Photo by Ingo Doerrie on Unsplash
Opium has been consumed as both a medicine and a poison for centuries, attested to by archaeological findings and written records from the ancient Mediterranean. For most of history, it was legal throughout most of the world and used medicinally and recreationally in many nations with minimal side effects, that is, without creating an endless string of addiction. There are two nations on earth which have dealt with an epidemic of users at such massively uncontrolled rates that it has destabilized their societies: one is China during the late Qing dynasty, and the other is the United States today. Opium use in China continued to be problematic throughout Republican rule and into Communist rule, totaling more than a century of serious and debilitating addiction. The United States opioid epidemic now marks its third decade of year after year increases in overdose deaths.
Opium use in China is marked by the Opium War, which was actually a minor (though incredibly damaging) event in the scheme of over a century of addiction. The Opium War was a short naval war, from 1840 to 1842, in which the British navy and troops attacked coastal China and burned villages there in order to exact demands that would turn the international trade between Britain and China more in their favor. The Qing dynasty, however, faced an opium crisis at a huge scale throughout the 1800s until finally being eliminated as massive social problem during the Communist period by implementing a zero-tolerance policy and sending heroin addicts into work camps for reform.[1] We can refer to the time period in which China dealt with huge numbers of addicts as the Chinese Opium Crisis.
Opium use spiraled out of control in China for decades before reaching the scale of a crisis. There were several high-profile cases that showed just how deeply the opium problem had taken root within Chinese society and the government. Supposedly, the heir to the throne, the 道光帝Daoguang Emperor’s oldest son, died from an overdose.[2] The bureaucracy was stacked to the brim with addicts; the Guangdong governor’s secretary burned down his whole palace while smoking in bed. The Daoguang government had a personal stake in stopping the crisis from growing, yet they were also fueling it. Bureaucrats and officials made huge quantities of money off the illegal trade, and they were heavy users themselves.
In the run-up to the war itself, many officials and scholars introduced policy proposals on how to manage and end the crisis:
In 1820, an independent scholar, 包世臣 Bao Shihchen, became popular for tracts he wrote proposing ending all international trade in order to protect Chinese national interests, the economy, and the people themselves from accessing opium.[3] In the 1830s, 許乃濟 Xu Naiji, another scholar, proposed simply legalizing the drug in order to solve the problem of money disappearing into the black market, and let the addicts kill themselves if they wished. At the same time, Qing official 黃爵滋 Huang Juezi wrote a policy proposal to the emperor in which he recommended execution of all those caught smoking as the most expedient solution to the problem. 林則徐 Lin Zexu, the most famous figure of the Opium War, implemented a modern proposal for a multifaceted drug policy which involved confiscation of drugs, rehabilitation of addicts, and prison sentences.
For many Chinese officials and scholars, they saw the Chinese Opium Crisis as a problem of domestic demand only. In the 1830s, 蕭令裕 Xiao Lingyu remarked that “if people in China did not smoke opium, then the English would not be able to sell it.”[4] If the men were not so addicted, they could carry on business as usual, continuing mutually profitable international trade. Although the massive scale of trade was beginning to create dependencies and have drawbacks, the idea of curtailing it was not only economically unacceptable but was considered impossible.[5] The Qing dynasty was in a difficult position, and it was easier to turn a blind eye to a problem and place the blame on the addicts themselves.
The general attitudes toward the Chinese Opium Crisis on both the British and the Chinese side condemned both the sellers and the users. The English Chartists, a working-class movement for universal male suffrage, saw the British opium trade as a deliberate attempt to poison the Chinese working class, as their own working class had been poisoned by gin. Temperance activists took up the cause of the Chinese Opium Crisis as they were disgusted by the corporate greed that profited off human misery and the British government which supported the trade. Many British, in their official capacity, passed the blame onto the addicts. After the Opium War's end in 1842, Chinese officials questioned Henry Pottinger (superintendent of trade with China) about why the British were still growing opium in India if they were going to stop selling it, and he dodged the question by placing the blame on China alone: ‘If your people are virtuous,’ he told them, ‘they will desist from the evil practice, and if your officers are incorruptible, and obey their orders, no opium can enter your country.’[6]
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The American Opioid Epidemic is an ongoing addiction crisis. Heroin, morphine, and laudanum were used in the United States medicinally since the 1800s. They were given to Civil War soldiers and veterans as well as infants and toddlers before bed to make them sleep through the night. Heroin addiction experienced a brief surge in the 1960s and 1970s, but despite being well documented in popular culture, it was short-lived and comparatively not widespread. The American Opioid Epidemic began in the 1990s and early 2000s, where it started with the over prescription of brand name pharmaceutical opioid pills, synthetically derived and often several times stronger than heroin. These opioids were not plant-derived, but they were combinations of industrial pharmaceutical ingredients, which act on the same parts of the brain, the opiate receptors. As with the availability of heroin as a medicine in the 19th century, the medicinal promotion of opioids in the late 1990s and early 2000s was careless.
