*Originally Published August 19, 2019
Following every mass shooting, the debate over gun control dominates the news cycle. Mainstream political discourse will reproduce almost an identical copy of political theater after every new mass shooting.
During the ensuing few days, liberals and conservatives regurgitate the same language regarding their stance on gun control. Immediately, conservatives will call for thoughts and prayers and depending on the race of the shooter will either cite mental illness or terrorism as an explaination for the violence. In contrast, liberals will quickly associate almost every mass shooting during the Trump era as a direct result of Trump’s policies and rhetoric.
Despite the heightened attention following a mass shooting, the gun control debate within the mainstream media news cycle quickly dissipates. Due to the increasingly polarized political environment in the United States, either zero measures of gun reform will be passed or any legislation garnering bipartisan support will simply be political window dressing designed to pacify the American public.
Attempting to make a significant impact curtailing gun violence in the United States, requires far more effort than just making it slightly more difficult and time consuming to acquire a gun. Absurd levels of gun violence in the United States are indicative of our unique gun culture that has been embedded within the social fabric of the nation.
In actuality, gun violence and gun culture in the United States parallels the current opioid epidemic. Both of these public health crises indicate a uniquely American obsession with guns and pills that can be attributed to the presence of a gun culture and pharmaceutical culture.
The United States accounts for slightly over 4% of the world’s population, but Americans consume approximately 30% of the global opioid supply and own roughly 42% of the total civilian-owned guns in the world. This large disparity in consumption translates into an equally alarming disparity in fatal abuse of guns and opioids. Roughly 27% of the world’s drug overdose deaths occur in the United States. The disparity among fatal gun violence rates in the United States is extremely pronounced when comparing the United States with other high-income nations. One particular study compared the United States with 22 other high-income nations and found the United States accounted for 82% of all firearm deaths, despite containing less than half of the total population.
Americans’ obsession with guns and consumption of opioids reflect how a gun culture and pharmaceutical culture have ingrained themselves through predatory marketing tactics. Gun manufacturers and pharmaceutical corporations have spent billions of dollars in an effort to inflate demand and overprescribe their products to Americans susceptible to falling for their marketing gimmicks. While these corporations have profited generously, gun violence and the opioid epidemic are currently two significant public health crises confronting the United States.
Creating a gun culture and inflating demand begins with embedding the perception of gun ownership as a necessary means of self-defense. Since the turn of the century, the primary reason cited by gun owners in the United States for owning a gun has evolved. Surveys have shown gun owners citing hunting as the reason they possess a gun has declined, while self-defense as the primary reason has significantly increased from 46% in 2004 to 63% in 2016.
Corresponding with the increased perception of gun ownership necessary for self-defense are several trends that have exacerbated gun culture and ensuing gun violence. Contributing to successfully invoking the self-defense aspect of gun ownership among the public imagination was a massive marketing and lobbying campaign by the gun industry.
Despite an absence of a significantly increased crime wave during the 2000s decade, fear tactics increased gun sales and corporate money influenced beneficial legislation towards the gun industry. Stand Your Ground Laws were adopted by nearly half of the states in the country during the 2000s. In accordance with the self-defense aspect, Stand Your Ground Laws empowered gun owners and contributed to a spark in gun manufacturing and sales.
Gun manufacturers in the United States produced 3.6 million firearms in 2006 and this figure increased sharply to 10.6 million firearms in 2016. Handgun sales spiked dramatically as manufacturing and demand of handguns designed for concealed carry became a direct business and marketing strategy by the gun industry. The proportion of handguns among the civilian stock of guns surged.
The combination of self-defense marketing, Stand Your Ground Laws, and the coinciding increase in gun manufacturing and sales effectively enhanced the gun culture within the United States that maintains the self-perpetuating cycle of gun violence in this nation. During the last few years, an uptick in gun violence has occurred. Death by firearm related injuries per 100,000 resident population in the United States decreased from 13.4 in 1995 to 10.2 in 2000, but increased to 11.8 in 2016. Gun violence claimed nearly 40,000 American lives in 2017, thus representing a 19% increase since 2012.
Research into the recent rise in gun violence reveals a few interesting trends. Homicides by firearm have increased slightly and this trend is most pronounced specifically in the states that have passed Stand Your Ground Laws. One study found an average 8% increase in the overall homicide rate in states that passed Stand Your Ground Laws, while homicide rates remained stable in other states. A separate study reveals how Florida experienced a drastic increase in both overall homicides and homicides by firearm after enacting a Stand Your Ground Law in 2005.
Perhaps most surprising to a majority of the American public would be the fact that Stand Your Ground Laws have resulted in a significant increase in the number of homicides among white males, while there has been no statistically significant increase in homicides among blacks. The discrepancy of Stand Your Ground Laws in regards to effects on ethnicity actually diminishes the predominant racialized narrative of protecting yourself from being a victim of a crime perpetuated by a minority.
The recent rise in gun violence can be mainly attributed to a steady increase in the rate of gun suicides. Approximately 60% of gun deaths in 2017 were suicides. In several states, the firearm suicide rate has increased by nearly 60% between 2008 and 2017. Unsurprisingly states with higher rates of gun ownership have higher rates of gun suicide. Demographically, the majority of Americans who committed suicide by firearm are white males.
Paralleling gun culture in the United States is the presence of a pharmaceutical culture that has grown uncontrollably. Since 1997, total spending on prescription drugs in the U.S. jumped from $116.4 billion to $329 billion in 2016.
