Drugs,Violence,and Capitalism: The Expansion of Opioid Use in the Americas

Abstract

In the past two decades, the United States has experienced a rapid rise in the use of opioids by its population, a context that has come to be assessed by the U.S. government as a threat to national and international security that requires emergency measures. The strategies of the U.S. government and transnational pharmaceutical corporations for resolving the insecurity generated by capitalist accumulation constitute what a certain literature calls “pacification.” In addition, these corporations export to the “foreign” the contradictions inherent in the opioid control policy that underlies the capitalist logic of drugs. Thus Latin American populations have been instrumentalized in the “solution” of this crisis either as a focus of violence by the state or as a focus of consumption by the market.

Nas últimas duas décadas, os Estados Unidos vivenciaram uma rápida ascensão do uso de opioides pela sua população, contexto que passou a ser avaliado pelo governo estadunidense como uma ameaça à segurança nacional e internacional que demanda medidas emergenciais. As estratégias do Estado estadunidense e das corporações farmacêuticas transnacionais para solucionar a insegurança gerada pela acumulação capitalista configuram o que certa literatura chama “pacificação” Ademais, elas exportam para o “estrangeiro” as contradições próprias da política de controle de opioides que fundamenta a lógica capitalista das drogas. Assim, populações latino-americanas têm sido instrumentalizadas para a “solução” dessa crise, seja como foco da violência pelo Estado, seja como foco do consumo pelo mercado.

Keywords

Latin America Opioids Pacification Drug Control United States

In the past two decades, the United States has experienced a rapid and enormous expansion of the use of opioids by its population both from the legal market, via pharmaceutical corporations, and from the illicit market, via criminal groups. As a result, the country annually sees thousands of fatal overdoses related to these substances. In 2017, it is estimated that there were 49,000 deaths, more than four times the number in 1999 (CDC, 2019). This situation has recently been assessed by the government as a national health crisis and a threat to national security that requires emergency measures (CCDA, 2017; United States, 2017b).

The literature that analyzes the international dimensions of the drug-security nexus in the Americas has grown since the 1980s. It studies the so-called war on drugs, focusing on the ways in which states combat criminal groups linked to the illicit market of drugs (see Bagley, 1988; Labate, Cavnar, and Rodrigues, 2016). In this article I analyze the drug-security nexus in the context of the use of opioids in the United States in a different way, emphasizing what Paley (2015) calls “drug war capitalism.” I share her interest in considering “other factors and motivations for the war on drugs, specifically the expansion of the capitalist system into new or previously inaccessible territories and social spaces” (Paley, 2015:51). To this end, I examine the current context of opioid use in the United States and its evolution toward Latin American countries— complementary processes that have been driving forces in state violence and in the interest of transnational pharmaceutical corporations. These actions configure what a certain literature has called “pacification” (McMichael, 2017; Neocleous, 2011; 2014), which is equivalent to the Foucauldian notion of “peace as coded war” and involves the construction/reproduction of a liberal social order (Neocleous, 2014: 34). Accordingly, the main question of this work is how opioids, capitalist interests, and state violence interact. The article is structured in four parts and a conclusion. In the first part, I briefly explain the methodology used in the research. In the second, I clarify the connections between drugs, pacification, and capitalism from an international perspective. In the third, I explain the relationship between legal and illicit markets for opioids in the United States and their characterization as a national and international threat. In the fourth, I look at the way Latin American populations have served as a “solution” of the opioid threat in the United States. I conclude by establishing the relationship between pacification and the expansion of opioid use in the Americas.

Method and Materials

The research, developed during a stay as a visiting researcher at the University of Ottawa in 2017–2018, analyzes the sociopolitical evolution of the expansion of opioid use in the United States and its consequences for Latin American populations within and outside that country. Process tracing was the chosen qualitative method. Its use, which has a long history among social scientists (e.g., Charles Tilly and Barrington Moore), provides parameters for investigating one or more cases. The analysis seeks to build causal inferences that critically dialogue with the literature (Bennett, 2010: 207). The objective is to identify the connections among the various factors relevant to the observed results and determine whether the actions and positions of the actors in the causal process are consistent with the implicit world image predicted by the theory (Hall, 2003: 394–395). In addition, the use of a single historical case, as in the study presented here, “not only can develop new theoretical ideas, but can also put them to the test and use the results in the explanation of outcomes” (Rueschemeyer, 2003: 307). This methodological proposal is innovative in the field of studies that link drugs, violence, and capitalism. Few works adopt such an approach, even implicitly. An exception is Correa-Cabrera (2017), which reconstructs the evolution of Los Zetas into a transnational criminal group with direct involvement in the Mexican energy sector.

