Originally published on Social Matter, March 20, 2018.

Why go about detailing the effects of a valium overdose, when it is clear beyond any reasonable doubt that the teenager M.S.J. died of sorrow?

So reads (in full) the entry titled, “The Redundant Autopsy” by Andres Gallardo, in his poetic collection of fictional obituaries. Though written by a Chilean and first published in Mexico in 1989, the point is well received in America today. Whether it be valium, xanax, klonopin, fentanyl, or oxycontin, Americans are sad, and the pills we take to treat that sadness are killing us. And as the bodies of overdose victims stack up in morgues, overworked medical examiners are indeed not bothering to perform what would assuredly be redundant autopsies on each one.

In 2014, 47,055 Americans died of drug overdoses. 10,574 of those deaths were from heroin. 21,103 were from natural, semisynthetic, and synthetic opioids (including methadone)—in other words, prescription drugs such as fentanyl and oxycontin. That was the first year the “opioid crisis” began to gain national attention.

But, as is often the case, things only got worse.

• In 2015, 52,404 Americans died of drug overdoses. 12,989 of those deaths were from heroin. 25,608 were from natural, semisynthetic, and synthetic opioids, including methadone.
• In 2016. 63,600 Americans died of drug overdoses. 15,400 of those deaths were from heroin. 37,680 were from natural, semisynthetic, and synthetic opioids, including methadone.

Here’s a chart summarizing these numbers:

(Sources for numbers are: here, here, here, and here.)

At present, overdoses (of any kind) are the leading cause of death for Americans under the age of fifty, with opioid overdoses leading the pack. The average life expectancy in the U.S. has gone down two years in a row now, almost entirely because of this.

Source

No one is hopeful that the numbers for 2017, when released, will show signs of a lessening crisis. After all, the sources of the pain fueling the drug use are not lessening, namely demographic displacement and economic dispossession. And those are trends we ought to strive to reverse—but let’s face it, that will take a while.

In the meantime, we should use state power to ebb the rising tide of fatal ennui. This particular effort (let’s call it the “Opioid War” to differentiate it from the generic “drug war” and the “Opium Wars” of the past) will be unique for one big reason: most of the drugs are being made legally. Granted, heroin is a big part of the problem as well, but that is being fueled by addicts switching to it from pills. As the Center for Disease Control and Prevention has noted:

Past misuse of prescription opioids is the strongest risk factor for heroin initiation and use—especially among people who became dependent upon or abused prescription opioids in the past year. The increased availability of heroin, its relatively low price (compared to prescription opioids), and high purity appear to be major drivers of the upward trend in heroin use, overdoses, and deaths.

That is to say that the fundamental problem is the pills. And while there are now more than a few illegal manufacturers of these pills, again, few addicts start there. As Andrew Sullivan recently pointed out in his heartbreaking look at the opioid crisis, “75 percent of those addicted to opioids in the United States began with prescription painkillers given to them by a friend, family member, or dealer.” Incredibly, the source of this country’s most fatal drug binge is legally available prescription drugs.

Of course, if the prescription pills were suddenly unavailable, most every user would rapidly switch over to heroin or street pills, as plenty have already done. Ergo, (and ironically) the opening act in the Opioid War should be to cut off sources of heroin and poppies (the root plant for non-synthetic opioids) in preparation for the cut off of pharmaceutical opioids.

Keeping heroin/poppy out of the country is easier than most people would have you think. Almost none of it is cultivated in the United States and between 75 and 85 percent of the world’s heroin comes from one country: Afghanistan. All ties between America and that shithole should be closed. Our military should completely withdraw, our embassy closed, diplomatic relations severed, and trade completely banned as it is with Cuba. They produce nothing of value, and we should have ended our occupation of the country years ago anyway. The ensuing chaos and violence will almost certainly cut down the heroin business immensely. If Islamists or the Chinese take over, it will end completely. China’s approach on crime makes Richard Nixon look like Michael Dukakis, and the Taliban was quite successful in its crack down on the drug trade in the early 2000s, when they cut down production by around 94 percent. As the New York Times put it in May of 2001, “At Heroin’s Source, Taliban Do What ‘Just Say No’ Could Not.”

The second big source of heroin is Mexico. That problem is trickier, but much can still be done. The wall should be built, its guarding force militarized, and drug sniffing dogs brought out en masse. Non-citizens caught smuggling hard drugs into the country should face a minimum of 20 years in prison before deportation. If we can put a man on the moon, aid insurgencies across the globe, and occupy other nations on a whim, we can secure the border. Simultaneously, we can incentivize the Mexican government to do its part. Tie all foreign aid to demonstrated progress on combating the drug lords. Build them free, maximum security prisons in exchange for increased arrests and harsher penalties for dealers. Let them know that ending the flow of drugs into our country is their number one priority.

As the flow of heroin lessens (which may well increase prescription abuse), the Opioid War will really get going. Its most important operation will be the day National Guardsmen are sent into the executive offices of every pharmaceutical company in the country that manufactures opioids. There, the denizens of the C-suite will be told that they have one calendar year to come out with non-lethal versions of their painkillers—or their companies will be nationalized in the interest of public health.