The synthetic opioid that was most well-known for kicking off the crisis was Purdue Pharma’s Oxycontin. In the early 2000s, Oxycontin began to be prescribed liberally by doctors to whomever would ask for it, because it was apparently marketed by pharmaceutical representatives as non-addictive. It was considered safe to be prescribed long-term, to users with chronic conditions, not simply those recovering from surgery or terminal with cancer. Brand name drugs such as Oxycontin, Oxycodone, Hydrocodone, Percocet, Vicodin and others were marketed as drugs which would not cause addiction, increase tolerance, or cause withdrawal, yet just like opiates, they did.
It seems hard to believe that researchers and doctors truly believed that long-term use of opioids was possible without addiction[7] – more likely, they had simply been given a green light to prescribe a desirable and previously much more well-controlled medication, which must have boosted their business. On the production side, the large pharmaceutical companies not only generated government revenue, but they directly shaped politics to remove impediments from the Drug Enforcement Administration.[8] A large recreational market sprung up due to the fact that the drugs were being prescribed liberally. It was similar in landscape to the medical marijuana industry today.[9] A sector of the public who initially was not motivated to buy illicit drugs became addicted, and a large illegal market was generated. When, eventually, there was a crackdown on over-prescription of opioids, many who became addicted turned to more dangerous illicit sources.[10] Many turned to heroin, and overdose deaths, which were already rising under the use of the prescription drugs, rose even higher. Enforcement increased and all opioids became more difficult to come by.
It was during this gap in the market when another synthetically derived opioid, fentanyl, arrived on the scene. Fentanyl is estimated to be fifty times more potent than heroin and one hundred times more potent than opium. It was and still is widely used in hospitals as an anesthetic. The ingredients needed to make it are very cheap. It was a perfect product for an illegal market: it was cheap to make with easily obtainable ingredients, it was highly potent, a concentrated form of the drug that made it preferable to smuggle. A triangle was created by which Mexican cartels would buy ingredients from China, manufacture fentanyl, and ship it into the United States. There, it could be cut into other, more desirable drugs such as cocaine or used to approximate such drugs.
Similar to the Chinese Opium Crisis, initially in the United States, the problem was understated. Many policy makers and government officials had direct ties to the pharmaceutical companies whose strategy relied on liberally prescribing opioid pain medication.[11] There was simply no political will to tackle the problem that was funding bureaucrats directly and generating revenue, especially when the victims were not sympathetic. Beyond this, there was a systemic weakness in approving and regulating pharmaceuticals, with many tasks being delegated to private industry with no reasonable means of oversight. Eventually, the cost came to bear. It is now estimated that the American Opioid Epidemic costs the United States $1 trillion per year in economic damage. In the beginning, it was simple to write off the growing mass of addicts as undesirables . Gradually, however, the problem became too big to ignore, especially as addiction doesn't simply affect the addicts alone, but their family members and neighborhoods.
Policy response in United States has been varied. Part of that $1 trillion loss had to be clawed back somewhere. As a result, the Sackler family which built a fortune on the opioid pharmaceutical industry has been broadly discredited, although they did win immunity to further civil lawsuits (personal injury claims) from opioid related damages.[12] CVS, Walgreens, and Walmart were ordered to pay out $13 billion due to activities of their pharmacies in refilling prescriptions.[13] Still, large as these amounts may be, they are a drop in the bucket.
The latest development in the ongoing American Opioid Crisis is to focus on international actors now that most of the domestic actors have been pinpointed (although not sufficiently punished). Vanda Felbab-Brown, a scholar on international crime, testified at a US congressional hearing to offer information and recommendations on the fentanyl trade between China, Mexico, and the US. Like 包世臣 Bao Shihchen, she has stated that the cost of international trade outweighs its value when drugs enter into the equation: “In 2020, estimates put the cost at nearly $1.5 trillion. In contrast, in 2019, U.S. goods and services trade with Mexico totaled only $677.3 billion, with imports from Mexico at $387.8 billion.”[14]
Others, in their response to the latest phase of the US response to the American Opioid Epidemic, have taken the same tack as that of the opium apologists who stated that if the British didn’t supply the Chinese with opium, someone else would: “even if China were successfully to crack down on fentanyl and fentanyl analogs it would not fix America’s opioid problem. Any decrease in Chinese fentanyl production will be offset by a shift in production to one of the many other nations with an entrepreneurial, lightly regulated chemical industry that has good connections to the United States.”[15] In the 1830s, 蕭令裕Xiao Lingyu prioritized the continuation of the status quo by shifting the blame onto users as well, simply wishing that the opium problem could be resolved so that trade could continue. Many of his contemporaries in Britain naturally relied on the same argument to absolve themselves of responsibility for the worsening of the Chinese Opium Crisis: even if we didn't sell it, someone else would.
