By Aiyanas Ormond
These days I arrive to work braced for the worst. As a community organizer working for the Vancouver Area Network of Drug Users, I expect to hear that we’ve lost yet another member, and I live in dread that the next death will be of a friend’s.
On Thursday December the 16th of last year, thirteen people in British Columbia died of overdose related to fentanyl – nine of the deaths were in Vancouver. The deadly night follows a ‘record’ November in which 128 people, more than 4 people a day, died of overdose in B.C.
The fentanyl crisis extends across Canada, with a shift in the drug market that started in B.C. now spreading to Alberta and moving East. Fentanyl-related overdose deaths are on the rise in Ontario and across the U.S.
A ‘market adjustment’
There is a lot of confusion about the origins of the fentanyl crisis. People who think of the drug market as shady back alley hand-to-hand deals rather than a massive, well-organized industry are shocked by how rapidly fentanyl went from a fringe player in the drug market to being present everywhere, so much that it’s showing up not only as heroin or mixed into heroin, but also in cocaine and even laced into marijuana.
The role of Big Pharma and doctors in getting a generation hooked on opiates is often discussed and usually followed up with policy prescriptions that would make things even worse. And a racist discourse about shady factories in China and India that are manufacturing and exporting fentanyl has been adopted by drug warriors in particular to justify calls for increased police and border security budgets.
Some of the mystification around the fentanyl crisis stems from deliberate misdirection by attempting to steer the public conversation away from a discussion of the root causes. Some is ignorance – a function of the fact of the criminalized illicit drug market. But the reality is that the emergence of fentanyl and its terrible human cost are actually the predictable outcome of an illicit drug market that follows the basic ruthless logic of capitalist production.
The fentanyl crisis is best understood as a ‘normal’ market adjustment in the context of a criminalized capitalist industry where both the capitalism and the criminalization generate harms.
The great virtue of fentanyl, from the point of view of drug industry capitalists, is its strength. Fentanyl is hundreds or even thousands of times stronger than heroin in its most concentrated form. This makes it highly transportable (a plus for any commodity in capitalist markets) and highly concealable (a particular virtue for a criminalized commodity).
Once it gets across the border, the fentanyl needs to be reprocessed for sale. Since there is no regulation of this process in a criminalized industry, nor any established ‘best practices’ within the industry in a period of market transition, this process looks to be highly haphazard. There is a low level of standardization across organizations and even within the same company, among packages sold by the same drug dealers.
This level of variability means that users don’t really know what they are getting until it hits them and puts them in a dangerous position, particularly when they are using in a covert, secretive context, either to avoid police and criminalization (a constant reality for many users in Vancouver’s Downtown Eastside), or trying to avoid the scrutiny of parents or other family members (as is the case for many young people). Young men, who make up a majority of fentanyl overdose deaths, are concentrated in these situations.
But there is more to the presence of strong dope on the streets than just these imperfections in the preparation of fentanyl for sale. Drug users, particularly those who are poor, are looking for a bargain, and a double strength package means your buck is going double the distance. Drug users don’t want to overdose but they are looking for the strong dope, something that the public health discourse about ‘toxic fentanyl’ in the heroin supply largely ignores. In many cases drug users are looking for fentanyl.
Meanwhile low level dealers, squeezed between bosses expecting high profits and consumers with a rising tolerance and expecting strong dope, are attempting to respond to market ‘demand’ while (in most cases) genuinely trying to avoid killing their customers.
This is not the first adjustment in the criminalized drug market, though every new one is treated as novel and problematic. From ‘chinawhite’ to crack to crystal meth, these changes are generally characterized as a phenomenon of problematic behaviour of people who use drugs or fetishized as a characteristic of the particular product.
A few years ago, the B.C. government changed its supplier of methadone and introduced a new more concentrated formulation, called methadose, which wreaked havoc on methadone patients’ lives leading to numerous ‘relapses’ and other negative outcomes. That market adjustment was considered acceptable for several reasons. The new formulation allowed the government to increase its control over the process of methadone dispensing, generated a lucrative private contract (for the U.S. based producer of the new formulation) and ultimately was established because the lives and well-being of methadone consumers are not considered to be very important.
The point here is that in all of these situations, capitalism is the real disease. Addiction and problematic drug use are the symptom. The drug industry and its marketized, profit driven response to the pain and trauma of capitalism confuses the problem and makes things worse. And the criminalization of a section of the drug market most impacts poor people who must rely on that illicit market.
The limits of harm reduction
The crisis has generated a great deal of discussion, at least here in BC. It has provided a forum for the ideology of harm reduction to reassert its hegemony over public health and policy discourse after the drug war push back of the Harper years.
Harm reduction provides an alternative framework (to criminalization and mass incarceration) for managing addiction, but without addressing the trauma, alienation, grinding exploitation, poverty, marginalization and violence endemic in capitalist society.
This ‘harm reduction’ perspective has for some years been the dominant perspective amongst health professionals, social workers and other liberal professionals – pretty much anyone who deals with illicit drug use who isn’t a cop. While this is a ‘progressive’ political position compared to the vicious framework of the war on drugs, it doesn’t even attempt to grapple with the root causes of addiction and problematic drug use.
Harm reductionists often speak of the long history of humans using mind altering substances, which is absolutely true. But under capitalism, drug consumption is qualitatively different. Where historically drugs were used as a gateway to altered states of consciousness and heightened social and spiritual experiences, in capitalist society drug use is, in many instances, a form of harm reduction itself.
Drugs are the salve that makes bearable the physical, mental and psychological pain and intergenerational/ transgenerational trauma which is produced and reproduced by colonialism, patriarchal violence, social and physical displacement, alienation, and grinding exploitation.
Reducing the harms (negative consequences to the individual) of the harm reduction (drug use, the individual’s response to social trauma) isn’t a bad thing necessarily, but when this practice is in place to prop up, protect and perpetuate the source of the initial harm (as it is when it’s an institutionalized practice of the capitalist state) it can no longer be considered a progressive or liberatory practice.
Poorer, sicker and ‘just don’t give a fuck…’
There’s more though. The full story of the overdose epidemic can’t be understood in the vacuum of the drug war. When the people are overdosing to the point that they need to be brought back to life with naloxone, three, five and even ten times, there is something more going on than a market adjustment to stronger drugs.
The underlying context that no one wants to talk about in any of these public policy discussions is that people who use drugs, and poor people who use drugs in particular, are sicker, more alienated, poorer and more hopeless than ever. Long time users, who have experienced the sadistic and humiliating violence of the drug war at its height, cringe at the way users in the younger generations treat themselves and each other. Neoliberalism and its marketized ‘helping institutions’ (NGOs, health care providers, poverty ‘professionals’) have reproduced the sickness of the mainstream culture within the subculture of illicit drug users.