Drug overdose deaths in the US, notably opioid overdoses, skyrocketed from under 10,000 per year in the 1980s to 100,000 in 2021. The crisis began with the FDA’s approval of Purdue Pharma’s OxyContin Painkiller in 1995, claimed as non-addictive without proper evidence. Subsequent aggressive marketing led to widespread addiction. Labeled as criminal acts of profit-driven corporations and a co-opted FDA, these actions resulted in significant damage with a reported 1 million deaths and cost of $2 trillion, prompting sanctions and funding to combat the crisis.
For most of the 1980s drug overdose deaths in the United States were fairly steady, well under 10 000 deaths per year.
Then, in the 1990s, deaths rose sharply. By 2000 nearly 20 000 people were dying from overdoses annually. In 2021 the number peaked at 100, 000, a 500% increase over the decade.
To put this in context, over the past 25 years more than a million people in the U.S. have died from drug overdoses. This is more people than died in both world wars combined.
Most of these deaths are caused by opioid overdoses. These deaths are from both natural opiates such as morphine and heroin, and synthetic compounds which have similar properties.
When did the opioid crisis begin?
The crisis began with the Food and Drug Administration’s (FDA) approval of Purdue Pharma’s OxyContin Painkiller drug in 1995. This drug was designed to be slow release. Purdue claimed that the slow release design would prevent it from being addictive. However, they made this claim without proper evidence. They conducted no clinical trials on how addictive or prone to abuse the drug might be.
Oxycontin
Before the release of OxyContin opioids had been used only in limited cases. They were only administered to cancer patients, those undergoing more invasive surgery and for end-of-life pain relief.
However Purdue engaged in aggressive direct marketing campaigns to doctors. The company encouraged Doctors to prescribe OxyContin for less serious conditions such as arthritis, back pain and sports injuries.
What effect did OxyContin have?
Prescriptions peaked in 2012 at more than 255 million in the U.S. that year. OxyContin, and other similar opioids such as Vicodin create a huge new class of addicts. By 2011 OyxContin was the leading cause of drug-related deaths in the US.
This is known as the first wave of the crises which also drove the second wage. Many addicts found prescription pain killers too expensive or too difficult to buy and so turned to heroin. Interviews with injecting urban drug users Between 2008-09 found that 86% of them had used prescription painkillers first. The illegal heroine trade expanded greatly because of this, as did the number of heroin overdoses.
In 2013 came the third crisis. This was caused by illegal, synthetic opioids such as Fentanyl which is 50 to 100 times stronger than morphine. This led to a huge increase in overdose deaths as the strength of the final street product varied widely.
Why did the crisis happen?
There are several causes, all of which seem fundamentally linked to the Marxist theory of crime…
The chief executives of Purdue Pharma were primarily concerned with making profit, rather than the safety of people. They didn’t do proper trials to check the risks of addiction and sold their product hard to doctors.
The Food and Drug Administration had been co-opted by the pharmaceutical industry. The FDA regulatory who oversaw the approval of Oxy, Dr Curtis Wright, left the agency shortly afterwards and took a job at Purdue.
The U.S. healthcare system prefers prescribing rather than other solutions. This is because it puts profits of corporations over the health and wellbeing of ordinary people.
Many of these overdose deaths are deaths of despair. They are linked to social ills such as poverty, declining wages, and declining stability in social life.
What is being done now?
The U.S. has tightened conditions for prescribing opioid Painkillers, but the levels are still high.
They have Sanctions on Chinese companies who make chemicals used to make Fentanyl,
They have allocated $5 Billion for mental health care and treating addiction.
Analysis: supporting evidence for the Marxist perspective on crime…?
It clearly shows that all classes commit crime. Here we have both the Corporate elite and the government working together.
Marxism says the ‘crimes’ (or harms) the elite does are much greater than working class crime. With over 1 million dead as a result of Oxycontin this harmful act is extreme. There were 100 000 overdose deaths in 2022 – 68% of them linked to Opiods, 2 million addicts, monetary cost $2 Trillion, misery can’t calculate. (According to the Stanford-Lancet Commission).