The massive increase in consumption of prescription drugs has coincided with an alarming rate of opioid abuse in the United States. By comparison, the European Union has a fraction of opioid abuse and drug overdose deaths. As Americans were increasingly overprescribed opioids during the late 1990s and 2000s, opioid addiction expanded rapidly. Consequences of the opioid epidemic are displayed through overdose statistics. Fewer than 17,000 people died in the United States from drug overdoses in 1999, however this figure reached 70,237 deaths in 2017. Opioids were involved in 67.8% of all drug overdose deaths in 2017.
Explaining the relatively recent surge in sales of prescription drugs and the ensuing opioid epidemic begins with examining the marketing aspect of the pharmaceutical industry. Nine of the ten largest revenue generating pharmaceutical companies spend more on sales and marketing than on research and development. As of 2016, total spending on medical marketing in the United States was $29.9 billion, an increase from $17.7 billion in 1997. Marketing to healthcare professionals has persistently accounted for the largest proportion of overall medical marketing spending, but spending on direct to consumer advertising of prescription drugs has experienced a greater proportional increase.
Combined both forms of medical marketing have shaped a pharmaceutical culture, which has uniquely altered Americans’ relationship with prescription drugs and specifically opioids. Marketing to healthcare professionals by pharmaceutical companies exists through multiple forms. Pharmaceutical companies may provide physicians with speaking fees, travel grants, subsidized costs for new medicines, or may fund educational programs.
One study documents how Purdue Pharma, the creator of Oxycontin, conducted over 40 national pain management and speaker training conferences between 1996 and 2001. Over 5,000 physicians, nurses, and pharmacists attended these all-expenses paid conferences. Coincidentally, the number of prescriptions written for Oxycontin for non-cancer related pain increased from 670,000 in 1997 to 6.2 million in 2002. Perhaps it should come as no surprise that physicians’ interactions with pharmaceutical sales representatives have been found to influence their prescribing patterns and develop a special affinity for overprescribing new drugs instead of more cost-effective options or generic drugs.
In collaboration with marketing to healthcare professionals, pharmaceutical companies have increasingly funded direct to consumer prescription drug advertising. Besides the United States and New Zealand, direct to consumer prescription drug advertising is banned in every industrialized nation. Since being legalized in the United States in 1997, total spending in the U.S. on direct to consumer prescription drug advertising has increased from $1.3 billion to $6 billion. Research into the increase of direct to consumer prescription drug advertising has found a correlation between this form of medical marketing and higher prescribing volumes of advertised drugs, increased patient demand, and a shift in prescribing behavior.
Unmitigated medical marketing is directly responsible for flooding America with highly addictive opioids causing widespread despair. In contrast to the common War on Drugs mentality of treating a drug epidemic with a disciplinary approach and portraying the drug epidemic as a threat to public safety, the opioid epidemic is approached as a public health crisis by the government. Demographically white Americans account for approximately 80% of opioid overdose deaths, thus explaining why the approach to the opioid epidemic by the federal government is a complete reversal in comparison to the previous crack epidemic.
Heightened attention in combination with several regulations have curtailed the number of opioid prescriptions written. Since peaking in 2010, opioid prescriptions have declined by 18%, but still remain three times higher than the rate in 1999. Regardless of the efforts to reduce supply, opioid addiction remains rampant and addicts unable to attain or afford painkiller pills have transitioned to heroin. Heroin-related overdose deaths increased by almost 400% between 2010 and 2017. One study found that 75% of heroin users in treatment who developed an addiction during the 2000s reported that they started with prescription opioids.
The pervasiveness of a gun culture and pharmaceutical culture in the United States can be directly attributed to deceptive marketing. Embedding a perception of gun ownership as a necessary means of self-defense along with a culture of fear has increased supply and demand of civilian owned guns. Paralleling the process of creating a gun culture, targeted direct to consumer advertisements for prescription drugs along with medical marketing for healthcare professionals has increased demand and medical professionals’ propensity for overprescribing opioid painkillers.
Oversaturation of guns and opioids in public hands has resulted in two daunting public health crises that cannot be alleviated simply by minor regulations intended to decrease supply. A substantial impact in curbing gun violence and drug overdoses begins with addressing economic inequality in the United States.
Mainstream discourse often overlooks the intersection of economic inequality, gun violence, and the opioid epidemic. However, a recent abnormal trend has been identified and labeled as deaths of despair. Deaths of despair refers to a rise in the mortality rate among middle aged white American males due to drug overdoses, suicides, and alcohol abuse.
Essentially as an increasingly globalized U.S. economy has decreased domestic industrial employment, certain geographic areas have experienced a higher degree of social dislocation and economic distress than others. By no coincidence, the geographic areas with higher levels of economic distress have a stronger association with deaths of despair.
Gun violence in regards to suicide and the opioid epidemic can even help explain the 2016 Presidential Election. Despite Trump under-performing nationwide relative to Republican Presidential candidate Mitt Romney in the 2012 Presidential Election, Trump over-performed in counties with higher levels of economic, social, and health distress.
Addressing gun violence and the opioid epidemic begins with highlighting how both public health crises are rooted in economic inequality. Rising economic inequality produces greater political inequality where corporations are given favorable treatment over citizens and the democratic power of the public diminishes. Failing to confront economic inequality will result in a self-perpetuating cycle of gun violence and drug addiction fueled by an unabated pharmaceutical and gun culture.