Trump has made combatting the flow of fentanyl into the US a political priority. He blames Mexico and its drug cartels for the ongoing opioid epidemic. He’s used the issue to justify his border crackdown and tariffs on Mexico, China, and Canada. Above all, he plays on the addiction crisis to reinforce his reactionary notion that immigration is the root cause of all the problems faced by the American working class.
It’s understandable why this rhetoric resonates with some. Opioid overdoses have killed over 800,000 Americans in the last 25 years, including 75,000 in 2023 alone. It has ravaged entire cities and towns, particularly in the deindustrialized Rust Belt where Trump’s anti-immigrant “America First” message already attracts support for economic reasons.
But the Mexican cartels didn’t start smuggling fentanyl on a whim. The real roots of the opioid crisis lie with the American pharmaceutical industry and the capitalist system as a whole. Starting in the 1990s, Big Pharma consciously and systematically pushed hyper-addictive opioid painkillers into the hands of American workers. Millions developed addictions—creating massive demand that is now being filled by fentanyl.
Profiteering from addiction
OxyContin, introduced by Purdue Pharma in 1996, was central to this process. Despite their own internal research showing that the drug was highly addictive, they lobbied and bribed FDA officials to ensure the pill would be approved without any addiction warnings on the label. They also funded medical conferences, research papers, books, and “pain advocacy” groups that praised the drug.
Purdue sent sales reps to wage a conscious campaign of misinformation. They showed doctors the FDA’s stamp of approval and literature from these “unbiased” academic sources, marketing the powerful opioid as a miracle “addiction proof” painkiller. Almost immediately after its release, the industry became aware that patients were becoming addicted in huge numbers.
Addicted patients began to look for higher doses or larger quantities of pills than they were prescribed. A black market sprang up to satisfy the demand. The market was supplied by so-called “pill mills”—medical offices that prescribed massive quantities of OxyContin to drug dealers who, in turn, would give a cut of their profits to the prescribing doctor.
Doctors and local police alerted companies like Perdue, Walgreens, RiteAid, and CVS to the existence of this black market. Their own sales data confirmed these reports—showing areas with distribution of OxyContin completely out of proportion to their respective populations. They even found some towns with more prescriptions for the drug than people.
It didn’t matter to the pharmaceutical industry whether the pills were being abused. As long as profits were increasing, they had no incentive to stop the flow. / Image: public domain
But under capitalism, businesses are incentivized to pocket profits by any means necessary. It didn’t matter to the pharmaceutical industry whether the pills were being used as prescribed for pain relief or whether they were being sold on the black market. As long as profits were increasing, they were satisfied and had no incentive to stop the flow.
In fact, Perdue sent even more sales reps to specifically target areas with clear signs of addiction. Appalachia—where a combination of harsh working conditions and a lack of quality healthcare had created a large population with chronic pain—was ground zero for these sleazy tactics.
In order to extend its patent on OxyContin, Perdue released a new version of the drug in 2010. It had a coating that made it harder to use for a quick opioid fix.
By that time, however the pharmaceutical industry had already pulled millions of Americans into opioid abuse and addiction. Unable to get high on the new version of OxyContin, these people had to turn to other drugs—first heroin and later fentanyl. In 2016, 80% of new heroin users had originally become addicted to opioids through prescription painkillers. Fentanyl, which is cheap, strong, and easy to make, soon overtook heroin as the number one drug responsible for overdose deaths.
No solution under capitalism
The pharmaceutical industry’s ruthless pursuit of profits is the most direct and immediate cause of the opioid crisis. But capitalism is to blame at every step of the way—from the backbreaking working conditions that cause chronic pain, to the influence of the profit motive on seemingly “neutral” regulatory bodies and medical researchers, to the lack of quality healthcare and effective addiction treatment.
Even the Mexican drug cartels formed as a result of the instability and underdevelopment caused by American imperialist domination of the country.
Both Trump and the liberals cry crocodile tears over the crisis, but neither are able to offer a genuine solution. They defend the interests of the system that is to blame, and they receive millions in campaign donations from the very industry that has profited enormously from the sale of opioids.
Only a socialist revolution can end the opioid epidemic. Expropriating pharmaceutical companies and other monopolies will liberate science and medicine from the profit motive, improve working conditions, and provide high-quality healthcare to treat chronic pain safely. A mass communist party would use its revolutionary program to address the layers of the working class devastated by opiates, redirecting their anger away from immigrants and the US-Mexico border to the industry and system that are actually to blame.