THOSE who scuffle and stumble on the streets in the search for artificially-induced serenity know certain truths. The first is that not all drugs are equal. There are legal drugs and illegal drugs, with the difference not measurable by any logical means.

The desperate tend to search for the drugs that may not have a precise molecular similarity but can be grouped crudely, but accurately, under the heading of Drugs that Make You Feel Really Really Good, Before Making You Feel Really Really Bad, and then often Really Really Dead.

Street heroin, of course, falls under this banner but so does alcohol and some prescription drugs. The effect is broadly the same for the consumer but hugely different for the dealer.

This disparity in perception is explained by reference to the Golden Rule: that is, those that have the gold make the rules. The dispensers of “feel-good” drugs thus lead different lives and can expect contrasting fates. Ethyl alcohol, present in that after-work pint or that routine glass of wine before bed, makes a lot of money legally for its dispensers. It kills 1000 people a year in Scotland (1020 in 2019), though this is almost certainly an under-estimation of its toll, given its impact on general health and on suicide.

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Street heroin, in contrast, can be crudely classed as a diamorphine, though it is corrupted by various additions that make precise definition impossible. Drugs kill at least 1000 people in Scotland (1264 in 2019) though, again, this may be a gross under-estimation.

The unassailable truth, however, is that one drug is illegal and the other is not and one is socially acceptable when the other is not. It is a truism to state that alcohol would find it extremely difficult to overcome licensing laws if it were first introduced today. It is also, of course, a reality that alcohol use is governed by law and has been subject in some countries to definitive bans, mostly incompletely observed.

This disparity in what is legal and what is not is intriguing but it becomes a matter for genuine horror when the perfect storm breaks. That deadly event has come to pass.

The cataclysmic force needs several elements to attain its full, death-inducing power. The drug has to reduce, even obliterate psychic and physical pain. It has to be readily available. But what if it is passed over without fuss from one’s local pharmacy on the instructions of a doctor and with a promise that no addiction can ensue?

Welcome to the world of oxycodone. Welcome, indeed, to the world of OxyContin, the brand name of a drug that contains oxycodone. It conforms to the imperatives of a street drug in that it makes you feel really really good. It can go on suddenly, however, to make one feel really really bad, and ultimately really really dead. OxyContin, and other legal painkillers, have contributed heavily to a death toll in the US that is careering towards half a million this century. These legal opioids have also served as a gateway to illegal opioids.

The ultimately deadly fog that consumed lives has obscured the line between illegal and legal drugs.

But there is an obvious truth about the attitudes to drugs and how society inflicts justice or even retribution on their dispensers. OxyContin was made and marketed by Purdue Pharma. The company pleaded guilty in November of last year to criminal felonies, including conspiring to defraud US officials and paying illegal “kickbacks”. The plea deal carried more than $5.5bn in penalties. There are trillions of dollars - yup trillions – of claims against Purdue. The fines and the claims will remain largely a matter of academic interest or, more accurately, part of Purdue’s bankruptcy proceedings. The Sackler family – who own Purdue and sat in the company board – have not been criminally charged.

Nobody is going to jail. Or, at least, not yet.

McKinsey, the business consultancy company, has agreed to pay $600m to settle civil claims from 49 attorney generals in US states about its role with Purdue and other opioid manufacturers.

The company has apologised for its role in trying to boost sales of OxyContin. It said: “As we look back on our client service during the opioid crisis, we recognise we did not adequately acknowledge the epidemic unfolding in our communities or the terrible impact of opioid misuse and addiction on millions of families across the country.”

McKinsey was accused of “turbo-charging” the opioid epidemic, with evidence showing the company encouraged Purdue sales reps to concentrate efforts on doctors who prescribed large doses of OxyContin.

Nobody is going to jail. Or, at least not yet.

The prescription drug crisis is thus being met with civil suits, fines that may or may not be paid and corporate apologies that neatly skirt any questions of liability. The dead remain, of course, impervious to all of this and so do many who are following in their footsteps to addiction.

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It is instructive to realise that cause and effect are measured in different ways by society. It is necessary, though, to investigate how Big Pharma seems to operate in a system that rules that corporate sins are paid for in money or on a largely worthless slip on a bankruptcy paper while one’s local, unfriendly dealer is normally punished financially and sent to prison.

The point, though, is moot for the increasingly lost and hopeless consumer. They face anguish or worse whoever is the supplier of both the balm to and, in time, the cause of their suffering.

There is money in addiction. Both the guy on the street corner and the executive in a Big Pharma office know this. There is money in the recovery industry, too, as Big Pharma has grasped with both alacrity and breath-taking cynicism.

There is, though, the core problem. How can society find a way to meet the needs of those drawn into addiction, whether their drug of choice is administered legally or illegally? How can we move from prejudice to those considered outsiders or from unthinking leniency towards the motives of the corporate world?

These questions seem destined to remain unanswered. There is no financial profit in addressing them.

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