Today, journalists representing Chinese state opinion take the position that the recent focus on Chinese involvement in fentanyl exports is a tactic used to shift the blame away from the United States’ complicity in the epidemic due to poor governance at its earliest stages.[16] This allowed it to take on the proportions of an epidemic. They have focused on shifting the topic back to the origins of the crisis rather than its present form.[17]
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Both the Chinese Opium Crisis and the American Opioid Epidemic were protracted and destructive epochs of mass drug addiction. Although they were vulnerable to a glut of outside supply by unfriendly nations, contemporaries framed the issue as primarily a domestic problem. 林則徐 Lin Zexu has been practically deified in standing up to the mass scale import of opium into China from abroad, but he had little overall impact on stopping the widespread use of opium in China. And even though the British won the opium war, they were soon undercut by cheaper domestic and nearby suppliers, and opium continued to be a destructive influence on Chinese society that was never fully rooted out. Although in the present, China no longer has an addiction problem at a mass scale, remaining tangentially involved in the industry (in the heroin trafficking Golden Triangle and now in the export of derivatives for fentanyl production) can be considered an enduring legacy of the Chinese Opium Crisis. In the US, heroin use was not uncommon after the Civil War, but opioid use exploded as a crisis only recently. Entering the third decade of the American Opioid Crisis, the outlook is grim as deaths and damages have primarily increased.
Policy proposals which both recognize the domestic demand and focus on choking off the illegal domestic markets are essential, rather than passing the blame onto a chimeric outsider. Sufficiently punishing the initial offenders and resolving the extent of the collusion between private industry, government regulatory agencies, and individual politicians who helped shield pharmaceutical companies who exacerbated this problem could prevent similar incidents from happening in the future. Users need to be viewed more coolly and less emotionally, neither shunned nor coddled, with support given to the family members, friends, and neighbors that they hurt. The difficulty in tackling these crises is that the victims are largely unsympathetic and significantly at fault. We each have our weaknesses, however, and the focus should be on preventing the exploitation of human frailty on such a massive scale.
[1] However, the Reform Era of the 1980s brought heroin back into fashion for a while as a luxury drug.
[2] Platt, Stephen R. (2018). Imperial Twilight: The Opium War and the End of China’s Last Golden Age. New York: Knopf. p. 314
[3] Additionally, he believed that farmers shouldn’t be allowed to grow grain that would be turned into liquor. They should only grow crops that were suitable for food.
[4] Imperial Twilight, p. 241
[5] Many Chinese government officials rightly feared reprisal from foreign navies if they cut back on trade and a return to piracy that had taken years to root out.
[6] Imperial Twilight, p. 427
[7] Maybe they really did believe that the synthetic version of morphine, heroin, and opium removed the addictive aspect, but in hindsight, that seems like wishful thinking.
[8] Anne Case, Angus Deaton. (2020). Chapter 8: Opioids in Deaths of Despair and the Future of Capitalism, Princeton University Press.
[9] In many states in the US, anyone can be prescribed medical marijuana, no matter how dubious their medical need is. Many are motivated to get medical marijuana in order to purchase it as a product to sell as well as to use.
[10] A new illicit market was created by people who sold pills they were prescribed. In the early 2000s, Broward County, Florida gained renown as a national hub of pill mills which buyers would export to other states.
[11] Deaths of Despair, Chapter 8: Opioids.
[12] They haven’t been discredited so much to lose out on a life of luxury, however: “In a court filing, the administration told the Supreme Court that Purdue's settlement is an abuse of bankruptcy protections meant for debtors in "financial distress," not people like the Sacklers. According to the administration, Sackler family members withdrew $11 billion from Purdue before agreeing to contribute $6 billion to its opioid settlement.”
[13] Tanne J H. US pharmacy chains settle opioid lawsuits for $13bn BMJ 2022; 379 :o2688 doi:10.1136/bmj.o2688
[14] Vanda, Felbab-Brown. 2023. "Why America Is Struggling to Stop the Fentanyl Epidemic." Foreign Affairs, May 14. https://www.foreignaffairs.com/mexico/why-america-struggling-stop-fentanyl-epidemic.
[15] Bryce Pardo and Peter, Reuter. 2019. "China Can’t Solve America’s Fentanyl Problem." Foreign Affairs, January 1. https://www.foreignaffairs.com/articles/china/2019-01-02/china-cant-solve-americas-fentanyl-problem.
[16] From Xinhua Net: 中国不背这个黑锅——起底美国芬太尼滥用难禁绝的根源 (July 2023)
“China is not to blame: getting to the bottom of the problem of fentanyl abuse in the US.”
[17] From Xinhua Net: 美国阿片类药物何以泛滥成灾——数字起底美国芬太尼问题根源 (August 2023): “Why the US is experiencing an opioid epidemic – the real root of the fentanyl problem”
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