top of page

Opiates and the Masses: Populist Oligarchy and the Totalitarian Itch in the U.S.


(DEA, Wikimedia)

Black Logo Mark.png

By Hugh Gusterson
February 2024

More a corporate oligarchy than a properly functioning democracy, the U.S. is increasingly characterized by widening income inequality, political polarization and paralysis, and a compromised state regulatory apparatus that has failed to protect the citizenry from opiate addiction, environmental injury, gun violence, the covid pandemic, and financial vulnerability.  The late capitalist U.S. state apparatus, simultaneously overgrown and hollowed out, is now worked by an oligarchy of financial, energy, industrial, pharmaceutical, military and social media elites who jostle for control of the spoils and strive to extract ever more surplus value from those below them while distracting them with incitements to discourse about cancel culture, wokeness, transgender politics and celebrity gossip.  Thinkers such as Martin Wolf (2023) and Peter Turchin (2023) worry that the system is fast approaching the point where it can no longer mediate the contradiction between democracy and widening income inequality, and that we are in danger of transitioning to a regime of what Theda Skocpol calls “minority authoritarianism” and “GOP Leninism” (Edsall 2023).

Let’s explore these issues through the example of the opiate addiction crisis in the U.S.. This crisis was originally precipitated by the narco-oligarchs of the pharmaceutical industry who made enormous amounts of money addicting Americans to opiates such as oxycontin.  When the full scale of the disaster they had unleashed became apparent, they sought to transfer blame to the petty drug dealers – often people of color – who followed in their tracks while their political allies used the crisis to advocate an authoritarian turn rather than the kinds of policies that many public health experts see as essential to saving lives.

"For example, one pharmacy in Kermit, West Virginia, population 406, was selling 4.5 million Oxycontin pills a year."

The opiate epidemic in the US commenced with Purdue Pharmaceutical’s release of Oxycontin in 1995.  Purdue Pharmaceutical was privately held by the Sackler family which, with $13 billion in assets in 2017, was wealthier than either the Mellons or the Rockefellers.  They launched Oxycontin – an opiate twice as powerful as morphine – with a brilliant marketing campaign that lamented the undertreatment of pain, which they now called “the fifth vital sign” (along with temperature, blood pressure, pulse, and respiration). They attributed this undertreatment to “opiophobia.”  These arguments were advanced in ads and videos, but also by a small army of doctors, paid by Purdue to speak at medical conferences, as well as sales reps touring doctors’ offices.  With Purdue making $1 billion a year from Oxycontin by 2000, some of these sales reps were making hundreds of thousands of dollars in commissions (Redden 2017, 2022; Macy 2019).  

The doctors and sales reps argued that Oxycontin’s special time release mechanism prevented addiction.  This was not true, and Purdue’s internal documents show they soon became aware of this.  Oxycontin was advertised as a twice-a-day pill, but many users were taking it three times a day to ward off withdrawal.  Others soon learned they could get a strong high by crushing the pills, thus circumventing the time-release feature.  This created an enormous black market of recreational users of Oxycontin, and Purdue knew from its prescription tracking that some doctors were functioning as pill mills, prescribing Oxycontin (now nicknamed “hillbilly heroin”) on a mass scale, no questions asked.  For example, one pharmacy in Kermit, West Virginia, population 406, was selling 4.5 million Oxycontin pills a year (Case and Deaton 2020:124). [1]  In journalist Patrick Keeffe Redden’s (2017) words, “everywhere the drug spread, addiction followed.”

These pill mills attracted the attention of the Drug Enforcement Agency, which began fining pharmaceutical distribution companies and threatening to close some of their distribution centers.  Big Pharma fought back, and their success shows how effectively corporate oligarchies can neuter the regulatory state and supplant the public interest in favor of private corporate interests.  Key to their strategy were Republican allies Tom Marino and Marsha Blackburn in the House of Representatives.  Although Marino and Blackburn both represented areas hard hit by the opiate epidemic, they were strong allies of the pharmaceutical industry, which would give them $1.4 million in campaign contributions in the following years.  They allied with Linden Barber, formerly a senior DEA official but now working as a lawyer for pharmaceutical companies.  Using his knowledge of DEA processes, he wrote legislation – The Marino Bill – that changed the standard the DEA would have to meet to close down a distribution centre from one of proving “imminent danger to public health or safety” to proving that a distribution center threatened “a significant and immediate risk of death or serious bodily harm.”  This may seem like a minor semantic shift, but DEA lawyers complained it made it almost impossible to close a distribution center because it required proving that someone’s death was actually imminent. 