The Sackler Family managed to get immunity from prosecution. They have to pay $8 billion in damages. However they have been given a number of years to pay this, and they will probably make that from returns on their investments.
Effectively they haven’t been punished for causing 1 million deaths.
Purdue Pharam and the Opioid crisis: find out more.
Netflix recently released an excellent series: Painkiller which covers this case study very well!
There have been some minor changes in the supply and taking of drugs in the United Kingdom since the onset of the covid pandemic, but the changes maybe aren’t as signficant as you’d think.
At least not according to a recent survey of UK drug users carried out in late 2020 by release.org.uk
Drug Use Increased slightly during the Pandemic
43% of users reported increasing their use of drugs, while 21% reduced and 36% kept their usage about the same.
The types of drug used also changed – with Cannabis use increasing and MDMA (the party drug) decreasing, mainly because of lack of opportunity to take it, with clubs being closed.
Drugs were slightly more difficult to find during the Pandemic
Around a third of drug users reported drugs being more difficult to get hold of a seller and having to source a different seller than usual, but overall only 25% reported it as being more difficult to find the drug they wanted, and only around 5% couldn’t find what they wanted or had to buy an alternative….
Unsurprisingly it became gradually more difficult to source drugs as the lockdown came into force and then eased.
Use of the ‘Darknet’ became slightly more popular
Use of the darknet increased by 13% and a full 30% of users would now consider using the darknet (buying drugs online) to purchase if the need to.
Drug dealers practiced social distancing
And many others took further precautions, well they are business people!
Relevance to A-level sociology/ analysis
Overall I’d say that this research shows us just how resilient the illegal drugs market has been during the pandemic.
Despite the UK borders being much more tightly controlled and huge restrictions on the movement of people with national lockdowns the drug supplies were largely unaffected, for the most part managing to keep up with the increased demand from nearly half of the UK drug taking population.
It’s also a nice reminder that UK drug suppliers are running a business, and they clearly take that business very seriously, showing the ability to adapt under extremely adverse conditions.
And they may be trading in illegal goods, but quite a few of them seemed to stick with the government suggested guidelines to stop the spread of the pandemic. I guess that was in their self-interest, it wouldn’t be good for business to infect your customers I guess!
This should be a useful update to both postmodern and global crimes as part of the Crime and Deviance module for A -level sociology,
This video with Professor David Nutt on the bizarre way in which drugs are (miss) classified and (miss) regulated in the UK seems to be coming from an Interactionist point of view:
In the video Professor Nutt discusses how authorities inappropriately label/ categories certain drugs as harmful when really they are not and then harsher than appropriate penalties follow as a result.
Firstly he reminds us that categorisation (labelling) by authorities is fundamental to the way we understand and manage drugs – for a start there are two types – drugs for medical use (legal) and then illegal drugs.
Illegal drugs are controlled and categorised by the ‘misuse of drugs act’, which Nutt describes as being made up by a group of people based on what they thought.
The act classifies drugs into categories A, B or C. Less harmful drugs are in category C while more harmful drugs are in category A.
Class A includes drugs such as heroine and ecstasy
Class B includes cannabis
Class C includes Steroids, for example,
Over the last 20 years politicians have got more involved in categorising drugs based on their desire to be seen as being tough on drugs and thus tough on crime, and Professor Nut believes certain drugs have been mis-categoriesed.
For example, the medical evidence suggests that Ectasy is not a particularly risky drug, but government officials have put it in category A, along with the highly addictive and really harmful heroine and cocaine.
As a result, people caught with Ecstasy receive harsher penalties than they should based on the relative harm the drug does, just because of the whim of government.
In fact they often face harsher penalties just based on the categorisation – because Judges tend to be more lenient handing out punishments to Heroine users precisely because the later is more addictive while Ectasy is not.
So we have a situation where people are being punished for using recreational drugs with little harmful consequence associated with the drug itself.
A more systematic classification system
Nutt has worked with medical experts to produce a new classification system for drugs based on nine categories of harm, outlining several different harms which drugs do, both to the individual and society.
There is only data for some of these measurements, but for the data that exists Alcohol comes out on top.
