Drugs and the American Void: Reviewing “Methland” and “Dopesick”

A few years back on a spring break trip home from Montreal, I took my brother to the library with the hope of scoring cheap reads at the Friends of the Library store. As I walked through the door, my eyes darted to a “closed” sign on the used bookstore — but I refused to drive home in vain. Instead of leaving, I decided to have a conversation with the bored-looking police officer serving as library security. We chatted for a good 15 minutes about various issues, and he told me (this was about 2017, so the height of America’s opioid crisis) that methamphetamine remained a greater problem for the Wichita Police Department than heroin, which was more prevalent on the coasts and in media circles. So, when I found Methland, I knew I had to read it — why had large cities avoided this scourge? Why had pundits and elected officials stopped paying attention as overdoses and addiction continued in the middle of the country?

Methland proved a stellar answer to my questions. More importantly, despite being published nearly a decade earlier, it brought to mind another book I read this summer: Dopesick by Beth Macy, about America’s heroin epidemic. In Methland, Reding argues that the heartland’s meth epidemic represents a confluence of factors around sociological divides. “The divisions fostered by a drug epidemic seem to run along the lines of class — or at least along the perceptions of class” (Reding 92). This approach differs slightly from Macy’s, which tracks how opioids infiltrated affluent communities, spurring people to finally evaluating the opioid epidemic as a health crisis. But both authors suggest that similar roots lead to the onslaught of addiction, prompting me to think more about how drugs fill a hole in left-behind America.

Reding and Macy begin from a similar point; substance abuse grows from a culture that pushes chemical remedies which in hindsight carry horrific consequences. This is the nature of science — advances uncover complications with older curative methods. But once a potentially dangerous remedy is in peoples’ drug cabinets, it provides pathways for people to get hooked and a patina of acceptability, especially for less-potent variants. The worst problems emerge when a prescription version translates into a duly refined-yet-adulterated form on the street. In her book, Macy chronicles how the fixation with pain management built up an entire industry from the idea that pain should be minimized at all costs (Macy 86). Americans came to seek out dopamine-fueled numbness not just from terrible injuries, but from the mundane aches of life. In turn, companies lied about addiction rates and doctors prescribed pills like candy, the perfect formula for overprescription. The United States, making up just 4.4% of the world’s population, ended up ingesting 30% of the world’s opioids! In the case of meth, as Reding notes, doctors prescribed Methedrine and similar products to combat common ailments like depression and weight gain (Reding 46). He argues, quite persuasively, that amphetamines became ingrained into work culture, from the Army to meatpacking plants. Therefore, both types of drugs developed a deep relationship with meaning, pain, and success in our hyper-individualistic society. For meatpackers, the grind of long, dangerous shifts could be transcended through stimulant use (Reding 49), while for coal miners blown-out backs could use an oxy, leading companies like Perdue to specifically target markets with high disability rates (Macy 49). When legally prescribed drugs and illegal ones both tied into work, their profile was bound to grow.

Addressing the issue hasn’t been easier than preventing its rise. Drug epidemics are like whack-a-mole; new rules often just make the problem pop up elsewhere. Reding compares them to viruses which “mutate periodically within a fairly closed system” (Reding 209). With opioids, this was visible in a shift to Chinese production of fentanyl (Macy 280). Despite the Chinese Government’s supposed crackdown on fentanyl, challenges remain as the drugs keep coming and “enforcement tends to be limited and subverted by powerful vested interests”. The US faced a parallel problem with amphetamines. According to Reding, after the 2006 Combat Meth Act made it harder to manufacture the drug in America, Mexican cartels took advantage of a porous border and difficult-to-penetrate illegal immigration networks to transport meth into the heartland (Reding 180). And China kept producing pseudoephedrine despite US regulations — notice the commonality with fentanyl here — (Reding 114). Despite advances in security on the Southern Border, drug smuggling continues, especially through overburdened ports of entry but also through difficult-to-patrol (and nearly impossible to build a wall on) terrain. Hopeless about controlling hard drugs tempts as the facts stack up. Howver, both authors provide potentially effective routes: normalizing Medication-Assisted Treatment [MAT] for opioids, making it harder for pharmacies to sell large quantities of pseudoephedrine, using international agreements for rule enforcement, etc. But these ideas are tough when they face interlinked corporate and cultural obstacles.

Interestingly, corporate over-concentration enshrines the untenability of solutions that hurt the bottom line. When already-large companies ballooned to have a grip over rural economies, they lowered wages and benefits using their newfound political power, a power that includes threats of outsourcing, and the importation of cheaper — often undocumented — immigrant labor (Reding 69, 161). While the impacts of mass immigration are mixed, in certain communities an upswing in undocumented labor as job opportunities shrank worsened the lack of control that local residents felt. This only exacerbated the creeping sense that out-of-touch elites in business and government didn’t care about them. Inextricably linked to a loss of control is vanishing economic dynamism and with it, hopelessness. On economic power, Reding even draws surprising parallels between agribusiness and the illegal drug industry; both are subject to monopolization (Reding 115–116). Importantly, he also likens the consolidation of agricultural supply chains to the extractive corporate dominance over mining communities, noting that both are “indistinguishable” in this aspect today (Reding 188). This isn’t new to coal mining; Harry Caudill in 1963 stated that “coal has always cursed the land in which it lies … it peoples this transformed land with blind and crippled men and with widows and orphans” (Night Comes to the Cumberlands). Methland predated reporting on the opioid crisis, but Reding nonetheless recognized the nexus between corporate over-concentration, extractive industry, and despair. Into this social void stepped pharmaceutical companies, a reflection of what Professor Adriana Petryna calls the “pharmaceutical nexus”, or the multifaceted nature of the pharmaceutical industry. There’s no escaping it.

