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What is OxyContin, the drug behind America’s opioid crisis?

Since 1999, 200,000 Americans have died from overdoses connected to OxyContin and similar prescription drugs.

Ten months into his “listening” tour of America, the Facebook CEO, Mark Zuckerberg, better understands the big issues that have divided the country. Some he anticipated, such as the lost jobs and economic uncertainty resulting from technological advances and free trade. But there was one that he did not.

Speaking in Kansas on 10 November, Zuckerberg said his “biggest surprise by far” was the extent of the opioid crisis – fuelled by the overprescription of pain management drugs – and its effect on the American psyche. Around 64,000 people died from drug overdoses in the US last year – more people than died from Aids at the height of that epidemic, Zuckerberg noted. “It’s more people than die of car accidents and gun violence, I think, combined, and it’s growing quickly.”

Opioids are drugs derived from the juice of the opium poppy, including heroin and prescription painkillers, or their synthetic equivalents, such as fentanyl. The best-known painkiller and the one attracting the most criticism for its part in America’s opioid crisis is OxyContin.

For many years, doctors were wary of prescribing strong opioids, except in cases of extreme pain or palliative care, because of their well-known addictive properties. But Purdue Pharma, which was acquired by the doctors Raymond and Mortimer Sackler in the mid-20th century, sought to change this.

Their breakthrough product was a slow-release morphine pill, MS Contin. The drug dissolved gradually over several hours in a patient’s bloodstream, allowing cancer patients to sleep through the night. When MS Contin’s patent was due to expire, Purdue decided to develop a new drug that could be used much more widely for chronic pain. Instead of morphine, which carried a stigma among patients who weren’t terminally ill, Purdue designed a new slow-release pill made of pure oxycodone, another, more powerful, chemical derived from opium.

Purdue launched OxyContin in 1996, making a bold claim: one dose relieved pain for 12 hours, twice as long as generic alternatives. The company paid doctors and funded research to support the case that the addiction risk was exaggerated and that the drug was effective for a wide range of ailments, including less severe, long-term complaints such as back pain. As the New Yorker reported in October, Purdue marketed OxyContin as a remedy to “start with and to stay with”.

The pill was effective in helping many people with chronic pain who until then had received inadequate treatment and, by 2001, annual sales exceeded $1bn. But controversy was mounting. For some people, the drug only lasted for six or eight hours, resulting in withdrawal symptoms. This created “a cycle of crash and euphoria that one academic called ‘a perfect recipe for addiction’”, Esquire noted in a investigative report last month. Sales reps told doctors, many of whom mistakenly believed that oxycodone was weaker than morphine, to prescribe stronger doses rather than more frequent ones, increasing the risk of overdose. And addicts had worked out that the pills could be crushed and snorted for a quick, intense high.

Purdue settled a number of class action suits before they came to trial. But in 2007 it was charged by the US federal government with “misbranding a drug with intent to defraud or mislead”. The company paid $635m in fines, one of the largest pharmaceutical settlements in US history, and three executives pleaded guilty to misdemeanour charges. But sales continued to soar. OxyContin sales now total $35bn, and have made the Sacklers one of the richest – and most controversial – families in the US.

Since 1999, 200,000 Americans have died from overdoses connected to OxyContin and similar prescription opioids. Addicts who can no longer source or afford prescription drugs often turn to heroin. The American Society of Addiction Medicine says four in five people who try heroin today started with prescription painkillers.

Though many of the opioid-related deaths are linked to drugs other than OxyContin, many experts blame Purdue’s marketing tactics for the significant rise in prescriptions of opioids. For every million Americans, nearly 50,000 doses of opioids are taken daily – four times the rate in the UK.

In Kansas, Zuckerberg said that the crisis has influenced people’s attitude to policy issues. Seeing family and friends succumb to addiction has made people more fearful of crime and eager for border controls that could stop the flow of drugs, he said.

White, working-class, middle-aged people have been especially affected. The Princeton economists Anne Case and Angus Deaton have noted the rise in the number of “deaths of despair” – from suicide, overdoses and drug- and alcohol-related diseases – among that demographic. Decades of wage stagnation and the decline of well-paying jobs were the main underlying causes, they wrote in the Washington Post. But: “Opioids are like guns handed out in a suicide ward; they have certainly made the total epidemic much worse.” 

Xan Rice is Features Editor at the New Statesman.

This article first appeared in the 16 November 2017 issue of the New Statesman, The plot to stop Brexit

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“I want the state to think like an anarchist”: Dutch historian Rutger Bregman on why the left must reclaim utopianism

The Dutch thinker advocates global open borders, a universal basic income and a 15-hour working week. 