The data collection procedures, based on the notion of drug war capitalism, were centered on the concept of pacification. Two sociopolitical dimensions guided the reading of materials and grouping of data on the context of opioids in the Americas: security and capitalism. The first guided the understanding of the identification of the use of opioids in terms of U.S. national and international security, highlighting the justifications of the actors involved and the projects and actions focused on Latin American populations. The second dimension guided the understanding of the interests and strategies of transnational pharmaceutical corporations that have influenced the use of opioids in the United States since the 1990s and projected the expansion of this market into Latin American countries, always in articulation with and supported by state structures. The sources used were documents from governmental, private, and third-sector entities (websites of these institutions, strategic plans, reports, press releases, and other materials available in digital format), interviews, journalistic texts, and the specialized literature.

The interdisciplinary bibliographic review mainly gathered reports from governmental organizations such as the Centers for Disease Control and Prevention (CDC) and the General Accountability Office (GAO) and nongovernmental organizations such as the Global Commission on Drug Policy, as well as scientific articles from different areas of knowledge, including social medicine and social psychology. This made it possible to trace the main debates relating to the evolution of opioid use in the United States and Latin America to pharmaceutical corporations and national health agencies. It also made it possible to understand the legal market for opioids in the Americas and its relationship with the consumption of opioids from the illicit market. In the second half of 2017, semistructured interviews were conducted with officials from Canadian government agencies directly involved with the topic of opioid use, such as the Center for Addiction and Mental Health, the Toronto Drug Strategy Secretariat, and the Canadian Center on Substance Use and Addiction. These interviews made it possible to contextualize the evolution of the use of opioids in North America and to identify relevant perceptions, information, and interpretations of the actors “on the ground” regarding the hypotheses formulated by the investigation.

Investigative journalism stories were also used, including the 2016 Los Angeles Times series of reports on the drug OxyContin and the pharmaceutical corporation Purdue Pharma and blogs such as Toronto Life, which reconstructed cases of people who had developed some kind of problematic opioid use. These sources provided details of the historical evolution of opioid use and its contemporary expansion to Latin America.

Such primary sources, with emphasis on interviews with specialists, have the function, according to Trachtenberg (2006: 147), of revealing the positions of the actors, their objectives and interests, which are not always explicit and declared. Instead of “truths” or the automatic description of reality “on the ground,” they reflect the biases of the actors, which can only be understood by comparing the different sources and considering connections with political dynamics and events and broader economic environments (King, Keohane, and Verba 1994: 8). I aim to follow this guidance when using these sources.

Drugs, Capitalism, and Pacification

The evolution of the use of opioids in the United States, its framing as a security issue, and the consequences arising from it express in an exemplary way the connection between drugs, violence, and capitalism. If “the economy of illegalities was restructured with the development of capitalist society” (Foucault, 1995: 87), the national and international control of drugs has played a fundamental role in this dynamic since the beginning of the twentieth century (Reiss, 2014). This process evolved around violence and political and ideological disputes related to race, religion, class, gender, and nationality, the result of a period marked by colonial domination, enormous industrialization, urban development, and, most important, immigration (Buxton, 2006: 18).