When drug companies attain unprecedented power, they also gain the ability to unduly influence political debates. In turn, Big Pharma lobbying watered-down government regulation of both amphetamines and opioids. With meth, inaction led to loopholes for pill-form ephedrine early on and pseudoephedrine later, enabling an easy transition for drug producers and component importers. A similar story played out with opioids; the FDA bafflingly approved painkillers that their own doctors disapproved of (Macy 260). Ignoring science at the behest of unrestrained profit destroys lives. But money often wins out in our politics, even if it means millions of Americans hooked on deadly substances. A better path was possible if not for greed; mirror image pseudoephedrine looked promising until Pfizer quashed research, apparently knowing that lobbying Congress to serve their interests would be easier than changing their formulas (Reding 118). I do not suggest that pharmaceutical companies are evil; however, these two books elucidate the frightening result of wrongheaded decisions in the name of profit.

Both works recognize that drugs fill into holes ripped in the social fabric by unrestrained globalization, austerity, and job loss (Macy 213). Effectively, these epidemics become “a metaphor for the cataclysmic fault lines formed by globalization” (Reding 58). In the case of Southwestern Virginia, which Beth Macy discusses, it was the brokenness of a region whose mountaintops and bodies were both scarred by the perils of coal mining (Macy 170). When those jobs vanished, the injuries didn’t but the salaries did, leaving even more despair. This relationship between deindustrialization and narcotics abuse spreads past rural White-majority communities. Beyond meth abuse in impoverished Indian Country and rising opioid overdoses in rural Hispanic areas, urban regions also faced addiction crises. Studies of the 1980s and 1990s crack cocaine epidemic point to “upsurges in harmful drug use result[ing] from the introduction of powerful new drugs … to populations that lack experience with them and that suffer from multiple dimensions of structural disadvantage”. This became evident in neighborhoods like Mantua, Philadelphia, where a socioeconomically diverse African American community became poorer and lost its class diversity as jobs fled Philadelphia overseas and robots replaced manual jobs here at home. According to the linked history articles, following this fraying of the neighborhood was an increase in crime and drug use. The same trends that impacted the African-American community when their jobs vanished are now manifesting in White working-class communities. But this time, society is not seeing it as a “crime story”, which would “oversimplify[y] the problem” (Reding 91). Sadly, Black communities were not given the benefit of the doubt. Through the 1980s and 1990s, legislators enacted “tough on crime” policies like the unscientific crack-powder cocaine sentencing disparity, feeding mass incarceration and exemplifying how systems are arrayed against Black individuals. While incarceration rates have fallen precipitously since the early 2000s, racial disparities persist, influenced by how policymakers approached the post-industrial drug crisis.

From their socioeconomic analysis, Macy and Reding reach the same conclusion, one that others like Anne Case and Angus Deaton make in Deaths of Despair and the Future of Capitalism [which I regrettably have not yet read]. Broken communities are the perfect at-risk host for a drug epidemic. Legal regimes should therefore seek to inoculate the patient, but it’s too late now to save all the lives lost, the families broken. The war on drugs has been misinterpreted, and none of us should be entirely shocked. Political cowardice reigns supreme. For example, when Reding suggested to former Indiana Congressman Mike Souder the solution of “fining companies that employ illegal immigrants while heavily taxing the products of those that move offshore”, Souder brushed off the suggestion (Reding 164). It all emerges from a broken political system. Special interests influence legislative priorities and an out-of-touch squabbling Congress can’t seem to address those discarded by our laissez-faire approach to globalization. But instead of electing members of Congress like Marcy Kaptur, who told John R. MacArthur, author of The Selling of Free Trade: “Anytime anyone is out of work or in trouble I think that’s what I’m here for. That’s why I was elected” (MacArthur 152), voters turned to demagogues like Donald Trump, full of bluster but devoid of solutions. I’m not blaming struggling people here; they’re angry and rightfully so, and there aren’t many politicians like Marcy Kaptur who present positive solutions and challenge the consensus. The War on Drugs should always (instead?) have been a war on alienation and the destruction of American communities. Instead of locking people up left and right for nonviolent offenses, we should have sought solutions to national crises. Instead of forgetting that globalization leaves some Americans behind, we should have invested in forgotten communities. Today, we will not turn back the clock on globalization and must not give in to the false idea that immigrants cause our problems. But solutions exist, albeit ones that challenge our political paradigm defined by a “liberalocracy” as Patrick Deneen calls it. We must refashion government to serve the common good. While we can disagree on a precise vision of what that looks like, many point to a need for strong associations. Macy ends her book noting that “an emphasis on the kinds of activities and relationships that people build their lives around” is central to fighting the drug epidemic (Macy 387). Philosophers and political theorists from Alexis de Tocqueville to Robert Putnam to Robert Nisbet highlight the importance of social capital and mediating institutions. Especially during the pandemic, as deaths of despair, especially those associated with opioid overdoses skyrocket, we must address the problems Macy and Reding uncover. Policy changes are needed. When America emerges from lockdown, policymakers should re-tailor the “War on Drugs” [end it as we know it perhaps] towards ending the cultural stigma around effective treatments (Macy 389) and humanizing addicts themselves. There’s common ground to be found on issues like dealing with addiction and mental health crises in a healthcare realm as opposed to a criminal one. Criminal justice reform must be paired with rebuilding economic opportunity in struggling areas, fighting corporate power in politics, and simultaneously working to end the flow of drugs into the country. And finally, most importantly perhaps, we must combat the resentment-breeding catastrophes of loneliness, atomization, and precarity. If we fail to address these festering problems, any war on drugs will be fought to little avail; other poisons will flood into the void like dopamine and serotonin flood into the user’s brain.