Extracts from Opioids for the Masses: Big Pharma’s War on Middle America And the White Working Class

 We spoke to Brandeis University opioid policy expert Dr. Andrew Kolodny to get a sense of how to properly understand what has been happening.

“To start with, the correct way to frame the opioid crisis is an epidemic of opioid addiction,” Kolodny told us. “The reason we’re experiencing record overdose deaths and that we’re seeing fentanyl and heroin in parts of the country we’ve never seen it before, and outbreaks of injection related diseases, and births of opioid dependent babies, is all because of the increase in opioid addiction coming from prescription opioids.” 

Noting the 900 percent increase in opioid addicts between 1997 and 2011, he said the majority of overdoses are among those already addicted. But this is by no means the whole story. “I have a friend who lost his daughter who was seventeen. It was the night before she was going to college, and she was at a party,” Kolodny said. “She was experimenting for the first time and took an 80 mg OxyContin which is a very high dose. One pill, and Emily died.

“That said, I really don’t agree with framing this as a ‘drug abuse’ crisis, because that implies we have a lot of people behaving badly and accidentally killing themselves while behaving badly and recreationally. Some people became addicted because they abused opioid prescriptions and liked the feeling, but more are dependent and continue to use opioids not because they feel good but because when they are not taking them they feel sick.

**

We now live in an America where working class, predominantly White, rural people whose parents and grandparents would have spat at the idea of shooting up are now living and dying with needles in their arms. And they are doing it in extremely large numbers. Many, including Dr. Kolodny, describe this as an “epidemic.” But is it really an epidemic? The world “epidemic” implies a disease spreading naturally, due to some pathogen. The “pathogen” idea makes it easy to get caught up in debating the best strategies or treatments for combatting this “natural occurrence,” just as you would an outbreak of the bird flu. It sounds inevitable. The only hope is to treat the disease and hope the “epidemic” subsides.

In truth, this crisis isn’t about a naturally occurring pathogen infecting the population. Centuries ago, it was possible to claim ignorance about the effect opiates have on patients. But the lessons of history are easy to learn if only we’d look. This wasn’t inevitable. There were guiding hands behind designing these drugs, obtaining regulatory approval, and marketing them to patients and doctors. Whether by plan or criminal negligence, this crisis wouldn’t have occurred without human action. Something set this in motion. Someone in the long chain of events that got us here were derelict in their duties or knew what they were doing. Maybe both.

Because this has both human intervention and a human death toll, maybe the more correct lens to view this through is not that it is an epidemic, but rather a crime. If one patient is deliberately and knowingly administered a deadly drug, we might treat it as murder, but now that the death toll is over 400,000, we call it an “epidemic”? What changes an event from a crime to a public health issue?

The full human cost is not simply an accounting of the dead, but includes the impact of despair and hopelessness that follows in the wake of opiate addiction and abuse. There is, as Adam Smith said, “much ruin in a nation.”

We began our investigation into this crisis by considering the places hardest hit by opiate addiction, overdoses, and deaths. To our surprise, the hardest hit areas were home to certain rural and working-class American communities—exactly those who had most successfully resisted drugs in the past.

The fact that “flyover America” is most affected by the crisis explains the relative paucity of coverage in the news. Rural White Americans are those least likely to receive sympathy from coastal media and politicians. Both the leadership of the left and right often take rural and working-class Americans for granted. But these Americans are part of the backbone of this country. They comprise a surprising percentage of our armed forces. They contribute a disproportionate amount to the Federal tax coffers. And historically, they have provided the labor that made America the industrial superpower of the modern world. Without them, America simply won’t be the same.

**

If a pharmacy fills two hundred prescriptions of all types on an average day, then today about twenty-five of those will be for opioids. That’s far and away the biggest single category of prescriptions filled in a pharmacy. That’s in every pharmacy in America, every single day.

*   *   *

In very large measure, this blizzard of opioid prescriptions really started with Purdue Pharma. “Blizzard” here is not a capriciously chosen word, by the way. According to court filings, a member of the Sackler family, owners of Purdue Pharma the maker of OxyContin, told attendees of the drug’s 1996 launch party that the drug’s takeoff would be “followed by a blizzard of prescriptions that will bury the competition,” according to filings and records produced in Massachusetts v Pursue Pharma et al. And he was right. OxyContin was the most successful pharmaceutical product launch in American history. It buried the competition in the years since. In that same period of time, OxyContin and its competitors also buried hundreds of thousands of Americans. 

According to the CDC, from 1999 to 2017, more than 700,000 people died from a drug overdose. Around 68 percent of the more than 70,200 drug overdose deaths in 2017 involved an opioid. In 2017, the number of overdose deaths involving opioids was six times higher than in 1999, counting both prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl.

**

Viral videos of people overdosing in public are now too common, like that of Ron Hiers and his wife, Carla, who shot up heroin in a Walgreens in Memphis, Tennessee and passed out at a bus stop. As Time described it in an article and video titled “Life after Addiction,” Hiers is “bent backward over a bus-stop bench, eyes closed, head brushing the ground and a cell phone in his outstretched hand. It rings, but the man doesn’t move. A few feet away, dangerously close to the road, a woman lies face down on the sidewalk, her legs buckled under her. She tries to get up but can’t make it, and collapses back down in a heap.”

In another heart-breaking scene, a mother lies sprawled on the floor of the toy aisle in a retail store in Lawrence, Massachusetts. Her two-year-old daughter, dressed in pink “Frozen” pajamas, cries and screams, vainly trying to wake her mother up.

Such stories, unthinkable a generation ago, can be found all across White Middle America. Flyover America. The Heartland.

A grandmother and her partner in East Liverpool, Ohio, are found sprawled out in the front seat of an idling car while her four-year-old grandson, still dressed in dinosaur pajamas, sits in the back.

Even the survival stories can make you feel a bone-deep kind of sadness. In Jacksonville, Florida, a young woman candidly told a local news station of her struggles with opioids that started when she was prescribed them at the age of sixteen to alleviate the pain of ovarian cysts. Twelve years later, she was still fighting addiction.

“I remember doing the pregnancy test, putting it on the ground and shooting up while I was waiting for the test results to come back,” Crystal Harrison told First Coast News. “I was prescribed them for about two months, and when the prescription ran out I started looking in the street for them. I went from Lortab to Oxycodone to heroin to fentanyl, and all it was just, it’s been a downhill effect since I was sixteen until now twenty-eight.”

She’s had to be revived with Narcan three times. She sought treatment, and as of the time of her interview in the fall of 2018, she had been clean for six months and regained custody of her three children. Assuming she beats the odds and stays clean, the cost in lost time with her children and to her health has already been levied, and it’s all because of a drug she should have never been prescribed.

*   *   *

In a way, it’s simple. Their first taste came from a person they trusted most—their doctor. Some might sneer at “pill poppers” for a moral failing, but the number one way Americans are introduced to prescription opioids is when they get them for acute pain for minor or major surgeries. The second most common way is wisdom tooth removal. The average age of the recipients of opioids for wisdom tooth removal is around seventeen years old.

So, we turned to a different kind of doctor for some answers: Dr. Robert Valuck, professor at the University of Colorado Denver’s School of Pharmacy and Pharmaceutical Science. Valuck is a fit and gregarious man with grey peppered in his brown hair. He can hold forth on the broad scale and history of the opioid crisis, in part because he saw it unfold in real-time, but also because it’s a passion he has made a part of his field of study. 

And he has no qualms about naming those he considers most responsible, the merchants of this crisis. “There’s a confluence of factors over a long period at play but you start in the early 1980s with the increased attention to treatment of pain and the recognition of pain,” Valuck says. “There was a lot of talk about the under-treatment of pain in the 1980s and in some ways there was a little truth to that, but the narrative was completely different. No one was talking about ideas like pain-free or ‘painkillers.’ I don’t like that word ‘painkiller.’ There’s no such thing.” Interestingly, addicts often describe opiates not as eliminating pain, but making it so they simply don’t care about the pain.

While the explosion of opioid prescriptions for pain treatment and pain management began in earnest in the early 1990s, Valuck said that one of the prime movers for the push cited by pain management experts, doctors, and especially pharmaceutical companies was something printed in the January 10th, 1980 issue of the prestigious New England Journal of Medicine.

It wasn’t a study or anything even close to so weighty. It was a single-paragraph letter to the editor. Here is the full text of it:

Addiction Rare in Patients Treated With Narcotics

To the Editor: Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients who were monitored consecutively. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well documented addiction in patients who had no history of addiction. The addiction was considered major in only one instance. The drugs implicated were meperidine in two patients, Percodan in one, and hydromorphone in one. We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.

Jane Porter

Hershel Jick, MD

Boston Collaborative Drug

Surveillance Program

Boston University Medical Center

“Even now the authors admit it wasn’t supposed to be carte blanche for opioids. This wasn’t a real study. It was basically a larger-case anecdote,” Valuck said. “This became something cited hundreds and hundreds of times as evidence for the fact that opioids were not addictive, if used legitimately. The claim was that it was less than 1 percent or one-tenth of a percent that became addicted and it showed no such thing.”

The truth was, Porter and Jick had analyzed a database of patients hospitalized at Boston University Medical Center. These were patients in a hospital given small doses of opioids for acute pain, not long-term pain. The drugs were administered by staff, not the patients themselves, and were delivered only in the hospital.

But pharmaceutical companies and pain management advocates were off and running. The Joint Commission is a prestigious national non-profit that accredits and certifies nearly 21,000 health care organizations and programs in the United States. They claimed that facilities needed to create a plan for addressing levels of pain and what to do about it. This sounds reasonable in and of itself – nobody wants to live in pain.

But consider the American Pain Foundation. While also official sounding and apparently reasonable, they were anything but. Valuck describes the American Pain Foundation as “a money laundering organization for the pharmaceutical industry.” Funding records bear this out. According to an investigation by ProPublica, fully 90 percent of its funding came from Big Pharma. It was the chief advocate for the proliferation of opioid pain relievers and expanded pain management as part of the medical practice for decades. That is, it was the chief advocate until it abruptly closed its doors in 2012, just as it came under intense Congressional scrutiny.

“The American Pain Foundation launched a campaign to make pain the ‘fifth vital sign,’” Valuck said. The Joint Commission joined them, and in 2001 rolled out its pain management standards which supported the idea of the fifth vital sign. “They said you have to assess and address it. They were not saying you had to use opioids but to assess and address it,” Valuck said. “That set the foundation.”

That may sound benign to a layman but think about it. What are the four things you get checked every time you go to see your doctor? It’s always body temperature, pulse rate, respiration rate, and blood pressure.