For good measure, Representatives Marino and Blackburn pressured the DEA inspector-general into doing an internal investigation of Joe Rannazzisi, the senior DEA official seeking tighter control of opiates, thus derailing his government career.  Meanwhile Representative Tom Marino who had worked so hard to make it easier for the pharmaceutical industry to turn ordinary Americans into addicts was, in 2017, nominated by Donald Trump to be the nation’s “drug czar.”  (I am not making this up!)  In a sign that democratic processes of accountability were not completely dead, his nomination was withdrawn when a Washington Post investigative team revealed his backstage plotting to keep the pill mills open (Higham et al 2019).




The Second Era of Opiate Addiction

By the end of the Obama Administration the mass epidemic of addiction caused by Oxycontin became impossible to ignore.  Purdue, ever alert to business openings, saw an opportunity to market Suboxone, a drug to treat opiate addiction.  “It’s an attractive market,” said a Purdue internal memo.  “Large unmet need for vulnerable, underserved and stigmatized patient population suffering from substance abuse, dependence and addiction” (Associated Press 2019). But it was the end of the road for Purdue, if not for the epidemic of suffering it had unleashed. By 2019 over 1,000 state and local governments had filed suit against Purdue and other pharmaceutical companies.  Purdue Pharmaceutical declared bankruptcy, while offering those with claims against it a one-time collective payment of around $10 billion.  (To put this in context, the Los Angeles Times estimates that the Sackler family, already worth several billion dollars, made $12-13 billion from Oxycontin [Case and Deaton 2020:114]). The terms of the settlement, awaiting final approval by the Supreme Court, would immunize the Sackler family from further lawsuits and protect their family wealth, generally estimated at several billion dollars even after the settlement (Kruzel and Chung 2023). 

 As public opinion turned against opiate painkillers, doctors became more reluctant to prescribe them and pill mills closed.  This left people who had become addicted to opiates now bereft of supply.  Instead of ending the burgeoning spiral of addiction, this led to a situation where, in Anne Case and Angus Deaton’s (2020:120) words, “the fire had jumped its boundaries.” The source many turned to, as described in Sam Quinones’ extraordinary book Dreamland, was a new network of young dealers, largely from the Mexican city of Xalisco, who offered home delivery of black-tar heroin smuggled in from Mexico.  They often recruited their customers at pain clinics.  Over time, what they sold was increasingly laced with the even more powerful opiate fentanyl, and many unsuspecting users met their deaths overdosing by accident. 

"Unlike victims of previous surges in drug use in the 1960s and 1980s, the victims are predominantly white.  Whites without degrees are, of course, a key part of the MAGA base."


Around 645,000 Americans died from opiate overdoses between 1999 and 2021, according to the Centers for Disease Control. The overdose death rate has been climbing dramatically, rising from about 40,000 a year in 2010 to over 100,000 in 2021 as fentanyl has become more pervasive.[2]  This is much higher than the peak annual death rate from HIV, gun violence, or car crashes, and in 2021 almost twice as many Americans died from drug overdoses as were killed over the entire duration of the Vietnam War. One American is killed by fentanyl every seven minutes (Kan et al 2022).  According to Case and Deaton, 90% of these deaths are concentrated among those without college degrees.  Unlike victims of previous surges in drug use in the 1960s and 1980s, the victims are predominantly white.  Whites without degrees are, of course, a key part of the MAGA base.

