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In early March, West Virginia passed an ugly milestone: A state program designed to provide money for burial assistance for needy families ran out of funds nearly four months before the end of the fiscal year. This is the fifth year in a row that money for the program ran out. The main cause? Increased deaths resulting from the worst opioid epidemic in any state in the United States. Deaths from drug overdoses in the state climbed to nearly three times the national average in 2015. But West Virginia isn’t alone. The opioid epidemic has reached such proportions in Ohio that the coroner for Stark County, where the city of Canton is located, had to ask the state Emergency Management Agency for a cold storage trailer — the kind used at disaster scenes — to store the overflow of bodies from the morgue. According to the Ohio Department of Health, the number of opioid-related deaths — including overdoses from both illegal opioids like heroin and prescription versions like fentanyl and OxyContin — was 296 in 2003. By 2015, that number had jumped to 2,590 — a 775 percent increase. In an interview with the Washington Post, Rick Walters, an investigator for the Stark County coroner’s office, said, “I’ve been involved in public safety for forty-some years. I remember the drug problem we had in the late sixties and early seventies when I joined the department. The fatality numbers were nothing even close to this.”

The Addiction Industry Now, some manufacturers are finding ways to exploit the addiction and overdose crisis to maximize profits. Recently, an advisory panel of the Food and Drug Administration determined that a powerful opioid painkiller named Opana ER had risks of abuse that outweigh its potential benefits. Opana ER is an update on an earlier version of the drug, reformulated to make it harder to crush — under the theory this would help prevent it from being abused through snorting. Instead, drug users found that they could inject the reformulated drug for a more powerful high — the numbers of those injecting it are estimated to have doubled. In 2015, use of Opana ER among intravenous drug users who shared needles was linked to an outbreak of HIV in rural Scott County, Indiana — the home state of Mike Pence, now the vice president, but then governor of the state. Pence’s solution to this public health crisis? Local and state health officials and even law enforcement begged him to implement a clean-needle exchange program, but Pence refused to act for more than two months, saying he would “pray” on it. Pence finally issued an executive order allowing syringes to be distributed, but he explicitly prohibited counties from using state funds to purchase syringes. Meanwhile, a total of 181 people who lived in or used drugs in Scott County contracted HIV. And the connection to pharmaceutical company profits? It turns out that the real motive for reformulating Opana was financial — to block competition from generic versions of the drug, which could have decreased net sales by up to $135 million, NPR reported.

Despair The opioid epidemic ravaging communities across the country is one aspect of a deep social crisis impacting workers and the poor. It shouldn’t be surprising that the crisis is sharpest in Rust Belt communities, where deindustrialization and job losses have caused deepening poverty and alienation. Such communities are emblematic of what researchers Anne Case and Angus Deaton have called a “sea of despair” engulfing white, working-class Americans. Because of poverty, racism, and a host of other factors, working-class and poor African Americans in particular continue to suffer a staggeringly high mortality rate. But Case and Deaton have found that “the death rate of midlife non-Hispanic white Americans had risen steadily since 1999,” in contrast to a decline for blacks and Latinos. Their original study in 2015 cited a spike in mortality for middle-age white women due to overdoses, alcoholism, and suicide — something unprecedented in a wealthy Western nation. Last month, Case and Deaton updated their study — and found that the trend has continued. The immediate source of the increasing death rates, according to the researchers, is the struggle to find work in early adulthood among whites who are less educated. This puts them at a “cumulative disadvantage” that leads to an increase in health and personal problems, including physical pain, that can result in drug overdoses, alcohol-related liver disease, and suicide. As the Washington Post reported: Whites continue to have longer life expectancy than African Americans and lower death rates, but that gap has narrowed since the late 1990s. The picture may have shifted again around the Great Recession, however: Graphs accompanying the new paper suggest that death rates for Blacks with only a high-school education began rising around 2010 in many age groups, as if following the trend that began about a decade earlier among whites. White men continue to die at higher rates than white women in every age group. But because women started with lower death rates, the recent mortality increase reflects a greater change in their likelihood of dying early. The numbers reported by Case and Deaton suggest that white men today are about twice as likely as they were in 1999 to die from one of the “diseases of despair,” while women are about four times as likely. While there have been some criticisms raised about Case and Deaton’s study, the phenomenon they are reporting on appears to be real. Their work points to the impact of a whole constellation of social and material factors that have contributed to declining living standards for working-class whites since the 1970s. This is more evidence of the growing immiseration of a section of US workers who were promised the “American Dream” in the past, but face grimmer prospects in the present and future. Of course, the “American Dream” was never in reach for black workers and other groups, but Case and Deaton’s study illuminates a social crisis affecting all workers, with seismic consequences. As Keeanga-Yamahtta Taylor said in a Socialism 2016 speech: The privileges of white skin run very thin in a country where nineteen million white people languish in poverty. Apparently, the wages of whiteness are not so great to stop millions of ordinary white people from literally drinking and drugging themselves to death to escape the despair of living in this so-called “last, best hope of earth.”