 “Now, every person at every visit to the doctor would get assessed and asked about it,” Valuck said. “It would put the issue top of mind, and plant the idea that any pain they had should be treated. But pain is not a vital sign. It is a symptom.”

So, taking together all of this, Valuck said, you had a generation of doctors taught to think of pain as a “vital sign” and that any and all pain had to be managed or ameliorated. It created a culture where doctors and patients alike viewed pain not as part of the human experience, or a natural warning sign, or even as a consequence, but rather as something that had to be eradicated.

Concurrent with the rise of the concept in medicine of perpetual pain management and eradication came the inclusion of pain management as part of the patient experience with government payment plans.  “Then there were discharge surveys for Medicare and Medicaid patients. Satisfaction surveys of care. Now granted... only a random sample of patients get these... but they were asked about how their pain was managed,” Valuck said. “And until only recently, scores on the pain segment were tied to higher and lower levels of reimbursement for the provider. I can’t think of a more perverse incentive for hospitals and providers to overprescribe.

“It created a perverse incentive to give everyone Vicodin. ‘Are you in pain? Have some Vicodin,’” Valuck said, mimicking the dismissive attitude.

But was it just misguided medical policies and a simple push from Big Pharma that got us here? “Don’t underestimate the power of marketing... the pharmaceutical companies never did,” Valuck said.

*   *   *

Big Pharma first marketed prescription opioids such as hydrocodone to treat pain. They claimed, leaning on the conventional wisdom of the Porter-Jick letter and what came after, that these drugs carried minimal risk for addiction. There are dozens of companies that manufacture and market opioids and synthetic opioids, but the biggest name in the business, especially when it comes to marketing, is Purdue Pharma run by the Sackler family.

Mortimer Sackler was the patriarch of the Sackler dynasty until his death in 2010. The second son of Jewish immigrants from Ukraine and Poland, Sackler and his three brothers became the leaders of a small pharmaceutical company in the 1950s. By the mid-1980s, Purdue Pharma was still a small concern, but Mortimer Sackler had big ideas on how to grow its product line.

“Mr. Sackler... is associated with a lot of well-known products like Valium and Librium, but he invented peer-to-peer influencing, thought leader influencing, and how to get doctors to sell to each other,” Valuck said.

That is to say, rather than relying on the typical “cute sales rep” that would go from doctor’s office to doctor’s office, Purdue spent tens of millions on programs to convince physicians to lean on one another to favor certain Purdue products over other pharmaceutical brands. Doctors, most of whom hold themselves in high esteem, naturally hold their peers and their peers’ recommendations in high esteem.

Purdue Pharma was a pioneer in campaigns geared towards patients directly, such as the “Get Your Life Back” campaign that was basically preparing the market for Purdue and the Sackler’s greatest achievement—the launch of OxyContin in 1996.

It all worked all too well.

“OxyContin was the most successful launch in the history of modern medicine,” Valuck says. By 2001, something like 80 percent of Purdue’s gross revenue of $3 billion came from OxyContin sales. And according to the New Yorker, OxyContin had generated for Purdue “some $35 billion in revenue” by 2017. The Sackler family had gone from owners of a relatively modest pharmaceutical company in the mid-1980s to the nineteenth wealthiest family in America in 2016, according to Forbes.

Pharmaceutical companies like Purdue and others continued the full-court press. Strategies included paying middlemen to get around state regulations and even going so far as to allegedly bribe doctors to prescribe opioid medications.

“They knew what was going on. They knew [OxyContin] was more addictive than they let on. They knew it wasn’t a twelve-hour medication. And it will eventually get proven in court,” Valuck said. “They’ve already paid multiple hundred-million-dollar judgments—they’ve already admitted that [it] doesn’t last as long as they claimed.”

More than forty states are involved in a multi-district litigation in Ohio. Hundreds of counties and municipalities have their own lawsuits. Whether Purdue survives or not is in the cards, but the damage to Americans has already been done. If the tobacco company lawsuits are any guide, little of the settlement money will end up in the pockets of victims. More likely, it ends up in government hands, which will then distribute it to corporate recovery programs with maddeningly ineffective recovery statistics. Either way, the price will be paid by Middle America.

Some media attention has been paid to the incredible body count the opioid epidemic has wrought, but there has been very little sense of emergency, and no sense of urgency. Not the way there was with the crack epidemic of the 1980s. Particularly not at the level of national policy and national media.

At the state level, some of the regions hardest hit have cracked down on “pill mills” where unscrupulous doctors took cash for prescriptions in storefronts that would pop up and disappear from month to month. And they’ve passed limits on the amount or duration of opioids physicians can prescribe. Of course, as mentioned before, this has only resulted in a grim game of drug choice “Whack a Mole” with those enthralled to opioid dependence seeking illicit sources like heroin and fentanyl.

The addictive nature of opioids has been known for over a century. Today, it isn’t simply anecdotal. We can almost measure the likelihood of addiction to the tablet. According to Valuck, there is a 6 percent chance a person given just 6 tablets will be taking opioids a year later. This comes from a survey of over half a million patients, not a letter to the editor of a medical journal. “And if you give a patient three weeks or more of tablets, say 60-90, there is a 20 percent chance they’ll be taking opioids a year later. Give them forty days—it’s a 40 percent chance. We know how this works,” he said. The calculus of opiate addiction is as consistent as it is depressing.

*   *   *

Many states have passed regulations limiting opioid prescriptions, and medical guidelines increasingly stress that opioids be avoided when possible for acute pain such as a new injury, or for patients who are post-op. There are new systems in various states where prescribers can look up a patient’s entire prescription history with other prescribers to ensure that the patient isn’t “doctor shopping.”

But there’s still the problem of illicit opioids, synthetics, and the persistent problem of those who have taken opioids for chronic, long-term issues.

“The most reduction has been in acute pain, but we’ve not gotten our hands on chronic pain, those who are physiologically dependent,” Valuck said. “There’s no real data to support opioids as long-term pain relief, and yet there are data emerging that people on opioids for longer periods are developing hyperalgesia,”—which is characterized by a patient receiving opioids potentially becoming, paradoxically, more sensitive to pain.

“These people aren’t addicts but they are physiologically dependent. In these cases, we’re really not treating pain but treating withdrawal. And they are teetering on the edge of addiction. It just robs the spirit and it robs a person of purpose,” he said. “Anyone can be tapered off but it takes time and commitment,” Valuck added. “That’s the next big challenge.”

**

Most people don’t associate Alabama with coal mining, but Jasper was once among the leading producers of coal. That’s part of the reason why there’s such a gap between the rich and poor here. It’s also why the area suffers problems similar to better-known coal areas like the towns in Kentucky and West Virginia. At its height there were half a dozen coal mines, two sandstone quarries, four hundred coke ovens and a foundry, according to the Daily Mountain Eagle.

Mining and its associated trades are hard, repetitive work that easily give injuries to the common workers, while making large profits for the owners. These injured workers were a natural target for pharmaceutical companies going back to the 1980s, when they began pushing for more aggressive treatment of pain.

“Physicians were prescribing it like crazy,” said Matt Brown, chief of staff at Addiction Recovery Care in Louisa, Kentucky. “We’re from coal country. It’s a lot of manual labor and a lot of injuries. And when the coal jobs go away, people still have their prescriptions. They have a dependence on the drug and a need to make money on the side.”

Government subsidies helped fuel Jasper’s addiction. As coal jobs started disappearing, Medicare and Medicaid ensured that retired or unemployed patients would still be able to get their medications. Moreover, the price of opioid tablets on the street was high enough in recent decades that many could sell pills to others while still having enough left to satisfy their dependence, perversely replacing some of the income lost to globalization. Ironically, patient health may have been at greater risk by having health insurance, Medicare, or Medicaid than not having it, due to the lack of interest the government showed in how it was being used and affecting people’s lives.

**

Allred has seen people come before him looking like they have every chance at getting cleaned up and their life back together, but too often it doesn’t work that way. He has pages of heart-breaking stories where he’s done everything he can for someone and he still gets word weeks or months later that they’re back in jail or dead. He’s seen people who actually get cleaned up do so too late and end up having severe medical problems from the damage they’ve already done to their heart or liver.

“You shouldn’t be thirty-three or thirty-four and having to deal with open heart surgery or liver failure,” Allred tells us. “The saddest thing for me though is seeing younger people, millennials, coming through here, and I can see exactly what’s coming for them and they don’t get it.”

He pauses for a moment and shakes his head. “Everything we do seems like it’s one step forward and two steps back,” Allred says. That’s not to say there hasn’t been progress, but Jasper has the same problem we observed in Kentucky. Even as they crack down on pill mills, heroin and Fentanyl slide right in to fill the gap.”

**

Adam is a slender man in his early fifties with piercing green eyes and a cautious demeanor. Joshua, in his early twenties, shares his father’s eyes and build. He’s an engineering student at an Ivy League university nearby.

Father and son share something besides their appearance. They share an addiction to opioids.

We’re at their house for the better part of a warm June day. It’s spacious and well appointed, in a classic style befitting the community. Adam’s wife serves us iced tea from a silver tray. Their family has roots in the area here that go back before Civil War. They’re deeply involved in the community and donors to the arts in Philadelphia. They don’t want to get more specific than that. The circles they run in are, in the end, a small world.

“I took a bad fall cycling,” Adam says, his wife settling warmly beside him on their large leather couch. Josh, in a navy golf shirt, sits on an ottoman. “I had to have surgery on my knee. Despite decades of practice, I’d never actually had to take any kind of painkiller stronger than ibuprofen.

“The first day after I was foggy, but by the second or third day I was really looking forward to my next dose. You’d think of all people I would have known what was happening, but it’s like it triggers something in you that short-circuits your logic and your knowledge. It’s like I knew what was happening and just didn’t care. I enjoyed the sense of well-being too much. And after all, I’m a doctor. I would know exactly my limits,” he snorts, self-derisively.

“Six months later and I was taking five Vicodin a day, and having to cover my tracks for some pretty shady tactics I was using to get them,” he says.

Adam considers himself lucky. It was his wife, not the state board or any controlling authority, that confronted him about his abuse of opioids. “She saved me,” he says. Adam checked himself into a high-end recovery clinic that specializes in helping medical professionals who have addiction issues. After a month, he says he was clean. But he still attends NA meetings twice a week with Joshua.

As a junior in college, Joshua fell into abusing Adderall, as many students do. The energy and focus he got from its use left him with powerful headaches that lasted days. His fraternity brothers came through for him, hooking him up with a steady supply of opioid pills.