Alcohol is the most common reason for deaths in men under 50, for example.
If you look at the individual only, Crack Cocaine and Crystal Meth come out on top, but because alcohol is so widely used once we factor in social harms it comes out as the most harmful
Why isn’t Alcohol regulated by the misuse of drugs act?
The fact that alcohol is not harmed is a huge anomaly – and the reasons it is not controlled is political and economic – the drinks industry makes a fortune and so does the government through taxes.
Relevance to A-level Sociology
This should be a useful addition for any student studying the Crime and Deviance module.
86% of the global population have used drugs in the last year, and more people have used cannabis than tobacco. Almost 30% of the world’s population have used Cocaine in the last year, at least according to the 2019 Global Drug Survey.
This survey asked adults in 36 countries about their use of drugs and alcohol.
According to the same survey, the British get drunk more often than people in any other nation, at least according to a recent
In Britain, people stated they got drunk an average of 51 times last year, with U.S., Canada and Australia not far behind. The average was 33 times.
Where Cocaine use was concerned, 73% of people in England said they had tried it compared to 43% globally.
How valid is this data?
I don’t know about you, but to me these figures seem very high, and I’m left wondering if they aren’t skewed upwards by selective sampling or loose questions.
This report is produced by a private company who sell products related to addiction advice, and I guess their market is national health care services.
Seems to me like it’s in their interests to skew the data upwards to give themselves more of a purpose.
I certainly don’t believe the average person in the UK gets drunk once a week and that almost 3/4s of the population have tried Cocaine.
Drug gangs are expanding their operations from large city centres such as London, Birmingham and Manchester into smaller towns and rural areas. To do so they are using a new business model referred to as ‘county lines’ – dedicated mobile phone drug deal lines which local drug dealers in smaller towns can use to order drugs from the suppliers in the city centres. According to a recent report by the National Crime Agency, there are over 1000 established county line networks which are each capable of making profits of £800, 000 a year.
These lines are so profitable that gangs increasingly resort to violence to protect them, so this county line model of drug gang expansion probably goes a long way to explain the 50% increase in knife crime since 2015. In fact, a spike in knife crime in a small town or city is believed to be an indicator that a new drug line has been opened up.
How county lines work
Drug gangs in larger cities establish branded mobile phone lines using ‘burner phones’ which are disposable and anonymous, and these are then used to send out group messages to the local dealers around the country offering what drugs are for sale, which is mainly heroine and crack cocaine. Frequently there are special offers such as two for the price of one deals. The drugs are delivered by runners who also collect payment from the local dealers.
Children and drug lines
School-aged children, typically aged 15-17, but as young as 11, are usually used to deliver the drugs and collect payment. The charity Safer London estimates that 4000 children from London are involved. Sometimes these children might stay away in a drug-hub for an extended period, which is known as ‘going country’ or ‘going OT’ (out there).
The children recruited are usually vulnerable, having been excluded from school or from broken families, and many are drug users themselves. They are roped into the gangs by the lure of financial reward, or some might be debt bondage because of their drug habits. Once in, they are exposed to a violent lifestyle and effectively take all the risks for the upstream dealers.
NB – from a legal perspective, the use of children as drug mules now counts as child trafficking, so anyone caught being involved in this is likely to get a very lengthy spell in jail.
Cuckooing
A particularly insidious aspect of these drug networks is a process known as cuckooing…. Where a new local recruit’s house in a rural or coastal taken over by a drug dealer from one of the main centres and that house is turned into a local dealing hub, used to store and possibly manufacture drugs, and sell drugs.
One way this can escalate is that the local dealer is allowed to get into debt, and then has their house taken over as a means to repay this.
Such victims will often be drug addicts with mental health issues and are also likely to be in poverty.
Countering the problem of drug gangs and drug lines
This is an enormous problem, and its growing fast: 75% of police forces believed new lines had been opened up in 2017 and it’s estimated that the 1000 lines in existence are worth £500 million a year. With that kind of coverage and that amount of money involved, tackling this isn’t going to be easy!
