A recent article in The New Yorker painted a troubling and vivid portrait of the opioid crisis facing many areas of the nation. In her piece, Margaret Talbot details a number of graphic overdoses that have taken place in West Virginia, the U.S. state with the highest rate of opioid overdoses per 100,000 people (39.3). What is the cause of this phenomenon, and what can be done to alleviate it?
The Center for Disease Control and Prevention reports that in 2015, there were more than 52,000 Americans killed by drug overdoses – or one every 10 minutes.
According to The Economist, about 33,000 of those can be attributed to opioids, the most common of which are prescription painkillers and heroin. While major cities feel some of the weight, it is actually areas such as Midwest America and Appalachia which are being truly devastated by this crisis.
In certain parts of the country, including Talbot’s focus of Berkeley County in West Virginia, overdoses are a daily occurrence. They seem to be taking place almost anywhere and at anytime. “Many addicts are collapsing in public – in gas stations, in restaurant bathrooms, in the aisles of big-box stores”, writes Talbot.
Graphic by The Economist
The number of overdoses has shot up dramatically around the country over the past several years as heroin has started to be laced with powerful prescription medications such as fentanyl. In the 21-country area surrounding Toledo, Ohio, there were only 8 overdose deaths in 2010. In the first six months of 2016, that same number was 127 deaths.
The burden placed upon paramedics has been so extreme that even entire teams of paramedics working 24-hour shifts are unable to reach every overdose in a timely manner. In those cases where they do, the main course of action is to administer a potentially life-saving dose of Narcan – a drug used to counteract the effects of an opiate overdose. Classes are now being offered to average citizens in areas with high overdose rates so that they know how to administer the drug themselves should the situation arise.
The issue can be traced, at least in part, to the explosion in powerful prescription medications in the United States. In 1991, the number of opioid medications (Oxycontin, Vicodin, etc.) supplied to pharmacies was 76 million. In 2011, that number was 219 million.
Perhaps even more telling is the fact, according to The Economist, “in 2002 one in six users took a pill more powerful than morphine. By 2012 it was one in three.” Pharmaceutical companies and doctors have begun scaling back the prescriptions for painkillers, but that has turned people already hooked on opiates towards drugs like heroin instead, which is substantially cheaper than any prescription opioid.
Photograph via Getty Images
Certain officials, such as Governor Hogan, have pledged money and attention to the issue. Even U.S. President Donald Trump commented on America’s “terrible drug epidemic” during his speech before Congress in February, and in one of his few positive moves he set up a commission on drug addiction and offered $500 million to combat the problem.
Making matters worse is the aforementioned fentanyl, a synthetic painkiller that is 50 times more powerful than heroin. The result is a dramatic increase in fatal overdoses in a number of states. In Maryland, Governor Larry Hogan declared a state of emergency after the combination of heroin and fentanyl killed 1,468 Maryland residents in the first nine months of 2016, a 62% increase from previous year.
It is not as if this is a problem we are mentioning for the first time. Highly regarded publications, including those cited in this article, have offered enormous spaces devoted to discussing this enormous issue.
Among others, The Economist firmly advocates the decriminalization of all drugs to replace America’s deeply-flawed policy of prohibition with a focus on health treatment and safe use centres:
Banning drugs is not just ineffective, it is also counterproductive. Fentanyl is a nasty substance, but prohibiting all illicit drugs, whether they are new or established, prevents the research that could distinguish between those which are more and less harmful. It also leads to topsy-turvy outcomes. Marijuana, which cannot lead to overdoses and which can be used as an effective pain-relief medicine, is classified by the federal authorities in America as a more dangerous drug than fentanyl, which is used in very controlled doses by cancer patients and abused fatally across the country.
It takes guts to legalise drugs when so many are dying from them. But it is better that addicts take safe doses of familiar substances under sanitary conditions than for them to risk their lives enriching criminals. Switzerland followed the legalisation path after a heroin epidemic in the 1980s, treating drugs as a public-health problem. Since then drug-taking and drug-related deaths have fallen. America should follow suit.
Every day that passes, 78 Americans die from an opioid overdose. And every day that passes without real solutions to this very real problem, those deaths will linger over the heads of those that have seen the problem, acknowledged it, and then decided to mire in inaction and rhetoric.
US foreign policy and the birth of neo-conservatism
July 26th 2017 | Indiana | Russell Hall
Graphic by Eva Bee
When former national security advisor Zbigniew Brzezinski died on the 26th of May, liberals mourned his loss and praised his accomplishments. Former U.S. president Jimmy Carter called him a “superb public servant”. Barack Obama offered similar praise, stating Brzezinski’s “influence spanned several decades, and I was one of several Presidents who benefited from his wisdom and counsel”.
This reaction is hardly surprising. An early opponent of the Iraq war and a critic of unilateral military intervention, Brzezinski was a hero for many on the left. In a 2012 interview with CNN, Brzezinski blasted Republican presidential candidates, stating “I literally feel embarrassed as an American when I see those people orate”.
When asked to comment on Republican claims that “America is number one, this is an American century, we should just assert our power”, Brzezinski replied: “The last three Republican presidents [said] God chose America and history commissioned America to be playing that kind of role. And that kind of rhetoric is just divorced from reality to the point of absurdity, actually to the point of danger for us.”
Photograph via The White House
But Brzezinski might not deserve our praise. The tragic fact is that his policies under Carter paved the way for the neo-conservative nightmare that has wreaked havoc across the globe. In 1976, Jimmy Carter was elected president on a promise to make human rights “the soul of our foreign policy”. It was a revolutionary statement, an acknowledgement that the Soviet Union was not the only source of evil in the world. America was as well.