The targeted companies will be the manufacturers some localities in America have already begun litigating against for their role in the opioid crisis: Purdue Pharma, Allergan, and Endo Health Solutions, among others. Given that they “only follow orders,” the distributors and major pharmacies (Walgreens, CVS, et al.) can be left out of it. Ultimately, not every single guilty party needs its skyscraper occupied. The threat of state intervention with the barrel of a gun will be sufficiently frightening that the entire industry will fall in line.

The idea would be to introduce to the pharmaceutical industry what libertarian economic historian Robert Higgs calls “regime uncertainty.” As defined by the Mises Wiki, regime uncertainty is: “a pervasive lack of confidence among investors in their ability to foresee the extent to which future government actions will alter their private-property rights.” Normally, this is meant to describe the kind of economic slump a country can enter in when every major industry is fearful that it may be next in line to get nationalized, so risky innovation, infrastructure maintenance, and investment plummet. That is certainly a bad thing; but when an entire industry is playing and profiting with drugs that are the leading cause of death in a nation, it is a good thing. Those companies should be fearful that some day the state’s hammer will fall.

Is nationalizing a private company legal in the U.S.? Yes and no. Has it been done? Absolutely. Most famously was in 1952, when President Harry Truman nationalized several dozen steel mills. The workers at the mills were on the brink of striking and could not come to a resolution with the owners, and steel production was incredibly important at the time because the U.S. was embroiled in the Korean War. President Truman got fed up with both factions and pre-empted the issue through nationalization. Three and a half months later, in Youngstown Sheet & Tube Co. v. Sawyer, the Supreme Court said the president had no authority to do this and the mills were handed back over to their prior owner.

However, plenty of other presidents have managed nationalizations without consequence. Indeed, President Truman himself had managed to get away with it before, putting the Army in charge of several railroads for nearly two years, and Woodrow Wilson did the same during World War I. When FDR nationalized the apparel retailer Montgomery Ward, the chairman had to be carried out of his office by guardsmen—and though that was the most dramatic one, plenty of other companies were briefly nationalized during FDR’s tenure as well. Nationalization has occurred more recently too, remember that before September 11, 2001, airport security was not run by one big government agency.

In short, in times of national emergency, nationalization can be done. And the opioid crisis is a national emergency. As others have pointed out, in 2016 more Americans died from overdoses than died in the Vietnam War. This is an emergency and we need to act like it. And as the world’s finest prophet of power Niccolo Machiavelli advised:

I consider that it is better to be adventurous than cautious, because fortune is a woman, and if you wish to keep her under it is necessary to beat and ill-use her; and it is seen that she allows herself to be mastered by the adventurous rather than by those who go to work more coldly. She is, therefore, always, woman-like, a lover of young men, because they are less cautious, more violent, and with more audacity command her.

Moreover, it would only take the threat of nationalization for these pill-pushing companies to act. Businessmen tend not to be a courageous bunch. None of them want to take a stand against the state if doing so risks prison and bankruptcy. On top of that, every one of them knows they will profit to high heaven if they are the first to develop a non-lethal opioid equivalent (“Soma,” if you will). The stocks for all these companies will plummet immediately after the troopers show up, but whoever wins the innovation race will see their stock top Facebook’s—and they’ll all know this. With stakes this high, I trust the American entrepreneurial spirit will save the day.

In the interim, the press and the left will squawk about fascism. Reason magazine will compare President Trump to Adolf Hitler. A few legal theorists will grandstand and the calls for impeachment will be renewed. But nothing will come of it. Meanwhile, no CEO is going to bank on the Senate or Supreme Court bailing him out of prison when instead he could just triple research funding for a drug that will make him millions if not billions of dollars.

None of this, nor all of it put together, would be a silver bullet. No policy solution ever is. But it would be an excellent start. With new patients receiving a drug that is both less addictive and less fatal, the entry point of this crisis will be largely cut off. Already existing addicts will still be in dire straights, but new ones won’t be joining them with half the regularity of today. Importantly, everything outlined above could be done through executive actions. No new laws or congressional approval would be required. President Trump could do this all from start to finish—and he should. Overdose deaths will not hit zero because of these actions, but they will dramatically lessen. If nothing is done, they will continue to rise. Better to take dramatic steps now instead of waiting for the body count to get higher.

If in one’s year time no company has developed an adequate fentanyl replacement, then the threatened companies should indeed be nationalized. From there, the government will take over the research process. It was the government, after all, that developed the atomic bomb, the hydrogen bomb, and the world’s most successful space program. Infinite funds and national determination can, quite often, make dreams come true. This recourse does risk being struck down by SCOTUS, and has a bigger chance of blowback of other kinds, including impeachment. But it would be worth the risk. Most any risk is worth saving tens of thousands of lives lost every year over nothing better or more preventable than a quick high. And should the Judge Roberts try attempt to check the President, he could stop emulating FDR, Truman, and Wilson, opt for an older Democrat to emulate, and say: “now let him enforce it.”