A new National County Lines Coordination Unit has recently been established so the 43 police forces in England and Wales can easily share information, and the police are using anti trafficking and anti-slavery laws to punish the dealers.
In a week of raids in January police arrested 600 people and referred 600 children and 400 adults to safeguarding authorities. More than £200 000 in cash and 140 weapons were also seized.
Relevance to A-level sociology
This is obviously highly relevant to the crime and deviance specification. Probably the most obvious links are to right and left realism, and to my mind it’s a great example that proves the limitations of the right realist approach – the nature of this crime is that it’s hidden, and so right realist crime control techniques will probably be ineffective in controlling it.
It seems to offer support for left realism – relative deprivation and marginalisation are the root causes, and maybe addressing these are the only way we’re going to see a reduction in drug related crime in the future?
we’re relying more on drugs to treat teenagers’ mental ill-health, but could we be giving out pills to thousands of teenagers which are not only ineffective but actually have severely dangerous side effects.
In a recent BBC documentary: ‘The Doctor Who Gave Up Drugs’ Dr Chris Van Tulleken (Dr CVT) set out to answer the above question. Here I summarise the section of part 2 of this documentary (which deals with teen mental ill health and antidepressants) and throw in a few links and additional commentary.
You can watch the documentary on BBC iPlayer here at least until Late June 2018, although TBH you may as well save yourself 50 mins and just skim read what’s below.
You will also find this post on ‘steemit.com‘ – a most excellent crypto-currency based blogging platform where users get paid in cryptocurrency (steem) for posting, commenting and even just upvoting other people’s work. I recommend you check it out!
Introduction: why are prescriptions for antidepressants in the UK increasing?
The general gist of the documentary is that we’re relying more on drugs to treat teenagers’ mental ill-health, but we could be giving out pills to thousands of teenagers which are not only ineffective but actually have severely dangerous side effects.
The number of British teenagers prescribed antidepressants has almost doubled in 10 years: in 2005, 30 000 teenagers were prescribed antidepressant drugs, increasing to 58, 000 in 2015.
The Increase in antidepressants: a visual representation
Each ping pong ball represents 4 teenagers prescribed antidepressants
2005
2015
This increase might be because more people are getting diagnosed and more effectively treated, however it might reflect the fact we are quicker to seek medicalised solutions to ‘depression’, and that these drugs are not effectively dealing with the underlying causes of depression, and maybe this doubling of prescriptions in 10 years is no a long term solution to depression.
A case study of teenage depression
To provide us with a ‘human face’ of depression, the documentary now visits Jess, 15 year old teenager who has been on antidepressants for 8 months and whose suffered from anxiety since she was a young girl, finds school stressful because she feels trapped (30 odd kids in a class, with everyone close together). She hasn’t been in lessons for 10 months, and may not be doing her GSCEs.
Following counselling, she was put on Sertraline to combat her depression, 100 mg, double the normal dose of 50 mg. We now get the usual trawl through the possible side effects of the drug, and it’s not pretty: clinical trials have shown an increased risk of suicidal behaviour in adults aged less than 25 years, and Jess says she has felt more suicidal since starting the medication.
Interestingly, Jess states a desire to be free of the drugs, while her mother appears more relaxed, saying that there’s evidence that they work, and that her daughter shouldn’t be afraid of the stigma attached to taking antidepressants: the idea of just ‘pulling yourself together’ and coping is outdated.
Research evidence on the effectiveness of antidepressants
Dr CVT now looks at a recent study conducted by professor Andrea Cipriani of the University of Oxford. This study summarised all available evidence of how effective 14 antidepressants are in children and adolescents specifically, (rather than just evidence from adult trials). The basic research question was ‘do these drugs work’ (not ‘how do these drugs work), and they compared the drugs with each other and against the effectiveness of a placebo, a sugar pill.
They found that only one drug: fluoxetine, or prozac, was more effective than a sugar pill in combatting depression among teenagers, which is worrying given that around 40% of teenage prescribed antidepressant drugs are on Sertraline. However, there is still a level of uncertainty around the research on the effectiveness on Fluoxetine – because people respond very differently to the drug.
