[SCMP Column] America's opioid crisis

June 30, 2018

I find it hard to get my head around America’s opioid crisis. It is hard not to be alarmed by reports of more than 300,000 Americans dying since 2000 from abuse of prescription opioids – more than deaths in car accidents, or from gun violence.

After declaring a national emergency last October, with substantial new funding to tackle the crisis, Donald Trump was clear: “Together, we will end the scourge of drug addiction in America once and for all. We will win. We will beat it. We’ll be tough. We’ll be smart. We’ll be kind. We’ll be loving. We’ll do whatever we have to do. But we’re going to win,” he said at a rally in New Hampshire in March.

“Whether you are a dealer or doctor or trafficker or a manufacturer, if you break the law and illegally peddle these deadly poisons, we will find you, we will arrest you, and we will hold you accountable.”

Brave words, but scratch beneath the surface, and the issue becomes steadily murkier, with some fascinating serendipitous side stories that link frequently back to China. Awful though the story of opioid abuse is, it seems it is neither especially unusual, nor new.

Certain aspects of the crisis seem genuinely new. A large proportion of victims are men in predominantly white parts of middle America. Much of the problem comes not from underground criminal gangs, but from painkillers being prescribed by the country’s doctors. And the drug Fentanyl – mostly imported from China, 50 times stronger than morphine, and more typically useful in knocking out a rhinocerous with toothache than a person with back pain – is playing an alarming role.

But much of the problem has ancient roots – and in intriguing ways has multiple links back to China. While it was Britain – the hegemon of the 1800s – that played the largest role in addling China’s population with opium up to and through the Opium Wars, American merchants like Russell & Co were plentiful in grabbing a share of the profits from the opium trade.

And what was the East India Company’s motive for plying opium on China? Of course it was China’s persistent trade surpluses. We wanted China’s tea, and silks and porcelain, but China seemed to want nothing from us – leading to steady depletion of Britain’s silver reserves. Funny, isn’t it, that China’s trade surpluses should again 200 years later be so infuriating the 20th Century’s hegemon.

It was India’s first governor general Warren Hastings who first struck upon the idea of hooking China’s population on opium as a way of eliminating a massive trade balance in China’s favour.

From annual sales of just 200 chests (about 54 kg per chest) in 1729, sales grew steadily to around 60,000 chests when opium trading was legalized after China’s defeat in the second Opium War. It eventually peaked in the 1880s at around 80,000 chests. By then, over 12m Chinese were addicts, and China’s “century of humiliation” was well under way. I wonder whether there are moments when Trump’s trade team are not frustrated that such a neat trading ruse cannot be rediscovered today to bring China’s present burgeoning trade surplus to heel.

But why does this distant ignominious period in history link to today’s American opioid crisis? Because it was the destitution resulting from the crippling of China’s economy that pushed so many Chinese to emigrate to US to find work during and after the 1849 gold rush – bringing their opium pipes with them.

As is noted in www.history.com, many in the US believed that opium smoking would encourage prostitution and other crimes, while fears about unemployment among white Americans fed into an anti-Chinese campaign that led to the Chinese Exclusion Act and a 10 year moratorium on Chinese immigration. It seems there is nothing new under the sun as the US Congress today looks at barring Chinese investment, and scrutinizing the loyalties of Chinese working or researching in the US.

Whatever Trump’s alarums, and the very reasonable concern over the explosion of opioid abuse, it seems the US’s problems are less traumatic or exceptional than he implies – and nowhere near the awful scale of China after the Opium Wars.

According to the UN Office on Drugs and Crime (UNODC), and the Centres for Disease Control and Prevention, the scale of harm from drug abuse worldwide is still awesome, but is stable and perhaps improving, with the lion’s share of heroin and opiates being grown – and consumed – around Afghanistan and across Central Asia.

The UNODC’s World Drug Report says that 250m people worldwide used drugs at least once in 2015, with 29.5m “suffering drug use disorders”, and just 6 per cent of these getting treatment. It calculates that 28m work years (called “disability adjusted life years” or DALYs) are lost every year because of premature death of disability. At least 190,000 people died prematurely in 2015 because of drug abuse.

But the US is not up there among the most serious casualties. Most victims are in Central Asia, and even among developed economies, the proportion of drug addicts in the population in the US is far lower than in the UK or Italy.

Where the US is out there on its own is in the massive role played by doctors, pharmaceutical companies and drug wholesalers who are over-prescribing opioids like Oxycodone initially as pain killers. Purdue Pharma, producer of Oxycodone in 2007 paid US$634m in a settlement with Federal prosecutors for its role in fuelling the crisis. As was reported in the New England Journal of Medicine: “Opioid companies unreasonably interfered with the public’s health by over-saturating the market with drugs and failing to implement controls against misuse and diversion.”

Donald Trump may be right to declare an emergency, but he is wrong to foster expectations that America’s drug abuse problem can be tackled quickly. It is a problem with a 150 year history, and is not going to be resolved any time soon – but hopefully will never gift the US with its own “century of humiliation”.
David Dodwell researches and writes about global, regional and Hong Kong challenges from a Hong Kong point of view. Opinions expressed are entirely his own.

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