For this reason, examination of the connection between drugs, violence, and capitalism must take into account two vectors. The first is the relationship between the control and marketing of drugs, which has triggered licit and illicit multibillion-dollar markets around the world whose main operators are, respectively, transnational pharmaceutical corporations and organized criminal groups. The structuring of this vector evolved pari passu from the “pharmaceutical invasion” since the nineteenth century, during which the development of the pharmaceutical industry and the medicalization of bodies and life had the counterpart of penalizing a wide range of drugs and practices associated with them (Foucault, 1982; Vargas, 2008: 51), The second vector is the relationship between the violent mechanisms for drug control employed by state security forces and private interests guided by the pursuit of profit in the capitalist logic. This relationship highlights what Christie (1998) calls the “productivity” of crime and drug control, whose long and documented history with opioids is particularly prominent in the United States (see Timmer, 1982). The allocation of billionaire public resources, the creation of several government agencies with a coercive mandate, and public-private partnerships in activities related to the criminal justice system and related ones are some of its expressions (Andreas and Nadelmann, 2006).

These two vectors allow us to understand the argument of Paley (2015), for whom the so-called war on drugs, whose contemporary format was established by the United States in the 1970s, is “a long-term fix to capitalism’s woes, combining terror with policymaking in a seasoned neoliberal mix, cracking open social worlds and territories once unavailable to globalized capitalism.” This is also the understanding of Neocleous (2011: 201), who at the same time conceptualizes the war on drugs as a “pacification security job.” With a long history that goes back to colonization and the expansion of capitalism in the West, the use of the term “pacification” was reinforced during the United States’ counterinsurgency war in Vietnam. Its current meaning, linked to its colonialist and capitalist history, refers to the central strategy of the state that works “to secure the insecurities” of capitalist accumulation at both the domestic and the international level, always affected by the instabilities of its growth (McMichael, 2017: 127; Neocleous, 2011: 192).

The international or, rather, transnational dimension of the case of opioids is explained, in part, by the concept of the “spatial fix” of capitalist expansion developed by David Harvey (2004: 64), who refers to “spatial displacements through opening up new markets, new production capacities and new resource, social and labor possibilities elsewhere.” In other words, the result of a surplus of opioid drugs that cannot be absorbed by the U.S. market is the opening of new consumer markets around the world, carried out jointly by pharmaceutical corporations with the support of state devices. Mexico and Brazil are on this list. These instances of “capitalist imperialism,” according to Harvey (2004: 32), explore “the uneven geographical conditions under which capital accumulation occurs and also tak[e] advantage of what I call the ‘asymmetries’ that inevitably arise out of spatial exchange relations.” Linked to this spatial adjustment, there also seems to be a dynamics of accumulation by dispossession related to the fight against drugs. Following Harvey’s interpretive trail, Paley (2015: 20) argues that the fight against drugs in Mexico contributes to accelerating “the forcible displacement, the privatization of public or communally held lands, the suppression of Indigenous forms of production and consumption, and the use of credit and debt to facilitate accumulation by dispossession.”

This imperialist international dynamic, which finds important support in the control of drugs, presupposes an effort at pacification. In contexts of formal peace, as in the Americas, this pacification is imposed as an “unequal process . . . targeting specific individuals, groups, and populations through a combination of coercion and consent” (Kienscherf, 2016: 1181). This suggests a different assessment of a certain Foucauldian interpretation of power-violence as a dichotomy, underestimating the importance of the latter in favor of the dynamics of self-regulation derived from the panoptic strategies of modern society and biopolitics (Davies, 2013: 3216). In this sense, I agree with Davies (2013: 3216) that coercion is integral to neoliberal governance and, in contrast to the dualist view of power-violence, is a condition for ruling. This is particularly clear in the case of drug control, which imposes a distinction between licit and illicit circulation of psychoactive substances under capitalist logic.

From the liberal order of capital—a constant “order of social insecurity”—arises a security policy that can be defined as “a political technique of framing policy questions in logics of survival with a capacity to mobilize the politics of fear in which social relations are structured on the basis of distrust” (Huysmans, 2006: xi–xii). This distrust, in the context of the use of opioids in the United States, is mainly directed against Latin American populations, historically stigmatized as responsible for bringing drug “addiction” to American society (Musto, 1999: 219–229). This prejudiced notion gained particular expression in the identification of transnational crime as an international threat to the United States in the 1990s (Pereira, 2015). Its main characteristic is the manipulation of the population’s fears and aggressiveness by the demonization of culturally/nationally/ethnically defined groups, ensuring support for punishment within and outside the state (Garland, 1996: 461). This “law and order” orientation for the protection of capitalist accumulation has particularly perverse effects on the poor and marginalized (Wacquant, 2003).