Where Sertraline there is good evidence that it works for adults, but the problem here is that teenagers brains are wired differently, and professor Cipriani’s research suggests what works for adults may not work for teenagers.
Wilderness Therapy as an alternative means of treating mental ill health
Dr CVT says there’s lots of evidence that being active out of doors is effective in treating mental ill health, especially depression.
To test this out, the documentary now returns to Jess, one month on, who has now had her prescription of Sertraline increased to 125 milligrams, and feels increasingly panicky and has upped her rate of self-harm, and expose her to a ‘therapeutic intervention’, in the form of the ‘Wilderness Foundation’ which uses activities in wild spaces and one on one counselling to help teenagers suffering from mental ill-health.
Research conducted by the University of Essex suggests that 83% of the kids on the charity’s leading scheme have successfully gone on the further education or full time employment.
Jess gets taken along to the the Wilderness Foundation for a day to do ‘stuff’ outdoors, and we get treated to footage of Jess in an extremely pleasant wooded glade sparking a fire to life and putting up a hammock. Wilderness therapy is apparently well established in the USA, and it certainly seems to work for Jess, who spends 6 hours out of doors.
Do antidepressants ’cause’ an increase in teen suicides?
The documentary also visits one mother, Sarah, whose daughter Rachel killed herself within 11 days of an increase in her dose of Sertraline.
Rachel’s story seems similar to Jess’: she found secondary school difficult and hit a wall at GCSEs, finding it difficult to cope with the stress. After a visit to the Child and Adolescent Mental Health Services, she was prescribed fluoxetine and experienced the following side effects after 2 weeks:
Violent thoughts
Disturbing dreams
Bodily shaking
Nosebleeds
Rachel tried to hang herself at one point, and after several months of this, she was prescribed a different drug: Sertraline. She actually wanted this herself, she wanted something to work, but within 11 days of an increase in her dose of this second antidepressant Rachel killed herself.
Rachel’s mum Sarah doesn’t blame the Doctors as they were just following the approved ‘pathways’ to treating mental illness laid down in the formal guidelines, she blames the system which seems to based on inadequate knowledge of the harmful side effects of these drugs.
NB – we cannot actually prove a causal link
Could antidepressants actually be harming our children’s health?
Drug trials should not only tell us if the drugs are effective, they should also tell us if the drugs have any harmful side effects. The problem is that many of the drugs trials are run by drugs companies, with a vested interested in making their drugs look both effective and sage.
Dr David Healy is one of the few people to have done independent research into the effectiveness and safety of antidepressants with the raw data provided by the company. He argues that we need to see the raw data to uncover how the drugs affect individual patient – and this raw data can run into several reams of paper if there 100s of people in a trial.
It is extremely rare for drugs companies to release this original data, in fact, it’s only happened once when in 2004 legal challenges were made against claims made about the effectiveness of Seroxat, and antidepressant manufactured by the pharmaceutical company GlaxoSmithKline.
Dr David Healey analysed this original data and found that the claims made in the original 10 page article summarising the findings of the trials which claimed the drug was not only effective but also sage, were basically false, with Healey’s team finding that not only did the drug not work, but that the number of teenagers who developed suicidal thoughts following the use of the drug was three times greater than intimated in the original study, in which this side effect was described as ‘some teenagers becoming more emotionally labile’.
This research actually led to GlaxoSmithKlein being fined $3 billion in penalties and fines for health care fraud.
Dr David Healy says that in between the raw data and the sometimes misleading ‘main articles’ on the research findings published by the drugs companies, there are ‘company reports’, and even if we dig into these, there is cause to be concerned over the safety of many of antidepressants.
The rest of the documentary
The documentary returns to Jess, who has kept up her therapy for 6 months (I think it’s 6 months, it’s not that clear) and after some ups and downs (including one suicide attempt at school) the therapy seems to be working – she gets taken through a process of gradually having things she finds difficult added into the programme, and eventually manages to cope with going shopping and buying something (progress for her, in dealing with crowds).
After 6 months, Jess even manages to return to school and sit her mock GCSE exams, and at the very end of the documentary, we even see her at her 16th birthday party on stage singing, in front of friends and family.