“It didn’t take long for me to go from using them for headaches to using them for fun,” he says.

After Adam had returned from rehab, he told his family about his addiction. That’s when Joshua realized that if a man he so admired and was as strong as his father could succumb to addiction, then surely he had already.

“It was the hardest thing in the world to tell my dad, days after he was out of rehab, that I was addicted as well,” Joshua tells us. Joshua joined an out-patient program close to his parent’s home and that summer he too got clean.

“The thing is, and what makes me angry about it when I let it, is that through rehab and meetings, both my son and I are in recovery, but we will always be addicted. We’ll never be sure that we won’t ever have a moment of weakness again. We’ll have to always be on guard. And our worst fear is that some injury might befall one of us, and that we’ll have to face the possibility of needing pain medications,” Adam says. “Nothing can ever make us whole.”

**

Lawyers, Drugs, and Money

Want to know why political policies and solutions failed? Consider the following statistics from the Center for Public Integrity:

Drug companies and allied advocates spent more than $880 million on lobbying and political contributions at the state and federal level over the past decade; by comparison, a handful of groups advocating for opioid limits spent $4 million. The money covered a range of political activities important to the drug industry, including legislation and regulations related to opioids.

The opioid industry and its allies contributed to roughly 7,100 candidates for state-level offices.

The drug companies and allied groups have an army of lobbyists averaging 1,350 per year, covering all 50 state capitals.

The opioid lobby’s political spending adds up to more than eight times what the formidable gun lobby recorded for political activities during the same period.

For over a decade, a group called the Pain Care Forum has met with some of the highest-ranking health officials in the federal government, while quietly working to influence proposed regulations on opioids and promote legislation and reports on the problem of untreated pain. The group is coordinated by the chief lobbyist for Purdue Pharma, the maker of OxyContin.

Two of the drug industry’s most active allies, the American Cancer Society Cancer Action Network and the Academy of Integrative Pain Management, have contacted legislators and other officials about opioid measures in at least 18 states, even in some cases when cancer patients were specifically exempted from drug restrictions. State lawmakers often don’t know that these groups receive part of their funding from drug makers.

Five states have passed laws related to abuse-deterrent opioids and scores of bills have been introduced, with at least 21 using nearly identical language that some legislators said was supplied by pharmaceutical lobbyists. Pharmaceutical companies lobby for such laws, which typically require insurers and pharmacists to give preferential treatment to the patent-protected drugs, even though some experts say the deterrents are easily circumvented.

So it’s pretty obvious they’ve gamed the political remedy. Those politicians that Big Pharma haven’t bought outright, they’ve managed to hoodwink with concern troll-style doubletalk—helping to write the very rules and regulations that they want in the guise of fighting the opioid crisis and delivering better patient care. By spreading their tentacles around Washington, DC and state capitols across the country, Big Pharma has made it well-nigh impossible for any actual regulatory crackdown, or even oversight with any teeth.

Surely, then, the courts could offer a solution?

After all, as we noted in the previous chapter, there have been hundreds of cases brought against Big Pharma, with some measures of victory. But the victories, in terms of the dollar amounts, the damage to corporate reputation, and the imposition of judicial orders in lieu of regulatory crackdown, have been picayune. Ultimately they have slowed the pace of the opioid industry juggernaut about as much as bugs splatting on the windshield slows a tractor trailer on the highway. 

In the latter half of the 2000s and into the 2010s, as the opioid epidemic consumed the American landscape, states and the US Department of Justice began the long slog of bringing lawsuits against Purdue Pharma and the Sacklers. The damage just couldn’t be ignored any more. A flood of lawsuits followed from municipalities and others. Eventually most of them were combined under a single umbrella in U.S. Bankruptcy Court.

And this is where it became a case “full of sound and fury, signifying nothing,” to quote Macbeth.

Because when you look at the big legal decision against Purdue Pharma that was announced in late August 2021, even as we were finishing this book, it became clear that there is no judicial will to bring justice against the perpetrators of this crime.

“Purdue Pharma Is Dissolved and Sacklers Pay $4.5 Billion to Settle Opioid Claims” reads The New York Times headline of September 1st, 2021. 

“The ruling in bankruptcy court caps a long legal battle over the fate of a company accused of fueling the opioid epidemic and the family that owns it,” declares the secondary headline. 

The news would appear grim for the Sackler tribe and Purdue Pharma, if the story were taken at face value. 

Under the terms of the deal reached in U.S. Bankruptcy Court in White Plains, New York, Judge Robert Drain ruled that Purdue Pharma was dissolved as a corporate entity, and that the owners and the Sackler family would pay more than $4.5 billion in fines, fees and restitution. That money is supposed to be paid out throughout this decade, with the lion’s share coming from the former Purdue entity and from projected profits of the “public interest” drug company that will emerge from Purdue’s corpse.

The king is dead, long live the king, it seems. It is also a cruel twist that the new company will focus on making drugs to fight opioid addiction. First they sold America the disease, then they get to sell America the cure for that disease. 

The details of the agreement and order provide that Purdue agreed to plead guilty in federal court to three counts of felony conspiracy to violate the Food, Drug and Cosmetic Act and the Federal Anti-Kickback Statute. The penalties under the deal include a $3.5 billion criminal fine and $2 billion in criminal forfeiture, the former of which is to be paid out in installments through 2030.  

That’s it. That’s the extent of their criminal charges—violating business laws and regulations. And while Purdue must make public some thirty million documents, emails, and records that detail some elements of Purdue’s role in the opioid crisis, it won’t reveal the full extent of their malfeasance. 

A few emails that have been made public in the course of the bankruptcy trial already are pretty damning, as reported by STAT News, with links to the full documents included.

In one email exchange dating back to January 1997, Purdue executives were hyper-concerned about Merck Medco, the national pharmacy benefit management firm, which was warning doctors that using OxyContin for chronic pain treatment could lead to addiction and abuse.

Richard Sackler told executives in the email chain that such concerns about addiction had to be “obliterated” as it threatened their move into the non-cancer pain management space:

I think that [Dr.] Paul [Goldenheim] has a good point, but we should consider that “addiction” may be a convenient way to “just say ‘NO’’’ and when this objection is obliterated, they will fall back on the question of cost. Unless we can give a convincing presentation that [Purdue’s] products are less prone to addiction potential, abuse or diversion than [other opioid] products. I think this can be done, but I defer to BK [Dr. Robert Kaiko] and RR [Dr. Robert Reder] and other experts.

In another email going back to 1996, the year OxyContin was brought to market, Sackler told executives that he wanted to highlight Purdue’s dogged willingness to fight any patent infringement by competitors so that the company would be “feared as a tiger with claws, teeth and balls.”

Another email exchange between Sackler and Michael Friedman, head of sales and marketing, came in 1997, where Friedman told Sackler that there was a false impression among physicians that OxyContin wasn’t as strong as morphine and that he didn’t want to correct that misperception because it was helping sales. 

“It would be extremely dangerous at this early stage in the life of the product to make physicians think the drug is stronger or equal to morphine,” the email states. “We are well aware of the view held by many physicians that oxycodone is weaker than morphine. I do not plan to do anything about that,”

Sackler replied, “I agree with you.”

Despite all this obvious, criminal intent, none of the executives are facing jail time.  

“Purdue deeply regrets and accepts responsibility for the misconduct detailed by the Department of Justice,” said Purdue Chairman Steve Miller, who joined the company leadership in July 2018, just before Purdue filed for bankruptcy.

As for the Sackler family? They are separately on the hook for—wait for it—just $225 million. 

This for a family with a current estimated net worth of between $11 billion and $13 billion, which during these suits revealed they had personally moved $1.36 billion into offshore—and therefore untouchable—accounts, according to court records from this very same bankruptcy court, which Judge Drain specifically addressed in his ruling, according to The New York Times coverage of the judge’s decision. In fact, it’s suspected that the Sacklers transferred more than $10 billion out of the company between 2008 and 2017, as scrutiny of the company increased. Via The New York Times:“This is a bitter result,” he said. “B-I-T-T-E-R,” he spelled out, explaining that he was frustrated that so much Sackler money was parked in offshore accounts. He said he had expected and wished for a higher settlement.

Trey Garrison

The Fourth Drive - motivation for intoxication

1

There is a natural force that motivates the pursuit of intoxication.

This biological force has found expression throughout history. It pushed all the animals from Noah’s Ark into patterns of drug-seeking and drug-using behavior. It has been the basso continuo in our own behavior since long before we were civilized primates. It has led to the discovery of many intoxicants, natural and artificial, and to demonstrations of its irrepressible drive. It was responsible for Annie Meyers’ invention of the “Cocaine Dance.”

The time was 1894. Annie C. Meyers, Chicago socialite, patron of the arts, congressional appointee to the World’s Columbian Exposition, and recent widow of a distinguished naval officer, had a bad cold. Her lawyer advised her to try Birney’s Catarrh Remedy, a popular over-the-counter cold powder containing cocaine. Soon she found herself sniffing cocaine day and night. A month’s supply of cocaine cost only 50 cents, but Annie’s runaway habit totaled $10 a day, a hefty sum that forced her to forge checks and steal.

Annie was caught shoplifting in the Marshall Field store in Chicago. She had concealed several costly silks and expensive pocketbooks in her clothing and was now confronted by the store detective and manager. “If we let you go, will you keep out of the store?” asked the manager.

“Gentlemen, excuse me while I take a blow of my cocaine,” answered the always polite Mrs. Meyers, who now needed a dose every five minutes. The men were fascinated by this little lady and her white powder. They asked her to show them how it was done. Then they asked to see it again. And again. Eventually they decided to let this “unfortunate” woman go. But a few days later they stopped her in the store just as she was trying to steal a pair of fur gloves.

“Have you any more goods on you?” snapped the detective.

“Search me!” invited Annie as she threw up her hands and stepped toward him.

“Don’t come near me,” begged the detective. “I am a married man.”

He let her go again. Annie still had about $25 worth of goods on her, part of the thousands she would eventually take from that store. She resold the items on the black market.

All the money went for cocaine. After stealing a valuable diamond, she tried to sell it for 10 cents, the amount she was short for another bottle of Birney’s. She would pet the bottles and speak to them as “my baby” and “my only friend.” The only time she would leave the house was when her cocaine supply was exhausted and she had to go out to the store to buy some more. Detectives were following her everywhere, or so she imagined. Once, in the midst of a drug-induced paranoid episode, she fled to the roof of a house and refused to come down until the police passed her some cocaine via a string she lowered to them. She talked her way out of that arrest, too.