In fact, security policy, a prerequisite for pacification in capitalist society, builds the transnational dynamic of violence, connecting the domestic and the international through the police power exercised by state security agencies, whether the armed forces or the police, and legitimized by laws that safeguard accumulation (McMichael, 2017: 127). According to Foucault (2009: 420), guaranteeing the functioning of the market through enforcement of the law is one of the privileged objectives of the police, acting through a “set of regulations, constraints, and limits, or the facilities and encouragements that will allow the circulation of men and things in the kingdom and possibly beyond its borders.” Along this path, “warfare abroad is linked, politically, ideologically, technologically, and industrially, to the maintenance of order at home; conversely, that order abroad often means warfare at home” (Neocleous, 2011: 201). The peace-security binomial that emerges from this creates an obsessive cycle that feeds on fear and violence. In the context of this liberal order, Foucault says, peace is codified war, and to this Neocleous (2014: 32) adds, “it is coded as pacification.”

From the Legal Opioid Market to the Latin American Threat

Opioids as a pharmaceutical commodity have had outstanding relevance in the history of the United States. Their control, in contrast to a war, has been institutionalized by the state through market regulations to ensure their supply and availability (Reiss, 2014). For their part, the pharmaceutical industry and medical associations, allied with other pressure groups, have played a decisive role in the development of the international United Nations conventions on the subject that became decisive for the delimitation of legal and illegal production, circulation, and consumption of these substances (McAllister, 2000: 208; Reiss, 2014).

With the enormous growth since the 1990s, the United States is the main market for legal opioids in the world, with the highest rates of medical prescriptions for these narcotics (Boudreau et al., 2009). This market for branded and generic opioid drugs includes a diverse range of transnational pharmaceutical corporations, notably Purdue Pharma, Pfizer, Roxane, Janssen Pharmaceuticals Inc. (a Johnson & Johnson subsidiary), Mallinckrodt, Actavis, Apotex Inc., Abbott Laboratories, and Endo Pharmaceuticals. In 2012 almost 260 million prescriptions for opioids in the United States were issued, representing a business of US$9 billion, double the value that this business had represented in 2002 (Stagnitt, 2015). Between 1999 and 2018, the quantity of prescribed opioids sold in pharmacies, hospitals, and medical offices practically quadrupled, although there was no change in the “amount of pain” reported by Americans (CDC, 2020a). According to the estimates of the International Narcotics Control Board and the World Health Organization, the percentage of opioids available per patient severely suffering from health problems in 2015 in the United States was 31 times greater than necessary (Knaul et al., 2017: 1).

Many studies have attested that the huge development of the legal market for opioids in the United States since the 1990s has resulted in increasing and uncontrolled use of these substances (Grau et al., 2007; Meldrum, 2016; Van Zee, 2009). In 2016, 64,000 lethal overdoses were officially reported, of which at least 54 percent were caused by opioids, four times the number in 1999 (CDC, 2019). According to the Centers for Disease Control, an agency of the U.S. Department of Health and Human Services, the recent increase in the number of overdoses and people classified as opioid-dependent is directly related to the increase in the number of medical prescriptions for this type of substance in the past two decades (CDC, 2020a). In this context, the opioid drug OxyContin, from Purdue Pharma, launched in 1996, is a paradigmatic case. It demonstrates that the articulation between pharmaceutical corporations and the U.S. Food and Drug Administration (FDA), the federal agency responsible for authorizing the marketing of drugs in the country, resulted in a huge expansion of the use of opioids. A hallmark of this articulation was the so-called revolving door—the movement of individuals from positions in the federal government, with emphasis on regulatory agencies and legislative committees, into lucrative positions in the private sector and vice versa. Research shows that half of the lobbyists hired by the pharmaceutical corporations previously worked in the federal government (Jasso-Aguilar and Waitzkin, 2011: 251). A revealing case of this dynamic is that of Curtis Wright, a renowned medical authority in clinical risk assessment during the 1990s who was in charge of the FDA’s Center for Drug Evaluation and Research. Shortly after the approval of OxyContin, for which he was responsible, Wright left the federal agency and became one of those responsible for the development of new drugs for Purdue Pharma (Ryan, Giron, and Glover, 2016).