The documentary also pays the standard visit to the Clinical Lead for Child Mental Health Care Services who reiterates that all Doctors are doing in prescribing antidepressants is following NICE guidelines, which are based on the best available evidence, however, Dr CVT’s point is the best available evidence is shaky at best.
NICE refuse to be interviewed, but do say they are reviewing their guidelines
Conclusions
The whole point of the documentary seems to be to inform us of the uncertainties surrounding the effectiveness and safety of many of the antidepressants we are increasingly prescribing to our teenagers.
Dr CVT suggest we are far too trusting of the research done by drugs companies, and we shouldn’t allow them to control the information we have about these drugs… we should be much more sceptical, and in the meantime, we should pursue alternative treatments such as wilderness therapy and mindfulness which are unlikely to cause harm.
K.T.’s Commentary
One thing I want to pick up on his the ‘social causes’ of Jess’ anxiety. Basically, it seems she just hates the crowded environment of the school, along with all the stress of testing that goes along with it….
Personally, I get this, it has exactly the same effect on me as a teacher.
I also get the ‘wilderness therapy’ as a solution – I love being outdoors, walking: it’s just that I don’t need anyone to structure it for me, I also don’t really regard it as ‘therapy’ – rather it’s just ‘doing something enjoyable’.
It appears to me that Jess’ depression is pretty much 100% socially induced – by the school system. Get her back to nature, and doing something ‘naturally’ empowering, and she’s O.K, as she is singing in front her friends and family – surely it’s the social context that’s the problem?
It’s not rocket science is it! What needs to change here is society, although that’s easier said than done.
I also have to admit being a bit taken aback by the size of that GSK fine – $3 billion for health care fraud, that’s something I’m going to have to come back to later!
Disclaimers/ health advice provided in the documentary
Doctor Chris Van Tulleken reminds us that it might be dangerous to stop taking antidepressants suddenly and that any change of dose should only be made with medical supervision.
There were 29,168 recorded murders in Mexico in 2017, or 20 murders for every 100, 000 of the population, more than at the height of the country’s drug war in 2011. (Source: The Guardian).
This dismal new record is being blamed on intense drug-related violence and turf wars – owing in particular to the rise and spread of the Jalisco New Generation Cartel.
Analysts also believe the spike could be related to a number of autonomous groups emerging in the vacuum created by the capture of several major cartel bosses.
This is of obvious relevance to the Crime and Deviance aspect of A-level sociology – it demonstrates the continued power of organised (or dis-organised?) crime in countries through which drugs travel and the relative powerlessness of nation states to get this problem under control!
To put Mexico’s homicide rate in context, it’s more than 20* higher than the UKs, and yet smaller than Brazil’s and Colombia’s (27/ 100, 000) and El Salvador’s, which stands at 60.8 per hundred thousand.
This has clearly been a popular change in the law for some: In Berkeley, queues of people snaked around the block from 6 a.m. (odd time to be buying weed?) to late into the evening as one the first dispensaries to open struggled to cope with demand, suggesting that there are eventually going to be many licensed venues selling legal weed.
However, there are those that are opposed to the legalization of marijuana movement, the most powerful being the entire Trump administration, who are looking for ways to derail those 6 states which have legalized the drug.
An estimated 90% of weed related business is still illegal, rather than legal. This is is because the regulations for legal growers are too complex and taxes are so high it is hard to make a profit for small businesses.
Small businesses find themselves unable to compete with large legal corporations and illegal drugs cartels.
Many small legal growers still trade in unlicensed illegal pot as a result.
This whole issue is a great example of how ‘crime is socially constructed‘ – you can quite literally hope over from California into the state of Arizona while smoking a joint and tada: you’re a criminal!
Given the situation in 2023 this also shows how changing the law can make very little difference to an already established illegal market. It demonstrates the limited capacity of social policy to make social changes.
From a Functionalist point of view, it might be worth thinking about whether this is happening as a sort of ‘safety valve’ mechanism – there’s so much strain in America, and so many people already using drugs to cope with it, we may as well legalise it because it’s easier for the system to cope with it, and focus more on the ‘real criminals’.