The unstoppable Mrs. Meyers used aliases and disguises, worked in different cities, and learned how to do the “Cocaine Dance”—a dance she would perform at public gatherings, then take up a collection to support her “baby.” Late one night, alone with no one to dance for, she took a pair of scissors and pried loose one of her gold teeth. With blood streaming down her face and drenching her clothes, she pawned the tooth for 80 cents. Her baby was very hungry that night.

Throughout it all, Annie was aware of a powerful force that was directing her drive for cocaine. No other experience in her life had made such a pleasing impression on her brain. During the eight years she spent under the influence, she was aware that her pursuit involved many social and psychological problems, but cocaine also stirred something deep inside her that was soothing, enlivening, vitalizing. It seemed to Annie that she was satisfying a natural, biological urge. Like the grizzly bear on the mountain ledge, it was a precarious but magnificent natural feeling.

Calling an event natural is sometimes just reporting that it happens. Over the centuries, people have sought—and drugs have offered—a wide variety of effects, including pleasure, relief from pain, mystical revelations, stimulation, relaxation, joy, ecstasy, self-understanding, escape, altered states of consciousness, or just a different feeling. These statements of motives, of what people say they seek with drugs—and there could be an endless catalogue of such motives—is also what they say they seek without drugs. They are the same internal urges, wishes, wants, and aspirations that give rise to much of our behavior. Plant drugs and other psychoactive substances have been employed as natural tools for satisfying such motives.

The motivation to use drugs to achieve these effects is not innate but acquired. The major primary drives, those associated with survival needs and part of the organism’s innate equipment, include the drives of hunger, thirst, and sex. These drives are a function of the organism satisfying certain primary biological needs. We are not born with acquired motivations yet they are not unnatural—they are simply an expression of what we strive to be. The pursuit of intoxication is no more abnormal than the pursuit of love, social attachments, thrills, power, or any number of other acquired motives. Man’s primary biological needs may be body-bound, but his acquired addictions soar beyond these needs.

Acquired motives such as intoxication can be as powerful as innate ones. As we have seen, animals will die in pursuit of cocaine with the same absolute determination that drives them in their quest for food or water. Additionally, many of the naturally occurring plant drugs and their derivatives produce effects that directly or indirectly address the needs of hunger, thirst, or sex, thereby increasing their value to the organism. Unlike other acquired motives, intoxication functions with the strength of a primary drive in its ability to steer the behavior of individuals, societies, and species. Like sex, hunger, and thirst, the fourth drive, to pursue intoxication, can never be repressed. It is biologically inevitable.

Annie’s dance to the power of this feeling was done in the footsteps and tracks of people and animals who have been inspired by the same driving beat throughout history. It began with Daniel’s Datura hop through the woods, along a path strewn with accidental encounters. It was where Kaldi’s goats pranced with coffee while livestock staggered on range poisons or galloped in addicting circles for locoweed. There were cats who leaped and turned for catnip while creatures everywhere twitched, shook, flipped, and rolled to a symphony of hallucinogens. Almost everyone caroused and reeled with alcohol or glided on opium. Mice jumped to the tune of morphine withdrawal. Grasshoppers did it awkwardly with marijuana resin. Llamas stepped assuredly with coca, and rats couldn’t stop with cocaine. And primates, great and small, selected a variety of chemical partners, from tobacco to ergot, so they could dance with their ancestors and gods.

We have seen that intoxication with plant drugs and other psychoactive substances has occurred in almost every species throughout history. There is a pattern of drug-seeking and drug-taking behavior that is consistent across time and species. This behavior is similar for many animals because it has been shaped and guided by the same evolution and environment, the same plants and pressures. In considering an evolutionary explanation of the phenomenon, we might ask if intoxication is in some way beneficial to the species. After all, the pursuit of intoxication with drugs has no apparent survival value and in some situations has certainly contributed to many deaths. The condition is so obviously disadvantageous for some animals, such as insect pollinators, that natural selection acted strongly to eliminate it or helped animals to coevolve adaptive mechanisms. Yet the laws of evolution, even with help from the prohibitive laws of Homo sapiens, have not prevented it from surfacing in every age and in every culture.

What then could be the evolutionary value of such a condition? One possibility is that the pursuit of intoxication is a side effect of a beneficial gene or genes. Intoxication with drugs is widespread in animals, especially mammals, and it seems plausible that in order to appear in so extensive a range of genetic contexts it was inextricably associated with something else that was of survival value. The universal pursuit of intoxication implies the existence of direct connections between the molecular chemistry of the drugs and the chemistry of the central nervous system, such as opiate receptors in the mammalian brain, a biological investment that is difficult to think of as arising by accident. We are organisms with chemical brains and drives that pit the chemistry of the individual against that of the environment. We have survived these interactions and learned to thrive on them.

Intoxication, like the syndrome of food poisoning, has adaptive evolutionary value. All species must have been under continual evolutionary pressure to develop protection against chemicals that are true toxins. The intoxication can produce sensory or physiological disturbances that so shake up the individual, they cause ingested food to be rejected by emesis. Recognizing bitter tastes, bad feelings, or other disturbances may also help the individual to learn to avoid future ingestions. These defenses provide an ideal warning system for detecting the early central effects of toxins. The emetic responses or learned taste aversions are highly advantageous for animals accidentally feeding on plant toxins.

Exposure to intoxicants can also produce pleasant experiences, thereby attracting us and forming the familiar “love-hate” fascination described by so many addicts. Annie Meyers described her passion for cocaine as an expression of motherly love and her intoxications were pure enjoyment; yet the cyclical withdrawal was hell. Her nonstop use prevented the agony of withdrawal, except when she was periodically arrested. These occasional unpleasant episodes only strengthened her determination to avoid them by staying “full of cocaine” all the time. The benefits of staying high on cocaine overshadowed the costs of stopping; use continued according to the same economic equation governing other types of intoxications.

This principle of positive effects outweighing negative effects can be illustrated by dizziness, a major drug effect that is triggered by disturbances in sensory input or motor control. When dizziness is accompanied by nausea, as in food poisoning or motion sickness, it is generally unpleasant. Animals as well as people usually reject drugs such as locoweed that produce intense dizziness. But when unaccompanied by nausea or severe physiological disturbances, the dizziness can become a desired state of intoxication, and inebriating amounts of such substances as alcohol will be sought after. Thus dizziness can be a pleasant or an unpleasant experience, and one that we seek almost as often as we avoid it. It is perhaps the most primitive form of intoxication and, aside from sleep and dreams, one of the oldest altered states of consciousness known to our species.

In the initiation rites of the !Kung Bushmen of the Kalahari Desert (the “!” denotes a click sound in their language), the men dance in a circular rut, stamping around and around, hour after hour. The dancing can generate a dizziness so extreme that it induces a trance state marked by visions. In the Umbanda rituals in Brazil, participants create an identical trance by spinning around rapidly as their heads and chests jerk back and forth in opposing directions. The whirling Sufi dervishes dance and spin like tops to achieve a similar altered state of consciousness.

Dizziness is not only an ancient and adult form of intoxication, it is one of the first to be discovered by children. It is common to find three-and four-year-olds whirling and twirling themselves into delirious stupors. Many children have discovered that a good way to induce dizziness is to wind up a swing and let it unwind while they are sitting on it. The “witch’s cradle,” a U.S. adaptation of the swinging basket once used by witches in the Middle Ages, is a more certain way to swing into a trance. The cradle is actually a metal swing in which a blindfolded rider stands upright. The swing hangs like a pendulum and moves the rider in rotating and horizontal planes in response to the slightest body movements. Typically, a trance is induced in a few minutes, giving the rider visions comparable to those produced by hallucinogens. Many amusement-park rides are designed to induce other thrilling experiences through dizziness. For example, “tilt-a-whirls” move riders in vertical and horizontal planes while spinning them around.

(...)

As they grow up, these children, who score high on psychological tests measuring their propensity to seek new sensations, sometimes experiment with household drugs that promise similar experiences. Intoxication from sniffing glue, gasoline, paint, or any number of other deliriants have been utilized by children too old to twirl yet too young to have access to other drugs, New Age Tom Sawyers who have found something else to do with the paint besides put it on the fence.

Adults were offered the opportunity to enjoy these “school-boy pleasures” in London theaters of the eighteenth century. The theaters provided “ladies and gentlemen of the first respectability” with the “chemical recreation” of nitrous oxide. People laughed and sang and danced. The gas was celebrated in songs, poems, and plays. And use continued in the nineteenth century. Philosopher William James believed that the intoxication revealed the uniqueness of our species to contemplate the hidden meaning behind language and thought. Writer Oscar Wilde once said that with the gas “I knew everything,” although he was surprised to learn that the little pink man he was watching on a distant stage was really his dentist who had just pulled a tooth. Throughout all these recreations and revelations, the people reported an intoxication marked by dizziness, delirium, and delight. A few had to be restrained from hurting themselves or others. Many became sick with symptoms resembling motion sickness.

Experiences with dizziness-provoking drugs like nitrous oxide are illustrative of intoxications in general, which cannot be easily separated into distinctive pleasant and unpleasant feelings. The initial encounters with many drugs are unpleasant and the reported effects for opiates, barbiturates, alcohol, and nicotine include nausea, vomiting, sweating, dysphoria, emotional lability, aggression, drowsiness, and lethargy. There may also be impairments in concentration, thinking, comprehension, memory, and judgment. William James didn’t vomit with nitrous oxide but his nonsensical statement that he was experiencing nausea “what’s nausea but a kind of -ausea? Sober, drunk, -unk, astonishment” leaves us with a little of our own astonishment at the cognitive dysfunction of this great thinker while under the influence. As a rule, some negative effects are accompanied by some positive effects. Why bother pursuing such a chancy condition?

2

Part of the answer may be found in the study of the self-administration of drugs that continually recycle the user through addiction and withdrawal. As we have seen, animals self-administer the same drugs we use. The behaviors of these animals have told us much about effects such as tolerance and breaking points. Yet with the exception of the pigeons and monkeys that were trained to report their hallucinations, few animal experiments tell us about the internal feelings that motivate use. And so we turn to human subjects for answers about their subjective sensations.

Many addicting drugs such as cocaine or heroin produce a rush of intense pleasure, especially if rapidly delivered through injection or smoking, followed by mild discomfort as the drug loses its euphoric effect through metabolic destruction. The discomfort is both physiological and psychological. Cocaine leaves the user with lethargy and fatigue. Heroin’s discomfort can be seen in the user’s runny eyes and nose, abdominal pains, clammy skin, and muscular malaise. Psychologically, both drugs create a craving, an aversive state that animals and people will seek to avoid by repeated self-administration of the drug. The aversive state will go away on its own, but the heightened contrast between the previous euphoria and the craving creates a universal impatience.

