Greed and pain: taming the twin devils that drive Scots drug epidemics

It can seem a world away from the day-to-day professionalism of our own National Health Service. But in examining our own conscience on drug deaths, the book draws out two crucial themes that cut across national boundaries: greed and pain.

The Sacklers are notorious for their role in developing Oxycontin, ground zero of America’s Opioid epidemic. Recently, their company, Purdue Pharma were ordered to pay over a billion in restitution for harms linked to Oxycontin, part of a deal that some believe will protect the Sackler family personally from felony charges.

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Marketed as a non-addictive pain management solution, it was, in fact, twice as strong as morphine, highly addictive and very often fatal. Generations of Americans, literally whole families, were wiped out by a legal pill, regulated by the Food and Drugs Administration (FDA), prescribed by professionals and obtained in pharmacies.

In Scotland, there’s no such obvious baddie. Responsibility for our shameful record on drugs deaths cuts across all political parties. There’s a general admission of national guilt and official apologies from politicians that disguise the obvious vacuum of individual responsibility and accountability.

In a twenty-year period, around fifteen thousand people have died from drugs-related causes in Scotland. That’s a big number, but also a disorientating one. Human beings, our own loved ones, have become statistics. Statistics become structural problems. Structural problems are then everybody’s fault and nobody’s fault, making solutions appear impossible to pinpoint.

Oxycontin was a legal drug, often acting as a pipeline to harder substances. In Scotland, too many people still tend to imagine our own drug deaths as simply an epidemic of heroin overdoses. Yet many of our deaths are linked to the prescription of pharmaceuticals that are perfectly legal – methadone, in some cases, but also a raft of benzodiazepines (temazempan, diazepam) prescribed at some point by doctors to ease everyday suffering and symptoms of alienation in various forms.

Deindustrialised, post-Thatcherite Scotland was a bottomless well of existential pain; legal and illegal depressants were the simple, and often low cost answer. And that story takes us back to Sackler, who himself led the marketing of valium as “mother’s little helper”, before professionals grasped the true ferocity of those calming little pills.

Scotland’s drugs crisis will not be fixed in one government term or by manifesto promises. It will not be solved by slapping on slogans to party leaflets or shouting declarations about the failed war on drugs.

Addressing the crisis will take decades to unravel and resolve. Pretending otherwise is dishonest and our politicians know it. Electoral politics isn’t kind to long term planning, but a cross-party, generational, long-term commitment to addressing the drugs deaths in Scotland could be part of the solution.

The prescription of pharmaceuticals that are perfectly legal also causes addiction (Image: free)

There are some signs of progress. Harm reduction is the buzzword of the hour, and there are benefits. By reframing the issue in health terms, instead of criminal ones, harm reduction will save lives. At the margins, it will bring down the shameful statistics.

But I’m not convinced that decriminalisation or overdose prevention schemes or needle exchanges are, on their own, going to do what needs to be done: eradicate the scourge of addiction. Because addiction, on its own, is a different kind of death. It’s one that tears up the soul and replaces it with an insatiable longing, where relationships become purely transactional, where your body is debased and your mind enslaved to the gnawing, groaning lurch of need and want.

After reading Empire of Pain, I thought about the safe consumption rooms that, in a way, already exist here in Scotland. There are pharmacies where people queue outside to receive their (legal) heroin substitute, administered by a professional.

I’ve met people who, now recovered, were weaned off heroin, only to be left on a prescription for methadone for nearly 20 years of their lives. Imagine all that you’ve seen and done in 20 years. Others have had that life stolen from them, by a medicalised solution to addiction with no further intervention or support, with zero payoff in terms of actual liberation or freedom. Staving off death doesn't automatically bring life.

Nearly every study of addiction nowadays, whether about Scotland or the States, agrees that poverty is a key factor in drugs-related deaths. That much is undeniable. But I worry that it’s an oversimplification of sorts.

The sheen of anti-poverty radicalism can bely an uglier streak of paternalism, which treats poor people as victims, more predisposed to addiction or violence, rather than as people with agency.

And the danger of such oversimplification is this: it distracts us from the underlying political sources of alienation. My grandparent’s generation were more materially impoverished than many of the poorest people today; but they also had communal institutions which instilled collective resilience, shielding them against the harsh exploitation of their day. Whether socialist politics, mass trade unions or the Church, they had a sense of choice and a way out.

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Above all, drug deaths are a class issue rather than just a product of poverty. They are about what was stolen from working class people with the forceful destruction of organised collectivism and the promise of democracy as a meaningful choice.

Genetically, we’re all vulnerable to addiction, as a species. And the atomisation of life, the sense of permanent rat race until you die, affects almost everybody; the miseries of alienation are clear enough across the middle class.

But being middle class means having choices; and it means having the space, when you’re young, to make dumb choices that don’t have to haunt you for the rest of your life. Scotland has only around 400 spaces for residential rehab: criminally few. But if you can find the cash, there’s other options.

There are people far more qualified than me on this topic, but I believe that until we can reckon with the idea that no pills, liquids or powders are a quick fix to the trauma of atomised life, then me, you and the people we love will always be at risk of becoming just another statistic.