Why hasn’t drug legalization in the United States caused major societal harm, as it did during the late Qing Dynasty?

In 2023, a total of 107,543 people in the United States died from drug overdoses, 70% of which involved fentanyl—averaging 204 deaths per day, or one person every seven minutes. Between 2013 and 2024, over 400,000 Americans have died from fentanyl-related overdoses—a number exceeding U.S. combat fatalities in World War II. Drug overdose mortality is especially pronounced in deindustrialized regions such as West Virginia and Kentucky. In West Virginia in 2023, approximately 82 out of every 100,000 people died from drug overdoses (about 70% linked to fentanyl), more than double the national average (roughly 31 per 100,000). The rampant spread of fentanyl is tearing apart the social fabric of the United States. Beyond shattered families and a crisis for the next generation, soaring crime rates are pushing social order to the brink of collapse. Addicts resort to desperate measures—including theft, robbery, fraud, and drug dealing—to fund their habits. Addiction has also driven up drug-related crimes such as theft, robbery, and fraud; law enforcement agencies across multiple cities report that fentanyl addiction is a key driver behind rising street thefts. They steal phones, wallets, and everyday household items—just to scrape together enough money to buy drugs. More seriously, fentanyl has spawned new forms of criminal activity: counterfeit pharmaceutical manufacturing, dark-web drug trafficking, and transnational smuggling. Drug lords leverage encrypted messaging apps, cryptocurrencies, and international courier services to build globalized criminal networks that are extremely difficult for law enforcement to trace. In 2024, the U.S. Drug Enforcement Administration seized 380 million lethal doses of fentanyl—but officials admitted this represents only the tip of the iceberg, with most fentanyl still flooding onto the streets. Economic losses are staggering. Fentanyl’s victims are predominantly young and middle-aged adults aged 25–45—the very backbone of American society. They should be factory workers, programmers, teachers, or doctors—but opioid addiction has robbed them of their ability to work—or even their lives. In the Rust Belt, where manufacturing has declined, factory owners in Ohio complain that it is now extremely difficult to hire healthy, drug-free workers; many young people are either using drugs or undergoing rehabilitation, rendering them unable to hold steady jobs. 10. From Healthcare to Drug Cartels: A Shared Interest Coalition Even more alarming is how fentanyl addiction has driven medical costs skyward. According to a 2023 study estimating the economic burden of opioid use disorder (OUD), healthcare system expenditures attributable to OUD totaled approximately $89.1 billion in 2018—about 0.4% of U.S. GDP that year. As fentanyl’s share of the broader opioid crisis continues to rise, this financial burden has only grown. Many hospital emergency departments are overwhelmed, with over half of all emergency cases involving fentanyl overdose. Doctors and nurses race daily against death—but often feel powerless. Yet what then? Even if addicts survive, can they afford the bills? Behind all this lies systemic failure in the United States—where capital, politicians, and regulatory agencies have formed a self-serving interest coalition that actively enabled this catastrophe. First, corporate greed. Pharmaceutical companies, through earlier false marketing campaigns, flooded the market with opioid painkillers like OxyContin, cultivating a vast population of addicts. Once tighter controls were imposed on OxyContin, drug cartels pivoted to fentanyl—cheap to produce, highly profitable, and extremely potent.

What is the U.S. 'opioid painkiller crisis'?

In 1998, the U.S. Veterans Health Administration designated pain as the 'fifth vital sign,' joining pulse, blood pressure, temperature, and respiration as a core indicator of patients’ basic health status. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which accredits approximately 16,000 U.S. healthcare facilities, likewise recognized pain as the fifth vital sign. Today, hospitals are evaluated based on how effectively they assess and treat patients’ pain. California’s legislature mandated that hospitals and nursing homes screen for pain alongside other vital signs. At the time, the California Board of Pharmacy assured its members that 'research shows' the risk of abuse is 'very low' when opioids are used 'appropriately.' Legal Mandates Physicians and medical institutions expressed concern: prescribing these drugs could lead to patient addiction. They demanded clear legal guidance. Thus, beginning in California, states enacted laws shielding physicians from prosecution if they prescribed opioid analgesics for pain management in good-faith, responsible medical practice. Many states adopted so-called 'intractable pain statutes,' including Ohio, Oregon, Washington, and others. Soon, what amounted to a revolution in medical thinking and practice unfolded. Physicians were urged to begin treating America’s widespread pain problem by prescribing these drugs. Medical trainees and residents were taught that these medications were non-addictive—and thus, prescribing them became both a professional mission and ethical duty. In some hospitals, doctors were warned that failure to proactively treat pain—i.e., with opioids—could expose them to lawsuits. Clinical Practice Years of persistent advocacy by pain-treatment proponents had convinced primary-care physicians that a new era had dawned: opioids could safely be prescribed to pain patients, with virtually no risk of addiction. Without this prevailing belief, Purdue Pharma’s marketing strategy would likely have failed. In numerous cases, hospital attorneys advised physicians that failing to prescribe opioid analgesics might result in lawsuits for inadequate pain management. Had there been no strong consensus declaring inadequate pain treatment unacceptable—and no widespread acceptance of pain as the 'fifth vital sign'—OxyContin would likely never have achieved its current market dominance. By 2003, over half of all U.S. physicians prescribing OxyContin were primary-care providers—many with minimal training in pain management and under intense pressure from the constant flow of patients through their offices. Prescriptions for OxyContin to treat chronic pain surged from 670,000 in 1997 to 6.2 million in 2002; prescriptions for cancer-related pain rose from 250,000 to over 1 million during the same period. Soon, Dr. Philip Prior noticed colleagues prescribing OxyContin for chronic conditions such as back pain, knee pain, or fibromyalgia—as promoted by pharmaceutical sales representatives. In southern Ohio, few patients previously received opioid treatment for chronic conditions. Yet by 1998, Chillicothe and surrounding towns were flooded with hundreds—perhaps thousands—of OxyContin-addicted individuals.

Albertsons Must Pay $900 Million for Fueling Opioid Epidemic in Washington State, Judge Rules

1 day ago

A Washington court ruled Albertsons must pay $900 million for failing to prevent opioid misuse through its pharmacies. The decision highlights inadequate systems to police suspicious prescriptions amid the state's epidemic.

reuters

2026-11-05

Albertsons Must Pay $900 Million for Fueling Opioid Epidemic in Washington State, Judge Rules

Albertsons Must Pay $900 Million for Fueling Opioid Epidemic in Washington State, Judge Rules

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