The important elements of this behavior are the changes in affect. The initial intoxication has a different emotional quality from the subsequent withdrawal. Cocaine’s first few doses, for example, produce an initial state of excitement and intense euphoria. The onset of the drug action is the reinforcer. But after the drug effect dissipates, the second state, the unpleasant withdrawal phase, begins. Withdrawal finally disappears with time or another dose. Therefore, both the onset of the drug effect and the removal of the withdrawal effect acquire the capability of reinforcing or rewarding behavior; both can motivate the continued use of the drug. This can be easily illustrated by cocaine addicts like Mrs. Meyers who continue to use the drug despite the fact that they no longer feel any pleasure or high from the intoxication. They have generated tolerance to the initial euphoric state, yet drug use is maintained because repeated doses act to block or remove the withdrawal effect.

Psychologist Richard Solomon has proposed a model to account for these events. It is known as the opponent-process theory and it is helpful in explaining a wide variety of acquired motivations, from addiction to Zen, from rock climbing to free-fall parachuting. According to the model, most organisms behave in the direction of restoring bodily functions to a normal state. Solomon explains that “the brains of all mammals are organized to oppose or suppress many types of emotional arousals or hedonic processes, whether they are pleasurable or aversive, whether they have been generated by positive or negative reinforcers.” The opposing processes are automatically set in motion by events that induce disturbances in physiological or psychological systems. These disturbances, in turn, elicit counterreactions that function to correct the imbalances.

For example, the first few doses of heroin produce a rush of euphoria followed by a state of craving. The rush is the positive reinforcer and the craving is the negative one. After many doses the rush is greatly diminished and euphoria is often absent. However, the withdrawal state of craving becomes longer and more intense. While the positive reinforcer (the rush) has lost most of its power, the negative reinforcer (the craving) has gained strength. It has acquired sufficient power to motivate behavior. The user may have become tolerant to the drug, but the intolerance to drug termination or absence drives him on.

The opponent-process model can also account for situations in which the rush is aversive and the withdrawal is positive. For example, a para-chutist experiences terror during his first free-fall jump. Studies of military parachutists have found that even the bravest men show an initial fear reaction: eyes bulge, lips retract, and the men yell with anxiety. Once they have landed safely, they appear too stunned to talk. Then they experience relief and begin a lively chatter with other jumpers. After many parachute jumps, the fear reaction is undetectable, and affective habituation is said to have occurred. This allows the positive aftereffects of withdrawal—the removal of the anxiety upon landing and the subsequent relief—to reinforce further jumps. Now the parachutists look eager before the jump and report a thrill during the free fall. The landing is followed by a long-lasting feeling of exhilaration.

These concepts help to explain how some drug-induced intoxications can be rewarding despite the occurrence of negative effects. The most unusual and “negative” drug taken by both monkeys and people is phencyclidine (PCP), a compound that produces negative effects in 100 percent of the intoxications and positive effects only 60 percent of the time. It defies convenient classification and has mixed excitatory, sedative, anesthetic, and hallucinatory properties. The intoxications are predictably unpredictable and almost everyone reports bad trips. In a sense, the persistent use and abuse of a drug like PCP seems to be a paradox. Yet the fourth drive is not just motivating people to feel good or bad—it is a desire to feel different, to achieve a rapid change in one’s state. The direction of change, up or down, good or bad, is of secondary importance. If we can understand this nature of PCP’s attraction, then we can understand how almost any intoxicant can satisfy the fourth drive.

Before PCP reached nonmedical users it was called Sernyl and was used as a surgical anesthetic for humans. The drug did not perform well in clinical tests. Patients were oblivious to the surgery but, in the recovery room, they awoke in the midst of a lingering and confusing delirium resembling schizophrenia. While some patients felt years younger—almost as if they were “born again”—others had a stormy emergence that required constant supervision because they could become violent. Therefore, PCP was restricted to use as an immobilizing agent for animals since veterinarians were generally less concerned about the psychological aftermath in their patients. However, because it was relatively cheap and easy to manufacture and the effects of sub-anesthetic doses mimicked those of many illegal hallucinogens, PCP began to appear as an adulterant in street drugs. Familiarity bred experimentation. People started to experiment with pure PCP itself and gradually acquired a liking for the drug experience.

PCP is typically smoked, although it can be used in a number of ways, and the symptoms start to appear within a few minutes. Users report peak effects within fifteen to thirty minutes, followed by a prolonged intoxication of several hours. Recovery may take many more hours, even days. The experience is triggered by PCP’s direct action on the brain, arousing the user’s body and elevating mood. Heart rate and blood pressure increase. The mood turns euphoric. But as the extremities are numbed, motor behavior becomes uncoordinated and the user acts in a drunken manner. Further doses produce bizarre and inappropriate motor movements.

Under PCP’s influence Luther R. cut off his own penis and swallowed it. The paramedics found him lying on the kitchen floor in a pool of blood. As they attempted to stop the bleeding, Luther regurgitated his penis. He never felt the pain. At similar points of intoxication users might not be able to feel a surgeon’s knife or a blow from a police baton, yet sensory impulses in grossly distorted form do reach the brain.

Seventeen-year-old Martin L. had just finished smoking a PCP cigarette when he started breaking store windows with karate kicks as he walked along the street. When the police arrived, Martin flashed a butcher knife and attacked. The police were unable to subdue him, even after multiple baton blows, and Martin, making no sound whatsoever, was showing no signs of fatigue or pain. Additional officers were called to the scene, six in all, and eventually they restrained and handcuffed the “super-human” Martin. The handcuffs held, although other people under the influence of PCP have mustered the 550 pounds of pressure necessary to snap them. Martin’s first words came in the form of a song he sang in the hospital, words that suggested some vague, albeit distorted, awareness of the preceding events: “I’m strong to the finish ’cause I eats my spinach, I’m Popeye the sailorman!”

What is so attractive about the state of PCP intoxication? When users like Martin are examined in the hospital, they do not look as though they should be singing. Flushed, feverish, and dripping with sweat, the users seem consumed by discomfort. There may be excessive salivation and tearing. Speech is slurred and difficult. A blank stare comes over the face. Unable to stand or walk properly, they start shivering, but it’s actually preseizure muscle activity. Touch them and their muscles may become tense and rigid. However, the users remain largely detached from these physical discomforts and focus on the subjective experiences. They are so unaware of physical sensations that they often have the sensation of floating clear out of their bodies.

It is precisely this dissociation, not unlike the trance from dizziness or anesthesia from nitrous oxide, that is so attractive to many users. They have dreamlike experiences in which they feel as though they were in a different place, in a different time. A common sensation is the feeling that one is watching oneself from a distance. When we think of the last time we went swimming in the ocean, we might see a mental image of ourselves running along the beach and into the water. This is an entirely fictitious memory. We couldn’t possibly have seen ourselves. Yet memory images often contain fleeting glimpses of oneself. PCP users have similar dissociated or out-of-body perspectives but while events are taking place. In such an altered state, PCP users report a generalized feeling of well-being and a detachment from worldly tensions and anxieties. In other words, their affect is changed. For many, there is ambivalence or a blanding of affect; users claim even this can be euphoric in light of preexisting depression or unhappiness. Others experience a negativism and hostility, sometimes coupled with feelings of “sheer nothingness” and thoughts about death. This, too, can be rewarding for individuals who can find escape from the stimulus overload of their normal lives and feel stronger after surviving a powerful psychological experience.

The names given to PCP by users tell of these varying stimulus properties: Angel Dust, Devil’s Dust, Embalming Fluid, Goon, Peace, Rocket Fuel, Whack, Wobble Weed, and Zombie. Other street names suggest that PCP intoxication can also recapitulate phylogeny, at least experientially: Amoeba, Worm, Busy Bee, Dog, Hog, Pig Killer, Horse Tranquilizer, Elephant Tranquilizer, Monkey Dust, and Gorilla Tab.

According to the Los Angeles Police Department, Lenny B. turned into one of these animals after smoking a tobacco cigarette that had been dipped in liquid PCP. In his mind, Lenny was flying over a duck farm. But in his house he walked like a duck, quacked like a duck, and announced to the startled guests that he was Donald Duck. Then he savagely stabbed a man to death. He was found waddling in a puddle on the sidewalk. Lenny was unaware of these events, and later told me he enjoyed the high and would take PCP again.

Elsewhere, Linda, one of my research subjects who had taken PCP in a controlled environment, had a quiet introspective experience. She reported seeing images of God and heaven: “I was flying with the angels. When I started coming down, I felt sad that I was leaving such a lovely place. I think I even cried. I hadn’t done that in years. But most of all I remember the peace and tranquility. Everything was good. I want to be there always.”

PCP will not automatically deliver a devilish or angelic experience. Many of the horror stories retold in the media are true, but the unsung tales of beatific paradises experienced by users like Linda are much more common. As with most mind-altering drugs, the intoxication from PCP is shaped and guided by both pharmacological and behavioral variables. Individual health and personality, the size of the dose, route of administration, and frequency of dosing are a few of the more obvious factors. And so are the set (expectations) of the user and the setting (environment) for the intoxication. Less apparent, but more important, are the patterns of use in which the pursuit of intoxication finds expression. These patterns are the most critical determinants of abuse. In other words, whether or not a drug will get an individual into trouble is often a question of whether an individual gets into a trouble-some pattern of use with the drug.

(...)

If use is motivated by a desire to achieve a specific drug effect that is helpful in coping with a particular condition, the pattern of use is called circumstantial or situational. This category includes long-distance truck drivers who have relied on stimulants to provide extended alertness and endurance, as did the Apollo astronauts who used amphetamine before reentry into the Earth’s atmosphere. Both the truck drivers and the astronauts were medicating themselves in order to obtain a certain self-prescribed effect, like the baboons who treated despair with tobacco and alcohol. The same pattern is seen in the case of a student who takes caffeine pills to stay awake, an overweight woman who takes cocaine to lose a few pounds, or a worker who relaxes with an afterwork drink. The pattern is the same although the choices of drugs may not always be prudent or legal. One of the greatest dangers of this pattern is that the user will become accustomed to having the drug in similar circumstances and will be unable to exercise the control that usually accompanies medically prescribed and supervised use. Mrs. Meyers may have felt that cocaine, in addition to helping her cold, also tempered the loneliness of her recent widowhood. It was undoubtedly tempting to use the drug well after her cold was over. She quickly moved into the next pattern: intensified use.When a person perceives a need to achieve persistent effects or maintain such effects, a daily or intensified pattern of drug use may occur. In the case of many drugs, this recurrent drug taking will escalate to states of psychological or physical addiction. Intensified users include the American housewife who regularly consumes tranquilizers, the coca-chewing Bolivian miner, the daily marijuana-smoking laborer in Jamaica, and the opium-munching water buffalo in Vietnam. In these instances the pattern of drug use has become a normal and customary activity of everyday life. Daily PCP users, who are often innercity youths suffering from a high rate of unemployment, frequently cite a need to achieve constant relief from persistent unpleasant internal and external environments. A young secretary who reported that she was using cocaine a few times each day “to white-out” the depression of her recent divorce was also an intensified user who ran the risk of escalating to still greater amounts.

