The Epidemic of DespairMarch/April 2020 101
heroin. Between 1999 and 2018, more than 200,000 Americans died
from prescription opioid overdoses. As the damage caused by these
drugs mounted, physicians stopped prescribing them as readily, opening
a gap for illegal drugs: heroin from Mexico and, more recently, fentanyl
from China, which is much more lethal. Without working-class distress,
these drugs would have done great harm and killed many people; when
loosed into a void o social disruption
and meaninglessness, they ampli¥ed
the suicides and alcohol-related deaths
that would have happened without them.
The mass prescription o legalized
heroin should never have happened—
and it did not happen in Europe. Painkillers such as OxyContin are
legal in Europe, but their use is largely con¥ned to hospitals, which
employ them to treat pain in the immediate aftermath o surgery (for
example, after a hip or knee replacement). In the United States, by
contrast, doctors and dentists prescribed these drugs in such large
numbers that in 2010 there were enough opioids prescribed to the
public to give every American adult a month’s supply. Pharmaceutical
distributors ooded the market, on occasion sending millions o pills
to pharmacies in towns with only a few hundred inhabitants. When
the Drug Enforcement Administration tried to stop that practice,
members o Congress brought pressure to remove the agents in charge,
and in 2016, it passed a bill to make enforcement o controls on opi-
oids more di¾cult. A subsidiary o Johnson & Johnson farmed pop-
pies in Tasmania in the mid-1990s to provide the raw material for
opioids, exploiting a loophole in international narcotic controls. Lob-
byists successfully fought against attempts by the ½ ̄³ to close the
loophole. According to court documents, the Sackler family, which
owns the privately held company Purdue Pharma, has made between
$11 billion and $12 billion in pro¥ts largely from selling OxyContin
since the drug’s approval in 1995. Europe, unlike the United States,
does not allow pharmaceutical companies to kill people for money.
CONTAINING THE EPIDEMIC
A number o practical measures would help curb the American epi-
demic o deaths o despair and end the United States’ status as an
outlier among wealthy nations. In health care, the United States needs
an agency such as the United Kingdom’s National Institute for Health
The mass prescription of
legalized heroin should
never have happened.