are.