Escalation is common for daily cocaine or heroin users. They use at high-frequency and high-intensity levels, the mark of the compulsive pattern of drug taking. They cannot discontinue use without experiencing some physiological discomfort or psychological disruption. Mrs. Meyers was so afraid of withdrawal that she would tear her hair out and throw a temper tantrum whenever she was arrested. The strategy worked; her jailers would take pity on her and sneak her some cocaine. A characteristic of these compulsive users is that they become preoccupied with drug seeking and drug taking, often to the exclusion of other behaviors. Compulsive users are not only the prototypical street junkies, they also include alcohol-dependent white-collar workers and white rats, opiate-dependent physicians and research monkeys, and chain-smokers everywhere. The eight-year cocaine career of socialite Annie Meyers was no different from that of the skid-row alcoholic she was often mistaken for.

Some drugs offer greater risks of developing compulsive patterns than others. Because hallucinogens like LSD stop working when taken daily due to tolerance, intensified and compulsive patterns of use do not develop with these drugs. The tolerance can be so complete that even superdoses have no effect if the person has been taking the drug too often. Therefore, most LSD users will adopt experimental patterns and take the drug no more than ten times over the course of their entire lives. Conversely, cocaine has an extremely short duration of action. It doesn’t last long and, coupled with tolerance, can cause even social users to escalate short runs or binges into long-term compulsive patterns. Compulsive cocaine smokers may take hits as frequently as ten times per hour.

In a sense, the escalating patterns of drug use, from experimental to compulsive, can be viewed as points on a continuum. The different patterns cannot be separated easily, and individuals move along this continuum at speeds governed largely by the amount of the drug that is fueling the drive. For example, large and frequent experimental dosages of morphine delivered during a binge may catapult the user directly into compulsive patterns. Conversely, small measured doses can maintain intensified patterns for years without difficulty.

4

These dynamics of the fourth drive are best illustrated by the history of cocaine. The experiences of Annie Meyers came at a turning point in that history, at a time when the dosages of cocaine preparations had recently changed. Before her time, people were prevented from developing runaway compulsive habits because only coca preparations were available.

A widely held belief in Western medicine was that most physical and mental diseases were caused by brain exhaustion and the best way to cure these conditions was to wake up the brain with a stimulating coca tonic. Physicians, pharmacists, and chemists recommended daily doses of coca extracts or wines that delivered an amount of cocaine equivalent to that obtained from chewing the leaves. While intensified dosage patterns were normally prescribed, abuse was held in check by the highly diluted preparations. Most coca wines contained only 10 milligrams of cocaine per fluid ounce, equivalent to one piece of the Coca-Peps gum used in the monkey studies.

Other patterns of use were encouraged by the commercial marketing of coca products. Coca was promoted as a wonder drug not only for medicine but also for social and recreational purposes. To make it more attractive, an assortment of coca preparations were sold, including tonics, gum, cigarettes, and soft drinks. Coca-Cola, originally promoted as a brain tonic for the elderly, was made with a coca extract. It reportedly contained slightly less than 60 milligrams of cocaine per eight-ounce serving, the amount found in a modern intranasal dose.

The tonics of Mrs. Meyers’s day were much more potent; cocaine had been recently isolated from the leaf, and the manufacturers substituted it for the coca extracts. Large amounts of cocaine alkaloids or salts could now be readily dissolved in almost any tonic or packed into any powder. Whereas coca products were treated as roughly equivalent to the chewing of the leaves, cocaine was advertised as two hundred times stronger. And it was. Just as the chimps on North and South Island had discovered, coca was not cocaine, and the golden age of coca medicine was in for some lackluster years.

Physicians started increasing the daily dosages to as much as 1,200 milligrams—a lethal dose for most people if taken into the body all at once. The effects of increased doses of cocaine were further complicated by the popularity of the highly efficient intranasal and injection routes of administration. By the time Mrs. Meyers bought her first bottle of Birney’s, many snuffs were pure cocaine and patients were instructed to take them as needed. Mrs. Meyers’s perceived needs went beyond the bounds of treating her cold and her pattern of use became compulsive.

When Annie Meyers was arrested for the last time, while trying to blow open a safe, she looked awful and she knew it: “My hair was mostly out. A part of my upper jawbone had rotted away. My teeth were entirely gone. My face and my entire body were a mass of putrefying cocaine ulcers. I weighed only about eighty pounds and it would be hard to conceive of a more repulsive sight.” Not hard at all. One need only examine more recent cases where users, faced with plentiful supplies of cheap cocaine, danced faster and harder than Mrs. Meyers ever could with her Birney’s.

During the early 1970s when cocaine once again became a social-recreational drug of choice for North Americans, the case of Annie Meyers seemed like a historical oddity. Studies of intranasal users during this period revealed that the daily intake averaged only 150 milligrams. But by the end of the decade, many social users had climbed the ladder to more concentrated patterns of use. Sniffing as much as 1,000 milligrams (1 gram) in a single dose, Kenny D. suffered severe nasal erosion. Once when he blew his nose, out came a large glob, thick as a cigar, that stretched across his palm. He displayed it to his amazed wife, who named it “Stillborn.” The glob was cartilage tissue. Kenny’s nose had collapsed. Cocaine seemed to dull the constant pain and Kenny continued his daily use even after another discharge, “Baby Sparrow,” was born.

Many cocaine users became concerned about the risks of such nasal damage and switched to smoking cocaine free base. Some users smoked as much as 85,000 milligrams a day! They were unaware that although their noses might be saved, their bodies and lives would be ruled by compulsive patterns of use.

Mitch R. couldn’t afford all the cocaine he wanted to smoke. When his supply was exhausted, he often searched the floors and carpet fibers for specks of cocaine to smoke. Like many cocaine smokers, Mitch had a hacking cough with a black, bloody expectorate. One day he “free-based” his black sputum and smoked it. He decided it was “a good hit” and continued the practice whenever supplies were low. Terry B. had a special glass waterpipe he named “Old Faithful.” He had been a super-stitious cocaine smoker for several years and never changed the water in the pipe. The pipe itself was wrapped in aluminum foil to prevent anyone from seeing what was growing in the stagnant, cocaine-saturated water. When Terry was out of cocaine, a swig from “Old Faithful” kept him going until he could replenish his supply.

These users had the same pale, cadaverous features that caused Annie Meyers to describe herself as repulsive. To prove her point, Mrs. Meyers included pictures of herself in her autobiographical book, Eight Years in Cocaine Hell, the first drug confession written by a woman and the first confession from a cocaine abuser. Those pictures showed the sunken eyes and emaciated look that was characteristic of Terry B. and so many other compulsive users, including the Michigan monkeys who injected themselves with cocaine. Annie’s ulcers were not shown, but a photograph of Terry’s leg, full of open sores that he picked while looking for “cocaine bugs,” was featured in a Time magazine cover story. Time decided not to use photographs of another patient who tried to remove the hallucinatory bugs from his body with a scalpel and forceps. When that effort failed, the patient attempted to burn them out with a propane torch: the pictures showed second-and third-degree burns covering his thighs and testicles.

Until the advent of the modern cocaine abuser, the odd horror tales associated with other drugs were exactly that: rare examples of highly idiosyncratic reactions to intoxications. There were cases of PCP abusers who had gouged out their own eyes; others had sat quietly while engulfed in flames; some had pulled out their teeth with pliers, and one woman had put her own baby in a caldron of steaming water. But cocaine users provided the quintessential examples of the fourth drive’s relentless power. Hit in the eye by a piece of cocaine-encrusted glass from an exploding waterpipe, one user described it as the best hit she ever had. She didn’t stop. After clumsily burning his hands with a lighter, a cocaine smoker took to wearing fireproof gloves. He solved the problem of constantly grinding his teeth by wearing a plastic mouth guard. He didn’t stop. Faced with increasing expenses for cocaine, a mother adjusted her budget by selling her baby on the black market. She didn’t stop.

Arrest finally stopped Annie Meyers from doing her Cocaine Dance. Her treatment consisted of a long stay in a sanitarium coupled with the religious and moral lectures that were popular in her day. Traditionally, society still tries to hold the drive in check through legal and moral controls that employ penalties for use, treatment for users, and preventive education for nonusers. Although these methods haven’t worked, our response in the face of such unstoppable examples of the drive as the modern cocaine abuser has been to intensify the controls. Accordingly, punishments escalate, involuntary testing programs for the detection of drug use become more widespread, treatment becomes mandatory, and educational campaigns tend to deliver more hyperbole than honest information, resulting in the recurrent message that “drugs will destroy your brain.”

Recently, there have been attempts to quiet the underlying drive itself. Psychiatrists try to block it with isolation, physical and chemical restraints, even electric shock. When all else fails, neurosurgeons in South America have severed the neural pathways in the brains of young cocaine users who refuse to stop. It seems as though the healing profession is stepping in to fulfill the promise that drugs will destroy your brain. In Annie Meyers’s time those in the healing arts also panicked. Dr. Albrecht Erlenmeyer, a famous nineteenth-century drug expert, saw so many unstoppable addicts like Mrs. Meyers that he proclaimed cocaine to be “the third scourge of mankind,” after opium and alcohol. It was really only the fourth drive, a drive our species had always danced to and always would.

Intoxication...

Ronald K. Siegel

Addiction By Design Machine Gambling in Las Vegas - some extracts

Addiction

The panic of the [addict] who has hit bottom is the panic of the man who thought he had control over a vehicle but suddenly finds that the vehicle can run away with him. Suddenly, pressure on what he knows is the brake seems to make the vehicle go faster. It is the panic of discovering that it (the system, self plus vehicle) is bigger than he is. … He has bankrupted the epistemology of “self-control.”