In the name of freedom, America had overthrown freely elected governments in Iran (1953), Guatemala (1954), Brazil (1964), and Chile (1973), provided military aid to repressive regimes guilty of genocide, and defended pro-American dictatorships when criticized by human rights groups. At the time, it looked as if America would finally move towards incorporating human rights as the cornerstone of its foreign policy.
In retrospect, Carter’s mistake was to appoint Brzezinski as his National Security Advisor. A Cold War hawk, Brzezinski saw the world as a game of chess – on one side was America, and on the other the Soviet Union. All other countries were the pawns of these two powers. If a pro-American dictatorship fell in Cuba, Nicaragua, Iran, or South Vietnam, it was the work of the Soviet Union.
“According to the official version of history, CIA aid to the Mujahideen began during the 1980, that is to say, after the Soviet army invaded Afghanistan on December 24, 1979. But the reality, closely guarded until now, is completely otherwise: Indeed, it was July 3, 1979 that President Carter signed the first directive for secret aid to the opponents of the pro-Soviet regime in Kabul. And that very day, I wrote a note to the president in which I explained to him that in my opinion this aid was going to induce a Soviet military intervention. […] The day that the Soviets officially crossed the border, I wrote to President Carter, essentially: we now have the opportunity of giving the USSR its Vietnam War.”
When asked if he regretted supporting Islamic fundamentalism, Brzezinski replied: “What is more important in world history? The Taliban, or the collapse of the Soviet empire? Some agitated Moslems, or the liberation of Central Europe and the end of the Cold War?”
Since the end of World War II, U.S. foreign policy had been based on the idea of containment. America was propping up anti-Communist dictatorships in Latin America, Africa, and Asia, but avoided overthrowing governments that were already aligned with the Soviet Union.
Although the US did try to overthrow Cuban dictator Fidel Castro in the 1961 Bay of Pigs invasion, Castro had not officially declared Cuba to be a Marxist-Leninist state until after the incident. While hardly humanitarian, the strategy of containment placed a restraint on American military power. It forced U.S. policymakers to use diplomacy instead of military threats when dealing with Communist governments.
Photograph via The National Archive
By waging war directly against established pro-Soviet governments, Brzezinski ushered in a new and more aggressive form of foreign policy known as ‘neo-conservatism’. Harry Targ, a professor of International Relations at Purdue University, defined this as the belief that the United States “has the right and responsibility to impose its wishes, its vision of government and public policy, and its institutions on the world. If people resist […] the United States should impose its domination by force.”
The fall of the Soviet Union in 1991 only increased the appeal of neo-conservatism. As the last remaining superpower, the United States used its military power to remake the world in its image. So far, the consequences have been deadly. Besides the lives and money lost from failed military campaigns in Iraq and Afghanistan, the United States’ decision to dominate the world has only increased anti-American sentiment in the modern age.
Human rights vs. hegemony
Are we being too harsh on Brzezinski’s foreign policy decisions? Could one argue that American interventionism was necessary against the threat of fascism from the USSR? Considering the implications of hegemonic stability theory and the 21st century’s resulting success as the most peaceful era in the history of humanity, that may be a valid justification.
One might also argue that, by historical standards, Brzezinski’s views were simply a reflection of what most members of Carter’s cabinet were thinking – but that would be a false conclusion. In fact, one of Brzezinski’s biggest critics was Cyrus Vance, who was Secretary of State at the time. Moreover, Carter’s campaign manager Hamilton Jordan once said: “If, after the inauguration, you find a Cyrus Vance as Secretary of State and Zbigniew Brzezinski as Head of National Security, then I would say we failed. And I’d quit.”
Diagram by The Economist
Mr. Jordan did not quit, but he was right. The moment Carter became president, the two men battled for influence. Unlike Brzezinski, Vance shared Carter’s belief American foreign policy should be guided by human rights. As the Carter presidency wore on, Vance grew increasingly frustrated with Brzezinski. In his 1983 memoir Hard Choices, Vance wrote:
“I supported the collegial approach with one critical reservation. Only the President and the Secretary of State were to have the responsibility for defining the Administration’s foreign policy publicly. Despite his stated acceptance of this principle, and in spite of repeated instructions from the President, Brzezinski would attempt increasingly to take on the role of policy spokesman. Eventually, as divergences grew wider between my public statements and his policy utterances, Brzezinski’s practice became a political liability, leaving the Congress and foreign governments with the impression that the Administration did not know its own mind.”
In time, Vance was marginalized and his influence began to wane. He finally resigned as Secretary of State following the failed operation to rescue American hostages in Iran, an operation he opposed but Brzezinski had supported. Near the end of his life, a reporter asked Vance how he wanted to be remembered. He answered: “I hope for being a reasonably decent, honest person who tried to do some things for the country that might have lasting effects and create a better life for a large number of people.”
Revisionist historian William Appleman Williams, in his iconoclastic book The Tragedy of American Diplomacy, wrote that “the tragedy of American diplomacy is not that it is evil, but that it denies and subverts American ideas and ideals”. The same could be said about Brzezinski. As a refugee from Poland, he was a statesman for those who were still living under Soviet-controlled Eastern Europe. To the rest of the world, however, he was a hypocrite. Throughout his life, Brzezinski criticized the Soviet Union for denying the citizens of Eastern Europe the right of self-determination, yet he refused to acknowledge what America did in Latin America and other third world countries.
By subverting Carter’s commitment to human rights, Brzezinski not only helped create the neo-conservative monster that haunts us to present, but also prevented America from becoming the humanitarian superpower that it has always claimed to be.