According to Jasso-Aguilar and Waitzkin (2011: 250), the pharmaceutical industry is currently one of the largest and most powerful lobbying groups in the United States, influencing political decisions at the federal and state levels. It follows that “pharmaceutical companies frequently develop close ties with politicians, who in turn tend to reciprocate their largesse.” As Meghani and Kuzma (2011: 584) point out, this dynamic reinforces the neoliberal orientation of regulatory agencies, which serves the commercial interests of pharmaceutical corporations at the expense of public health interests. The financial contributions of pharmaceutical corporations to the Republican and Democratic parties in the United States in election years between 1990 and 2020 amount to more than US$250 million, divided 55 percent for Republicans and 45 percent for Democrats (CRP, 2020a). In 2018, the main donors were Pfizer Inc. (US$1.7 million), Amgen Inc. (US$1.4 million), Eli Lilly & Co. (US$1 million), AbbVie Inc. (US$913,000), and Merck & Co. (US$911,000). Lobbying is the pharmaceutical corporations’ main way of influencing public representatives to vote for their private interests (CRP, 2020b).

In 2017, pharmaceutical corporations spent about US$170 million on declared lobbying activities, mobilizing a total of 889 lobbyists. Of these, 68.5 percent were considered “revolvers.” Pharmaceutical Research and Manufacturers of America, the leading association of pharmaceutical corporations in the United States, alone spent more than US$26 million in 2017 on lobbying. The conflict-of-interest and ethical issues that emerge from this logic are evident from recent investigations based on Purdue Pharma’s confidential documentation on OxyContin (see Ryan, Girion, and Glover, 2016). Reports of misconduct began with questions from the initial clinical studies of the drug in the late 1980s and the leniency with which the FDA approved it. In addition, the corporation’s marketing strategies were strongly criticized, along with the release of the use of opioids for the treatment of chronic pain (Van Zee, 2009) and the authorization that allowed its consumption by adolescents from 14 years of age. Several of these instances of misconduct were approved by the FDA, and a number of problematic cases have had limited oversight that has not resulted in penalties. To date, OxyContin is estimated to have generated approximately US$35 billion in revenue for Purdue Pharma, making the Sackler family, which owns 100 percent of the company, among the wealthiest families in the United States, with a fortune estimated at US$13 billion (Morrell, 2015).

Legal and Illegal Opioid Markets

Since the late 1990s, the number of deaths in the United States from heroin and synthetic opioids such as fentanyl has increased dramatically. In 2016, 42,000 deaths from opioid overdose were recorded, five times higher than in 1999 (CDC, 2020b). Deaths from overdoses of fentanyl and other synthetic opioids jumped from just over 3,000 in 2013 to almost 20,000 in 2016, an approximate expansion of 660 percent.

Studies carried out since 2013 indicate a strong association between the increased consumption of illicit opioids and the high levels of legal opioid prescription in the United States (Muhuri, Gfroerer, and Davies 2013; Schuchat, Houry, and Guy Jr., 2017). According to the United Nations Office on Drugs and Crime (UNODC, 2017: 10), “the misuse of pharmaceutical opioids, coupled with an increase in heroin and fentanyl use, has resulted in a combined and interrelated epidemic . . . , as well as in an increase in morbidity and mortality related to opioids.” Understanding this context requires attention to two related processes. On the one hand, the huge increase in opioids prescribed in the United States generated a large supply of them that could be diverted to inappropriate consumption. On the other hand, this fueled an upward cycle of heroin use motivated by the decrease in its price and the increase in its purity as a consequence of the excess supply (Mars et al., 2014). According to the Drug Enforcement Adminnistration (DEA, 2017: 28) this is because people who use opioid drugs, when they cannot find or pay for them, migrate to cheaper and/or more available substances with similar effects. This assessment is corroborated by recent studies that point to a connection between the large increase in heroin overdoses and synthetic opioids from 2010 on and the reduced availability of prescribed opioids (Schuchat, Houry, and Guy Jr., 2017). In fact, after a dizzying increase in recent years there has been a relative stranglehold on the availability of prescription opioids. Nationally, on average, there was a 14.4 percent decrease in opioids prescribed between 2010 and 2016 (CDC, 2020a) because of stricter programs for monitoring the medical prescription of opioids and increased awareness of the health problems related to their use.