—Gregory Bateson

*

By day, she advises others on how they might best insure against future losses, yet one gets the sense that she does not quite believe in what she is selling; it is as if her awareness that the levels of risk assigned to lives and investments by the insurance industry are always more arbitrary than stated leads her to take greater personal financial risks. Her gambling both employs and rejects the actuarial logic of insurance and the monetary value that undergirds it. “In my life before gambling,” she tells me, “money was almost like a God, I had to have it. But with the gambling, money had no value, no significance, it was just this thing—just get me in the zone, that’s all. … You lose value, until there’s no value at all. Except the zone—the zone is your God.”

*

O. B. laughs and holds up his hands—one of them large and tan with light brown hair and a gold ring, the other small, hairless, and pink, only partially developed. “I know all about scars,” he says, placing the small hand back into the big hand and settling both into his lap, “so I told her go ahead and take it off.”

As a young bowling champion in Southern California, O. B.’s disability had earned him the nickname “Onearm Bandit,” O. B. for short. The irony that his eventual slot machine addiction lent to this moniker was not lost on him. Beyond this irony, he has discerned a connection between his bowling and his machine play. “Back then when I had problems I’d go to the alley, concentrate on my game, socialize with friends.  Today when I have problems, I come here—or to the gas station, or to the casino—to play video poker. I do it to forget, to get lost.” What he comes to forget is his profound loneliness, his tense relationship with his adult son, a drug addict, and the situation that awaits him at home, where he acts as sole caretaker for a bedridden friend who has succumbed to illness. “I could say that for me the machine is a lover, a friend, a date—but really it’s none of those things. It’s a vacuum cleaner that sucks the life out of me, and sucks me out of life.”

 SUSPENDING MONEY VALUE

At the same time that machine gambling alters the nature of exchange to a point where it becomes disconnected from relationships, it alters the nature of money’s role in the social world. Money typically serves to facilitate exchanges with others and establish a social identity, yet in the asocial, insulated encounter with the gambling machine money becomes a currency of disconnection from others and even oneself. Contrary to Clifford Geertz’s interpretation of gambling as a publicly staged conversion of money value into social status and worldly meaning, the solitary transaction of machine gambling converts money into a means for suspending collective forms of value.21 Although money’s conventional value is important initially as a means of entry into play, “once in a game, it becomes instantly devalued,” observes the gambling scholar Gerda Reith.22 “You put a twenty dollar bill in the machine and it’s no longer a twenty dollar bill, it has no value in that sense,” Julie tells me of bill acceptors in the mid-1990s. “It’s like a token, it excludes money value completely.” With credit play, says another, “money has no value, no significance, it’s just this thing—just get me in the zone, that’s all.” “In the zone state,” echoes Katrina, “there is no real money—there are only credits to be maintained.”

Attesting to the conversion of money value into zone value, Sharon admits that she would rather “play off ” a jackpot than cash it out, as this would mean halting her play to wait for the machine to drop her winnings, or, in the event that its hopper is low, for attendants to come pay her off. “It’s strange,” says Lola, “but winning can disappoint me, especially if I win right away.”23 As we have already seen, winning too much, too soon, or too often can interrupt the tempo of play and disturb the harmonious regularity of the zone. Julie explains: “If it’s a moderate day—win, lose, win, lose—you keep the same pace. But if you win big, it can prevent you from staying in the zone.” In gambling, Reith writes,  money is “prized not as an end in itself but for its ability to allow continued consumption in repeated play.”24 If in the everyday economy time is spent to earn money, within the economy of the zone money is spent to buy time. “You’re not playing for money,” says Julie, “you’re playing for credit—credit so you can sit there longer, which is the goal. It’s not about winning, it’s about continuing to play.”

Paradoxically, in order for money to lose its value as a means of acquisition, that value must be at stake in the gambling exchange. “The transaction must involve money,” Australian gambling researcher Charles Livingstone elaborates in a Marxian vein, “because money is the central signification of our age, the materialization of social relations and thus the bridge to everyone and everything that is to be had in modernity.”25 In other words, it is possible for a sense of monetary value to become suspended in machine gambling not because money is absent, but because the activity mobilizes it in such a way that it no longer works as it typically does. Money becomes the bridge away from everyone and everything, leading to a zone beyond value, with no social or economic significance. In the zone, instead of serving as a tool for self-determination, money becomes an instrument for “sustained indeterminacy,” as Livingstone puts it.

Peter Adams clarifies the nature of this indeterminacy by arguing that machine gamblers seek through play to transcend the limits of finitude: constraints of space and time, the gaze of intersubjectivity, and the bounds of personal mortality. The zone state, he argues, arises out of a delicate tension between finitude (embodied in the fact of a limited monetary budget) and the possibility of transcendence that comes with each spin or hand. The zone “is a fine balance,” Adams writes, “and [gambling machines] are the ideal instrument for achieving it.” Machines facilitate the “fine balance” of the zone by allowing gamblers to constantly recalibrate the rate and magnitude of their betting such that they may continue approaching the transcendence of personal, social, and financial limitations, without ever quite arriving at that transcendence.26 Julie breathlessly recounts the recalibrations that transpire over the course of a typical play session:

I got four aces four times, that’s 200 dollars a shot, 800 credits each time, that means I could have cashed out 800 dollars total. But each time I hit, I’d play it down to 200 credits from 800 credits and I’d say, “Well, I’ll just hit the aces again and then I’ll leave.” Then I’d get four of a kind and have  like 437 credits and I’d say “I’ll just go to 400 and leave,” and then at 400 I’d just push the button again and drop below 400, and I’d say, “Well now I’m down past 400 I’ll just get back up to 400 and then I’ll cash out.” And then I’d find myself closer to 300 and I’d say, “Once I get down to 300 I’ll go.” And then when I go below that I’d say “Well, I might as well keep going, I’ve already blown what I was gonna blow—I might as well try to get the aces again,” and it would continue …

Whenever Julie arrives at the ending point she has set, she resets it, thus never reaching a point of stopping and cashing out. No matter how high her credits become, their value as tokens for “time-on-device” holds sway over their market value—even as this value initially (and ultimately) serves as the condition for her play. “In the long run,” Livingstone notes, the zone’s “stream of indeterminacy is determined, but the [machine] gambler is concentrated in the immediate, and in the immediate moment of pushing the button, indeterminacy, as it were, rules.”27It is when credits get too low that money’s determinacy moves to the fore and begins to matter once again. “I get really tense if I only have twenty credits left,” says Lola, “the tension, the anxiousness, starts building in me; all I really want at that point is enough credits to just keeping playing.” “When you start losing,” Julie tells us, “the pace picks up—you’re running out of player credit, you’re running out of money, you begin to chase …”28 As the worldly value-charge of money intrudes upon the zone, it introduces tension where tensionlessness is sought and relationality where dissociation is sought. “In the back of my head I know it’s going to end, I know the transition is going to come—no longer the world according to the zone, but the real world. The things I escaped from start crowding back into my brain.”

Even as the world crowds back in, the moment that definitively fractures the zone always feels sudden; before the instant of total credit expenditure, there is still a chance, however small, of continuing. In the moment of its total loss, money returns to the scene as a tangible limit and a medium of dependency. “Money disappears in the zone,” writes Livingstone, “yet in the moment when the money’s gone, so too is ‘the zone.’”29 The value of money reasserts itself precisely because money in its conventional, real-world state remains the underlying means of access to the zone.

This is not to say that money’s real-world value remains unaffected by zone value. “Gambling changed my relationship to money,” notes Randall.  “I’d conserve gas so I’d have the money to gamble, and instead of going to the grocery store regularly, I’d wait to go to Walmart and do it all at one time—that way I wouldn’t have to waste the gas to go more than once. I economized.” In “machine life,” acts of everyday economizing—the responsible accounting behavior of the risk-managing self—are harnessed to the nonmaximizing, self-liquidating ends of the zone. “I pinch pennies at the store, skip a meal to save money, watch for sales or bargains, yet think nothing of dropping $100 into a slot machine and watching it go away in 10 minutes,” says Rocky. “Money became the means to gamble, that’s all it was to me,” Isabella remembers. “I’d pour out the milk so I had an excuse to go to the grocery store to gamble.” Caught between the zone and the ordinary world, gamblers “economize” in a register of value that has no clear reference point. Patsy tells me of the compulsive budgeting rituals she enacted in between her play sessions:

For me, getting the money together was part of the process. I’d go to the bank and get $1,000, $400, whatever amount. I had a weird thing where I could never just take out $20, or just spend $43—I had to spend in 100s. And other weird things too. … Like if I won, I could spend back to $500 but I would never keep $600; it would be okay to put back $800, but I had to keep another certain amount—there were lots of strange little rules that didn’t make any real sense, financially speaking.

After gambling, Patsy would sit and count her money, “over and over again, in my car, at stop lights in the dark, in my lap, hundreds of dollars—what was the use?” Money became fetishlike, unhinged from exchange value—a “weird thing,” as she calls it above, that served no clear purpose. “I spent a lot of time thinking about money, touching money, calling the bank to keep track of my money, to know the time frame of when checks cleared, counting it and counting it … but in fact, I wasn’t actually counting at all.” The year after Patsy stopped gambling she did her back taxes and was shocked to discover that over a six-month period of gambling, during which she had not been “counting,” her losses had exceeded $10,000.

“In a society such as ours,” asks the cultural historian Jackson Lears in his book on gambling in America, “where responsibility and choice are exalted, where capital accumulation is a duty and cash a sacred cow, what could be more subversive than the readiness to reduce money to mere counters in a game?”30 Because gamblers play with money rather than for it, he concludes that they pose a challenge to the maximizing  ethos of American culture.31 Yet as their “machine lives” show us, despite their seeming renunciation of money they continue to act, however perversely, within the mainstream monetary value system. This becomes readily apparent when one considers gamblers’ extensive know-how and use of everyday finance and banking practices. In The Chase, Lesieur describes with remarkable ethnographic detail gamblers’ expert techniques for acquiring the means to gamble—some of them thoroughly or partially illegal, yet many involving complicated arrangements with mainstream financial entities.32 Then as today, gamblers operate inside the financial system, juggling mortgages, credit cards, bank loans, and alimony payments.

21. Anthropologists and game scholars have found that online, virtual worlds can be rich social arenas replete with transactional commerce, governance, romance, vocations, shared meanings and values (Dibbell 2006; Malaby 2006; Taylor 2006; Boell storff 2008; Turkle 2011). The zone of machine play is not a parallel world of exchange, but rather a world in which conventional value fades away.