The Authoritarian Itch


In a healthy democracy, one could imagine a number of responses to this extraordinary crisis in public order and public health – responses that might both ameliorate millions of addictions and deepen democracy.  These could include prosecuting pharmaceutical executives who knew the human cost of their profits; going more aggressively after the financial reserves of those who profited; reforming the FDA (Food and Drug Administration) and DEA (Drug Enforcement Agency); and implementing campaign finance reform to end the system of legalized bribery (aka “lobbying” and “campaign donations”) that enables profit-seeking oligarchs to bend Congress to their will.  Focusing more on the management of those who have become addicted, many public health experts would strongly recommend safe injection sites (like the one in Vancouver, where I live) where those who overdose can be revived with Nalaxone before they die.  They would also recommend more publicly funded addiction treatment centers.  Some public health experts, sensitive to the enforced humiliation of lining up every day outside a methadone maintenance clinic, would advocate a return to the situation before World War I, when doctors routinely prescribed maintenance doses of heroin to addicted patients (See Waterston 1997).


"Prominent on the national agenda instead are a set of proposed authoritarian responses that build on previous authoritarian measures targeting drug users and dealers."  

While a few local grassroots activists advocate safe injection sites, by and large the list of remedies above is not on the U.S. national agenda.  You will search for them in vain in the press releases of establishment Democrats as much as Republicans. Prominent on the national agenda instead are a set of proposed authoritarian responses that build on previous authoritarian measures targeting drug users and dealers.  Drugs and authoritarianism have long had a co-productive relationship in the U.S..  As Michelle Alexander shows in her book The New Jim Crowe, the surge in drug use, especially crack cocaine, in the 1980s and 1990s became the pretext for a parallel surge in incarceration that targeted black men in particular and left the US with the highest incarceration rate in the world.  It also weakened American democracy because so many of the incarcerated lost their voting rights forever.  A new set of proposals from politicians and pundits would go still further, advocating militarization of the U.S. border, even invasion of Mexico, and mass executions of drug dealers.


Regarding the US-Mexican border, pundit Ann Coulter (2016) sets the tone.  She says “any politician who claims to care about the drug overdose deaths sweeping the nation, but does not demand that we build a wall, deport illegal aliens and end the anchor baby scam, is a liar.”  In fact drug experts agree that undocumented migrants – who often surrender to U.S. authorities and request asylum – are not for the most part engaged in drug smuggling, and that drugs are smuggled by a few of the vast number of cars and trucks that cross the border legally every day.  Nonetheless the association of undocumented migrants and drug smuggling, more symbolic than factual, is strong on the right, as is talk of crushing the Mexican drug cartels.


We now know that in 2020 Donald Trump had to be talked by his Secretary of Defense out of striking Mexican drug cartels with missiles.  James Comer, a leading Republican Congressman, has said of Trump’s decision to back off, “I think that was a mistake,” and in a debate for the Republican presidential nomination almost every candidate endorsed using the U.S. military to attack drug labs in Mexico.  Vivek Ramaswamy said the U.S. should “use the military to secure our own border and to annihilate the drug cartels if necessary.”  Ron DeSantis said “I talk about using the military to take on the drug cartels because they’re killing tens of thousands of our citizens… We have every right to do it, I’m going to do it. I’m not just going to get into office and say ‘forget about it.’”.  And Nicki Haley said “you tell the Mexican president, either you do it or we do it.”  Meanwhile several Republican members of Congress are co-sponsors of legislation proposed by Representative Dan Crenshaw of Texas to authorize the use of military force against Mexican drug cartels.” (Concepcion 2023; Haberman 2022; Swan et al 2023; Ward et al 2023.)


Finally, there are calls on the right to adopt something like Philippino President Duterte’s policy of mass executions.  "We're going to be asking everyone who sells drugs, gets caught selling drugs, to receive the death penalty for their heinous acts.  Because it's the only way," said Donald Trump (NPR 2023).

Policy Futures in a Narco-Oligarchy?