The current scenario of opioid use and overdose is thus marked by a great diversity of drugs. On the one hand, there are controlled drugs, produced legally. They can be obtained both licitly, by prescription, and illicitly, diverted from this legal market by theft, falsification of prescription guides, and illegal sale or distribution by pharmaceutical corporations, doctors, and patients themselves. On the other hand, there are drugs produced illegally. Heroin and synthetic opioids such as fentanyl are produced in illegal laboratories and sometimes look like pharmaceutical products, but they contain opioid or analogous substances of great potency and therefore carry a higher risk of overdose (UNODC, 2017: 13).

The United States considers the context of opioid use not only a national health emergency but a security issue with international dimensions. This narrative is expressed in the report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis as follows: “The opioid crisis is both a national security and homeland security threat that impacts the health of individuals and the safety of communities” (CCDA, 2017: 58).¹ The concept of a threat to public health gained expression in the U.S. presidential declaration of a national health emergency centered mainly on the high rates of deaths from overdose (United States, 2017b). For the U.S. government, however, the threat to public health is derived from another threat, domestic and international, represented by transnational opioid trafficking and the groups involved in it, and it is from this that Latin America has emerged as the main focus of the problem. According to the DEA (2017), Mexican and Dominican criminal groups are among the main actors responsible for this illicit opioid market in the United States. The main source of heroin in the U.S. market is the illegal cultivation of poppy in Mexico and, to a lesser extent, in Colombia, and the heroin reaches the country by land, through its southern border, and by air, mainly from Colombia, Guatemala, and Ecuador.

Recently, to make it more profitable, this drug has been mixed with fentanyl produced both in clandestine laboratories in China and, according to the DEA, in Mexican cities. Mexico is also one of the main centers for money laundering from this opioid trade. For their part, according to the DEA, the Dominicans, articulated with Mexican and Colombian criminal groups, are responsible for promoting the distribution of opioids in the United States along the country’s East Coast, including controlling retail trade in major cities such as New York, Philadelphia, and Boston. Thus, to a large extent, the opioid threat seems to be mixed up, in the United States, with a Latin American threat. According to the National Security Strategy (NSS, 2017: 11–12), the illicit opioid trade is one of the main sources of funds for the growth of organized crime organizations, assessed as one of the most significant transnational threats to the United States.

State Violence and the Opioid Market: The Latin American “Solution”

In one of his speeches on the opioid threat, Donald Trump, like other presidents before him, called for a “drug-free society” (United States, 2017b). He was referring, however, not to a society without opioids but to one in which the opioids used were produced and marketed licitly by transnational pharmaceutical corporations. Therefore, he also stated that his government would be “spending lots of money” in “an ambitious public-private partnership with pharmaceutical companies to develop non-addictive painkillers and new treatments for addiction and overdose” (United States, 2017b). Thus the reaffirmation that pharmaceutical corporations are the legitimate traders of opioid drugs reinforces the criminalization of groups that escape this circuit articulating capital and politics. In this opioid game of power and money, in which the illicit is the by-product of the licit, the focus of state protection is the capitalist corporation and the focus of state violence is distributed among individuals in the domestic and international space. Latin Americans, who have been in the crosshairs for decades, are witnessing the strengthening of this orientation due to the current context of opioid use in the United States.

