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Fintan O’Toole: The Mexico wall is Trump’s opium for a drug-saturated people

The biggest drug problem in the US is not heroin or crystal meth, but painkillers

After marijuana, the most commonly used illicit drug in the United States is not heroin or cocaine or crystal meth. It is painkillers manufactured by respectable corporations and initially prescribed by doctors.

These are mostly opioids such as hydrocodone (marketed as Vicodin) or oxycodone (OxyContin or Percocet). Approximately 91.8 million adults in the US have used such prescription pain relievers in the past year – a staggering 37.8 percent of the entire adult population. Of these, 11.5 million adults abused prescription pain relievers at least once in the past year – 4.7 percent of all adults.

But that’s not all. As well as the pain relievers, there are the tranquillisers like Xanax and Soma. Some 38.2 million people in the US have used one of these in the US in the last year and 5.7 million misused them – 2.3 per cent of the adult population.

And then there are the prescription stimulants – amphetamines like Adderall and methylphenidates like Ritalin. About 15.4 million use them and 4.8 million – another two per cent of the entire adult population – misuse them.

Finally, there are the sedatives, such as Ambien. About 18 million adults in the US used one of them in the last year and 1.4 million abused them, another 0.6 per cent of the adult population.

It may be a rather crude calculation to simply add all these figures together (some adults are misusing more than one category of drugs, and users under 18 are not included) but, if we do, they suggest that around one in ten adults in the US is abusing a prescription drug. That’s a breathtaking figure.

And it amounts to a huge human, social and economic crisis. Since 1999, more than 400,000 people have died of opioid overdoses in the US. Every day, more than 130 new names are added to the death toll. Last year, 28,466 people died from overdoses of prescription drugs alone. An estimated 1.7 million Americans currently suffer from chronic substance abuse disorders related to prescription opioid pain relievers.

This form of drug abuse feeds the trade in more obviously illicit drugs; about 80 per cent of people who use heroin have misused prescription opioids first. According to Donald Trump’s Council of Economic Advisers, the total economic cost of opioid misuse in the United States is $500 billion a year.

The scale of abuse of prescription opioids is so vast that it is now having a measurable effect on life expectancy in the US. In Philadelphia, for example, life expectancy has actually been falling since 2015, largely because over 1,000 people a year are dying from drug overdoses, which has become the third largest cause of death after cancer and heart disease.

In 2013, the city had 20 overdose deaths per 100,000 people. In 2017, it had 59.The official Health of the City report published last month is blunt: "This epidemic is largely fuelled by years of over-prescribing of highly addictive pharmaceutical opioids".

National emergency

This really is a national emergency. Its annual death toll is now 10,000 a year higher than the number of Americans killed in the worst year of the Vietnam War.

"Imagine if that many people were dying at the hands of a terrorist organisation," writes one prominent Trump supporter, the former New Jersey governor Chris Christie, in his new memoir.

And indeed last November, Donald Trump himself declared the opioid crisis a "national public health emergency".

Yet, of course, this is not the national emergency Trump declared last week – the one he has chosen to define his presidency by. That emergency is his own desperate need to be able to claim, when he stands for re-election, that he has built a “great big beautiful wall” along the US border with Mexico.

In making that declaration, Trump’s primary argument was that the wall is urgently needed “because we have tremendous amounts of drugs flowing into the country”, an “invasion” of drugs that “would be very easy” to stop with a physical barrier.

No one really believes this to be true: the vast bulk of the illegal drugs actually enter the US through official ports of entry. Fentanyl, which is now the most deadly of the prescription painkillers, is largely imported from China, often by mail.

But truth is not the point – the idea of the wall is not to do anything real. It is to “explain” America’s massive drug abuse problem as the work of malign, brown-skinned foreigners. It takes a genuine social and health crisis that is emphatically Made in America and recasts it as a drama of invasion.

A current court action being taken by the state of Massachusetts has revealed documents showing that the vastly wealthy Sackler family, owners of Purdue Pharma, discussed "tactics that could be used to promote the sales of OxyContin (particularly in higher doses), to encourage doctors to prescribe the drug over longer periods of time, and to circumvent safeguards put in place to stop illegal prescriptions".

The suit alleges that: “From the beginning, the Sacklers viewed limits on opioids as an obstacle to greater profits.” But the Sacklers (who reject the charges) and their corporate peers are of no use to Trump – they are American billionaires, not invasive foreigners.

This contradiction, however, exposes Trump’s great underlying weakness; the very slogans that appeal most to his voters also tell lies about their lives. For it is Trump supporters who suffer most from the home-made crisis created by US corporations and US doctors pushing highly addictive drugs at them with assurances that they were safe.

Core demographic

The part of the population worst affected is “non-Hispanic white males” – Trump’s core demographic. Geographically, the correlation between his base and the opioid crisis is very strong: in counties with higher-than-average rates of chronic opioid prescriptions, 60 per cent of the voters supported Trump. In the counties with lower-than-average rates, only 39 percent voted for him.

Trump has made a great song-and-dance about his backing for a bipartisan plan that provides $3 billion to tackle the crisis this year.

But no one thinks that's anywhere near enough – a more realistic plan put forward by Democrats Elizabeth Warren and Elijah Cummings would provide $10 billion a year for ten years. Trump has given it no support, and his party has blocked it in the Senate.

Neither, of course, do he and the Republicans support the kind of public health care that families devastated by the crisis need.

In a sense, Trump’s wall is just another drug. For his fans, it is a fix of xenophobia that dulls the pain of the real epidemic that is blighting their lives and their communities.

The wall is the opium of the Trump-supporting people. Both he and they are addicted to the rush it gives them. He needs his supply of adoration as much as they need his narcotic hope. He has no choice but to go on pushing. And when the next fix is on the line, everything is an emergency.