22. Reith 1999, 146. As Baudrillard has written, “the secret of gambling is that money does not exist as value” (1990, 86).

23. Participants in a qualitative study on slot machine play in Australia argued that “winning straight away is no good.” One said, “Heck, I don’t want to win, I want to keep playing!” (Livingstone and Woolley 2008, 107). For behavioral research on the way in which big wins disrupts the flow of machine play, see Dickerson et al. 1992, 246.

24. Reith 2007, 42. Kocurek (2012) argues that the phenomenon of coin-operated video arcade gaming of the 1970s and 80s reflected the rise of credit culture and the new spending practices it demanded.

25. Livingstone 2005, 533.

26. Adams n.d., 35.

27. Livingstone 2005, 530; see also Adams, n.d.

28. The “chase” is gamblers’ shorthand for “chasing losses,” an expression that describes the race to regain what has been lost through further wagering (the opposite of “cutting losses”). For an extended discussion of the gambler’s “chase” see Lesieur’s book of that title, in which he wrote: “It is the chase that provides the initial push for the spiral the gambler becomes committed to and that gives the spiral velocity” (1977, 2). Lesieur’s description of gamblers’ narrowing “spiral of options” evokes Devereux’s earlier phrase, “circle of despair.” Devereux wrote of the gambler: “He sees himself getting in deeper and deeper; yet if he quits now, all this is irretrievably lost. The only way to get it back is to keep on playing” (Devereux 1949, 729).

29. Livingstone 2005, 533.

30. Lears 2003, 8; see also Lears 2008.

31. “This peculiar form of consumption appears as the consumption of nothing at all,” writes Reith of gambling (2007, 51).

32. Contemporary machine gamblers are less involved in illegal money-acquisition schemes than the card and sports gamblers that Lesieur (1977) described, most likely because they are not part of a gambling social network or culture of book making. The day-to-day life of machine addicts is more isolated, and their methods for acquiring money are more integrated with legitimate systems of consumer banking and credit.

(...)

SUSPENDING CLOCK TIME

The element of time is another resource of calculative selfhood that gambling addicts manage to revalue through their machine play—again, by distilling its real-world value to the point where it assumes another value altogether. “Time is liquidated to become an essential currency of the problem gambler,” writes Livingstone. “It may well be the most important and significant currency. But time as such is elided during the term of the session. It ceases to exist in its socially recognizable form.”34 While gambling addicts may remain for seventeen hours or even whole weekends at machines, the “clock time” (as they call it) by which those long stretches are measured “stops mattering,” “sits still,” is “gone” or “lost.” “I would get off work in the afternoon, and I would plan to play just one roll [of quarters]—but I would go right into a complete daze and look down at my watch and see I had to be at work again in two hours,” Randall tells me. “I would have gambled almost in a blackout for hours.”

The time of the machine zone departs from the order of chronos—“the time of measure that situates things and persons, develops a form, and determines a subject,” as Deleuze and Guattari describe it—to follow instead the “the indefinite time of the event,” a kind of time measured by “relative speeds and slownesses,” proceeding “independently of the chronometric or chronological values that time assumes in other modes.”35 Mihaly Csikszentmihalyi similarly observes that time in flow activities seems to “adapt itself” to one’s experience rather than the other way around, such that “the objective, external duration we measure with reference to outside events like night and day, or the orderly progression of clocks, is rendered irrelevant by the rhythms dictated by the activity.” Flow activities mark their own pace, achieving “freedom from the tyranny  of time.”36 Commenting on the signature absence of clocks from casinos, Reith writes that “clocks are markers of a shared, objective temporal consensus, imposing order on the flux of human relations and their surroundings.” “In the timeless void of the casino,” she goes on, “the length (or rate of play) of a game becomes gamblers’ measure of time, constituting their own internal ‘clock.’”37 Like money, time in the zone becomes a kind of credit whose value shifts in line with the rhythms of machine play; gamblers speak of spending time, salvaging it, squandering it. Randall, noting a phenomenological kinship between his video poker play and his race car driving, comments that both activities make him feel he is “bending” time: “I go into a different time frame, like in slow motion … it’s a whole other time zone.”

Just as gamblers must maintain sufficient monetary credit to keep the “sustained indeterminacy” of the zone going, they must maintain sufficient temporal credit; too little time, and the real world will impinge upon the zone—work shifts to begin, doctors appointments to be kept, children to be picked up from school. When time begins to “run out,” players thus seek to extract more and more plays from it, as Julie describes in the passage below. In the same manner that she extends zone value by resetting her credit target every time it is reached, so she extends zone time by constantly resetting the endpoint of her play:

When the time comes to leave and the things I escaped from start crowding back into my brain, I find myself rationalizing, Well, I don’t really have to go today … and I ask an attendant to hold my machine while I run to the payphone to call and buy myself more time, and then back to continue, and now there’s three more hours. And when those three hours are up, I think, I’ll have to save money for the phone calls I’ll have to make to cancel all the appointments I am going to miss. … I’m thinking of how to arrange things so that I can stay there, how to economize.

In the intervals of tension that threaten the continuation of her play, Julie calculates in two registers of time at once—clock time and zone time. How can she parlay the former into the latter? Or, as she asks above, how to economize? At the edges of the zone, Julie must remain mindful of the coins she needs to “save” to cover the cost of phone calls that might free up clock time and thus buy her more zone time. (Again, we see that the zone never entirely loses its economic market metric, for real-world money is what buys the clock time that buys zone time.)

When she can buy herself no more time and real-world demands press upon her, Julie resorts to speed, as she does when her play credits are running dangerously low. “When I absolutely have to be somewhere, then I have to play as much as I can possibly play before leaving. I start chasing, I play faster and faster—Oh goodness, I only have fifteen more minutes, ten more minutes …” Like Randall, who feels that he can “bend time,” Julie’s conviction is that she can intensify her experience of gambling time by ramping up the “event frequency” of her play; less of a lag or hiatus between play events, she seems to reason, means that more can occur.38 In the zone, she experiences time as event driven rather than clock driven.

To understand event-driven time in its broader social-historical context, it is instructive to consider Walter Benjamin’s mid-twentieth-century analysis of manufacturing technologies, in the course of which he drew a comparison between the temporalities of assembly-line labor and that of gambling. Both activities involved a continuous series of repeating events, each having “no connection with the preceding operation for the very reason that it is its exact repetition.”39 “Each operation at the machine,” he wrote of factory work, “is just as screened off from the preceding operation as a coup in a game of chance is from the one that preceded it. … Starting all over again is the regulative idea of the game, as it is of work for wages.” This “starting over again,” this constant beginning that is discontinuous with all previous beginnings, meant that each act of labor or play was experienced as a nonchronological event “out of time.” Even as industrial work depended on clocks so that time could be precisely measured and segmented, that very mode of measurement and segmentation erased time by “screening off” each of its moments from the others. Likewise, Benjamin argued, the isolation of each gambling “moment” from the rest—“the ivory ball which rolls into the next compartment, the next card which lies on top”—removed gamblers from the ordinary passage of time.

While Benjamin highlighted how gambling dechronologizes time by turning it into a disconnected series of events, Goffman’s later analysis focused on the temporality of gambling events themselves, in which action and outcome are compressed into a single moment: “The distinctive property of games and contests is that once the bet has been made, outcome is determined and payoff awarded all in the same breath of experience.”40 Present-day machine gambling further shrinks the time span of uncertainty, immediately resolving the event of the bet with the quick  press of a button. Its “rapid succession of events of anticipation and consummation,” as the Australian gambling scholar Jennifer Borrell writes, has the effect of continually collapsing an uncertain future into the present.41 Machine gamblers experience a time that has been technologically infused with a surplus of moments, allowing them to feel they can alter its course depending on how fast or slow they play.

The machine zone’s elasticization of time, like its elasticization of money, distills key elements of contemporary social and economic life. Clichés like “time is money,” “time is running out,” and “life moves fast” capture a phenomenon of which machine gambling is only one example—namely, that capitalism operates at increasingly high speeds. E. P. Thompson wrote of the new temporal relations that accompanied the transition to industrial society, in which working habits were restructured such that time was not something that passed, but something that was spent, as a sort of currency. He was concerned with “time-sense in its technological conditioning.”42 Since he wrote, the rise of digital information, communication, and transportation technologies has sped up production, travel, consumption, and financial transactions to a degree that previous eras would have considered astonishing. Digital technology has “compressed” time by packing ever-more moments into service-based and financial-sector work, media and entertainment, and private life.43 Under such conditions, the actuarial self must also be a time-maximizing self; she must either maintain a fast tempo or else fail to be the enterprising being she is supposed to be, falling “behind the times,” so to speak. One could say that the industry of machine gambling profits by issuing a perverse version of this imperative to gamblers, some of whom respond at the cost of acquiring an addiction. Whatever else they may be, intensive machine gamblers are individuals who embody the imperative to act at a continuous high velocity. As such, they reveal both the pervasiveness and the existential perils of the wider social valorization of speed.

If real-world temporal tendencies express themselves in the zone and in gamblers’ addiction to it, it is also the case that the technologically accelerated temporality of the machine zone enters into and saturates gamblers’ experience of real-world time. “Time in general, not just when I’m playing,” Sharon notes, “becomes very distorted. I feel like I can manipulate it very easily, salvage much more than I can from a small unit of it: go grocery shopping on the way to the casino, and while I’m there make a doctor’s appointment on the cellular phone, and then on the way home get the shoelaces I need. … Everything I do is relative to gambling time.”  As Lesieur wrote, “the process of getting even is all [a gambler] thinks about when he reflects on his total situation. Therefore he concentrates on each immediate situation and the next bet he will make. The time span is shortened to the short-term chase and the specific event he is in.”44“I’d be later and later and later to work,” Patsy recalls. “At break time, I’d ask my supervisor, Do you mind if I go to the bank?—and I’d already be out the door. My sense of time was totally out the door. I was just wound. I’d win a royal [flush] and I’d be ticked off because I’d have to wait for them to come pay me off. The other workers would look at the clock when I came back and I would think, What are you looking at the clock for? Mind your own business.” At every chance, Patsy attempts to escape clock time, such that she becomes almost like a clock herself: she is “wound”; she is “ticked off” as time ticks by during her wait for a jackpot payoff; when she returns to work, resentful co-workers look pointedly at the clock. “When I wasn’t playing,” she told us at the start of the chapter, “my whole being was directed to getting back into that zone. It was a machine life.”

Natasha Dow Schüll

PRINCETON UNIVERSITY PRESS

PRINCETON AND OXFORD