As a strategy for dealing with the Latin American opioid threat derived from its illicit market, the U.S. government has deepened a set of coercive state mechanisms historically structured for the treatment of drugs as a “model of war” (Elkins, 2010). In this way, there has been a relativization of civil rights and an increase in violence directed at certain Latin American populations inside and outside the United States, in addition to the maintenance and empowerment of the state apparatus responsible for the logic of combating drugs, particularly the DEA. Crime is “productive”; it propels the criminal justice system and the diverse security industry, including arms manufacturers and surveillance technologies, lawyers, private security companies, prisons, and any number of other activities. The cost of the U.S. correctional system at the federal, state, and local levels in 2010 was US$80 billion, an increase of 350 percent in relation to 1980 while per capita expenditures increased by approximately 250 percent during the same period (Kearney et al., 2014: 13). These expenditures finance the supervision, confinement, and rehabilitation of adults and young people convicted of crimes and those still awaiting trial. This figure soars to US$261 billion when police protection and judicial services are included (see Kearney et al., 2014: 13). Thus the commodification of security favors the accumulation of capital derived from the control of opioids, whose annual budget in the Americas is in the billions. I say “in the Americas” because of the link between the U.S. budget for drug interdiction, which has an important element of international cooperation, and the budgets of Latin American countries such as Mexico.

This is evident in the recent meetings between agents of the United States and Mexico with the aim of developing or deepening repressive instruments to combat the flow of opioids between the two countries. In general, the proposals emerging from these meetings reaffirm the traditional repressive policies in force in the region for decades, expressed in the Plan Colombia of 1999 and the Mérida Initiative of 2008. Their focus is a direct attack on organized crime by the armed forces, arresting drug cartel leaders and destroying poppy fields and clandestine laboratories (Wayne and Olson, 2017). This strategy has promoted an increase in violence in several places, particularly where there has been a great development of the opium industry. By weakening certain criminal groups and fragmenting the power of the cartels, these actions promote an increase in clashes over territorial control of opioid production and flow. In Mexico, the state of Guerrero, for example, has become both the main heroin producer in the country and the most violent because of the conflict between the rival cartels Los Rojos and Los Ardillos and the violent action of state forces characterized by increasing levels of corruption (Epstein, 2017).

In a more general context, ever since President Felipe Calderón launched his “war on drugs” in 2006, with U.S. encouragement, the most noticeable change in the dynamics of drug trafficking in Mexico has been the huge increase in the number of violent deaths. In 2005, the number of intentional homicides per 100,000 people was 9,359; in 2018 it was 29,071 (World Bank, n.d.). In the past decade, more than 175,000 people have been killed in Mexico, with June 2017 representing the most violent month in two decades (Linthicum, 2017). U.S. policies, whether land-based or directed at ports and airports, have focused on the border, aiming to prevent the flow of opioids from Mexico. At the center of these actions are the investments planned for the infamous wall to be built on the southern border, Donald Trump’s segregationist mantra during his election campaign, which will cost an estimated US$21.6 billion (Ainsley, 2017). In February 2019 Trump declared a national emergency on the border with Mexico with the aim of gaining access to the funds necessary for this construction after Congress’s denial of them, which put in check the separation of powers spelled out by the constitution. U.S. Customs and Border Protection, meanwhile, requested an increase of US$260 million in its 2018 budget intended exclusively for opioid-fighting activities on the southern border, reaching a total of US$14.4 billion (United States, 2017a), an increase of 39 percent over the 2002 budget (United States, White House Office, 2002). Such policies and resources are in direct dialogue with the President’s Commission’s recommendation of “additional technologies and drug detection methods to expand efforts to intercept fentanyl before entering the country.”

The same report called, domestically, for a tightening of laws to combat drug trafficking, recommending the “enhancement of federal sentencing penalties for the trafficking of fentanyl and fentanyl analogues” (CCDA, 2017: 10). In response, Tom Cotton, a Republican senator, supported by several important government figures, presented a bill to Congress in which he proposed to lower the drug threshold for mandatory minimum sentences and increase the jail time for people convicted of marketing opiates. This logic tends to deepen the mass incarceration that the country is experiencing after decades of punitive policies directed mainly at the black and Latino/a population. In addition, the law also provides for the death penalty in specific cases. This demand has been made repeatedly by Trump, inspired, according to him, by the success of the policy of countries like the Philippines, which has seen thousands of extrajudicial executions per year. Attorney General Jeff Sessions, in turn, demanded increased Internet surveillance of the opioid trade and a more punitive stance on the part of prosecutors in states and municipalities across the country (Lopes, 2018).