History consists of the impossible becoming the inevitable. Universal suffrage, the abolition of slavery and the welfare state were all once dismissed as fantastical dreams. But in the Western world, politics today often feels devoid of the idealism and ambition of previous generations. As the mainstream left has struggled to define its purpose, the right has offered superficially seductive solutions (from Brexit to border walls).

One of those seeking to resolve what he calls a “crisis of imagination” is the Dutch historian and journalist Rutger Bregman. His book Utopia for Realists advocates policies including a universal basic income (a guaranteed minimum salary for all citizens), a 15-hour working week and global open borders. Since its publication last year, Bregman’s manifesto has been translated into more than 20 languages, establishing him as one of Europe’s pre-eminent young thinkers.

“I was born in 1988, one year before the fall of the Berlin Wall, and people of my generation were taught that utopian dreams are dangerous,” Bregman recalled when we met for coffee at the London office of his publisher Bloomsbury. A softly-spoken but forceful character, dressed casually in a light blue jacket, jeans and Nike Air trainers, Bregman continued: “It seemed that the age of big ideas was over. Politics had just become technocracy and politicians just managers.”

Bregman’s imagination was fired by anarchist thinkers such as the Russian philosopher Peter Kropotkin. He identifies with the left libertarian tradition, which emphasises individual freedom from both market and state domination. Another formative influence was Russell Jacoby, Bregman’s history professor at the University of California, Los Angeles, whose book The Last Intellectuals (2000) lamented the decline of the polymath in an era of academic specialisation. Utopia for Realists, a rigorously argued and lucidly written work, fuses insights from history, politics, philosophy and economics. Bregman echoes Oscar Wilde’s sentiment: “A map of the world that does not include Utopia is not worth even glancing at.”

Such romanticism partly filled the void left by Bregman’s loss of religious faith at the age of 18 (his father was a Protestant minister in the church opposite the family home in Zoetermeer, western Netherlands). “Maybe utopianism is my form of religion in a world without God,” Bregman mused.

For him, utopia is not a dogma to be ruthlessly imposed but a liberating and inclusive vision. It would be “completely ludicrous”, Bregman remarked, for a Western politician to suddenly propose global open borders. Rather, such ideals should animate progressive reforms: one could call it incremental utopianism.

“History will tell you that borders are not inevitable, they hardly existed at the end of the 19th century,” Bregman observed. “And the data is behind me.” Economists liken the present system to leaving “trillion-dollar bills on the sidewalk” and estimate that allowing migrants to move to any country they choose would increase global GDP by between 67 and 147 per cent.

The thoughtful Conservative MP Nick Boles recently objected to a universal basic income on the grounds that “mankind is hard-wired to work. We gain satisfaction from it. It gives us a sense of identity, purpose and belonging”.

Bregman did not dispute this but argued for a radical redefinition of work. “A YouGov poll in 2015 found that 37 per cent of British workers think their own job is absolutely meaningless,” he noted. Rather than such “bullshit jobs” (to use the anthropologist David Graeber’s phrase), work should be defined as “doing something of value, making this world a little more interesting, richer, beautiful – whether that’s paid or unpaid doesn’t really matter.”

In Utopia for Realists, Bregman decries “underdog socialism”: a left that is defined by what it is against (austerity, privatisation, racism), rather than what it is for. How does he view the ascent of Jeremy Corbyn? “Most of the ideas are sensible but they’re a bit old-fashioned, it felt like stepping into a time machine,” Bregman said of the 2017 Labour manifesto (which majored on renationalisation). Yet he recognised that Corbyn had expanded the limits of the possible. “All this time, people were saying that Labour shouldn’t become too radical or it will lose votes. The election showed that, in fact, Labour wasn’t radical enough.”

“We need a completely different kind of democracy, a society where you don’t think purely in terms of representation,” Bregman explained, citing the Brazilian city Porto Alegre’s pioneering experiments in participatory democracy (citizens’ assemblies, for instance, determine public spending priorities). “I call it the anarchist state. The anarchists want to abolish the state; what I want to do is to make the state think like an anarchist.”

Rutger Bregman has a fundamentally optimistic view of human nature: “People are pretty nice” (his next book will challenge “the long intellectual history in the West that says, deep down, we’re all animals, we’re all beasts”).

He dismissed those who cite the 20th century – the age of Stalinism and fascism – as proof of the ruinous consequences of utopian thought. “People are always yearning for a bigger story to be part of, it’s not enough to live our own private lives. If you don’t give them [people] hope, they’ll go for something else.” 

George Eaton is political editor of the New Statesman.

This article first appeared in the 15 February 2018 issue of the New Statesman, The polite extremist