The U.S. has just about the worst drug overdose rate in the world.  This rate has increased enormously over the last three decades because the narco-oligarchs of the pharmaceutical industry saw an opportunity to turn the addiction of predominantly poor and blue collar white men – America’s loudest patriots -- into profit.  A belated clampdown on the medical-pharmaceutical-industrial complex, in the absence of accessible treatment options for addiction, only created fertile ground for Mexican drug cartels to take over the terrain.  Now the escalation in “deaths of despair” is being used to advocate securitization of the border, unilateral military operations in Mexico, and mass executions in the U.S.  However, in the words of Denise Cullen, whose son Jeff died of an overdose, “criminalization and punitive drug laws have resulted in nothing but more imprisonment, more deaths, and more devastated families. We must, instead, invest in health-based solutions that will save the lives of the ones we love” (Ludwig 2023).

References cited:


Alexander, Michelle (2012), The New Jim Crowe: Mass Incarceration in the Age of Colorblindness.  (New Press).


Associated Press and Corki Siemaszko (2019) “First it sold Oxycontin, then pharma company saw market for anti-addiction drug, suit says,” NBC News, February 1.


Case, Anne and Angus Deaton (2020), Deaths of Despair and the Future of Capitalism.  Princeton University Press.


Concepcion, Comer (2023) “Comer says it was a ‘mistake’ that Trump didn’t bomb drug labs in Mexico,” NBC News March 8


Coulter, Anne (2016), “Heroin Addiction: Blame it on America.”  St. Augustine Record, February 7.


Edsall, Thomas (2023), “The Republican Strategists who Have carefully Planned All of This,” New York Times, April 12.


Haberman, Maggie (2022), “Trump Proposed Launching Missiles into Mexico ‘to Destroy the Drug Labs’ Esper says.”  New York Times May 5


Higham, Scott, Sari Horwitz, Steven Rich, and Meryl Kornfield (2019) “Inside the Drug Industry’s Plan to Defeat the DEA,” Washington Post, September 13.


Kan, Counrtney, Nick Miroff, Scott Higham, Steven Rich, and Tyler Remmel (2022), “From Mexican Labs to U.S. Streets: A Lethal Pipeline,”  Washington Post December 15.


Keeffe, Patrick Redden (2017) “The Family that built an empire of pain,” New Yorker, October 23.


Keeffe, Patrick Redden (2022) Empire of Pain: The Secret History of the Sackler Dynasty (Anchor Canada)


Kruzel, John and Andrew Chung (2023), “U.S. Supreme Court Torn Over Purdue Pharma Bankruptcy Settlement, Reuters December 4.


Ludwig, Mike (2023).  “GOP Presidential Contenders Cling to Drug War Policies Fuelling Overdose Crisis.”  Truthout September 29.


Macy, Beth (2019), Dopesick: Dealers, Doctors, and the Drug Company that Addicted America.  (Back Bay Books).


Meier, Barry (2018), Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic (Random House)


NPR (2023) “Trump Wants the Death Penalty for Drug Dealers,” May 10


Quinones, Sam (2015).  Dreamland: The True Tale of America’s Opiate Epidemic.  (Bloomsbury).


Swan, Jonathan, Maggie Haberman, Charles Savage, and Emiliano Rodriguez Mega (2023), “Trump Wanted to Fire Missiles at Mexico.  Now the GOP Wants to Send Troops,” New York Times October 3.


Turchin, Peter (2023) End Times: Elites, Counter-Elites, and the Path of Political Disintegration.  Penguin Books.


Ward, Alexansder, Matt Berg, and Eric Bazail-Eimil (2023), “DeSantis: I’d strike drug cartels in Mexico on ‘day one,’” Politico August 24


Waterston, Alisse (1997), Street Addicts in the Political Economy (Philadelphia: Temple University Press).


Wolf, Martin (2023), The Crisis of Democratic Capitalism.  Penguin Books.


Hugh Gusterson is Professor of Anthropology and Public Policy at the University of British Columbia.  He is the author of the books Nuclear Rites (UC Press, 1996), People of the Bomb (University of Minnesota Press 2004), and Drone (MIT Press, 2016).  His most recent research is on the polygraph.  He has written regular columns for The Bulletin of Atomic Scientists and Sapiens.

Cite this article as: Gusterson, Hugh. February 2024. "Opiates and the Masses: Populist Oligarchy and the Totalitarian Itch in the US." Today's Totalitarianism.

White Logo Black Background.jpg
bottom of page