The amount used at the federal level to fight drugs has increased along with the increase in opioid consumption and the growth of its illicit market. Between 2007 and 2017, federal programs increased their spending from US$21.7 billion to approximately US$27.5 billion (GAO, 2017: 5). Demand for 2018 was US$27.8 billion, an increase of US$300 million linked almost exclusively to combating opioids. With regard to supply reduction programs alone, there was an increase of 16 percent, from US$13.3 billion in 2007 to US$15.4 billion, in 2017 (GAO, 2017: 4–5). Demand for 2018 was US$15.6 billion, an increase of US$200 million (United States, 2017a: 6).

Since 2010, the number of prescriptions for opioid medications has fluctuated in the United States, with a steady decline from its peak in 2012. In that year, more than 255 million prescriptions were filled, representing 81.3 prescriptions per 100,000 inhabitants. In 2016 this number was 14.4 percent lower (CDC, 2020a). Some specific medications, such as OxyContin, have seen a 40 percent drop in sales since 2010 (Ryan, Girion, and Glover 2016). This decline is attributable to public awareness of the huge increase in harmful use and lethal opioid-related overdoses, regular warnings of the danger of treating chronic pain with this type of medication, stricter government monitoring of prescriptions, and CDC guidelines calling for alternatives.

In this context, some transnational pharmaceutical corporations have been expanding their market to other countries, including countries in Latin America, to maintain and/or increase their profits. A network of multinational pharmaceutical corporations called Mundipharma has been making such investments for some years. Belonging to the Sackler family, this transnational network is present in 120 countries and, according to the company itself, generates an annual income of US$3.4 billion (Mundipharma, n.d.a). Since 2013, it has launched operations in most Latin American countries, with an emphasis on the large markets of Mexico, Brazil, and Colombia (Mundipharma, n.d.b). Such markets have great growth potential, given that opioid consumption in the region, less than 1 percent of world consumption, indicates limited availability of analgesic opioids (Manjiani et al., 2014: 210). This is partly because these countries still have restrictive laws related to the use of opioids and partly because the cost of opioid therapies has until recently been prohibitive for much of the population (Manjiani et al., 2014: 210). The percentage of the annual distribution of opioids equivalent to morphine per patient in need of palliative care in Haiti and in Bolivia is, respectively, 0.8 percent and 6 percent, and Mexico, which has the highest percentage in the region, does not meet 64 percent of the demand for morphine for palliative care (Knaul et al., 2017: 2). Mundipharma’s investment in selected Latin American countries is due to the fact that those countries have growing middle classes capable of supporting the cost of this type of opioid medication and at the same time are healthy enough to consume these drugs for a long time.

Interviews of executives of Mundipharma Latin America reveal important aspects of this expansion process, such as the support that the conglomerate has received from government authorities to make such an undertaking feasible (Pharma Boardroom, 2014). Latin America is seen as potentially “one of the most significant growth drivers” in the medium term, with projected growth in Mexico of more than 25 percent in 2017 alone. Mundipharma Latin America aims to help public authorities “shape a more modern and patient-centric pain management regulatory framework,” for which it will be necessary “to work on enhanced access to highly regulated pain management products and increase the number of points of sale” (Pharma Boardroom, 2016). In Colombia, which is expected to invest heavily in publicizing the company via social media, sales of three opioid drugs recently launched—Oxyrapid, Targin, and Tramacontin—exceeded initial expectations, reaching a net value of US$3.4 million in 2017 (Pharma Boardroom, 2017).

According to an extensively documented report in the Los Angeles Times (Ryan, Girion, and Glover, 2016), Mundipharma Latin America is using marketing practices in Latin American countries similar to those that Purdue Pharma used in the United States. In medical seminars and media campaigns, the network’s companies have emphasized the need to “overcome” what they call “opiophobia”—the exaggerated fear of using opioids—while offering discounts to extend access to people who cannot afford the initial costs of the opioids prescribed (Mundipharma, n.d.c). One of the network’s main advertising tools for doctors and potential consumers is the testimony of “key opinion leaders”—doctors, university professors, and former employees of government health agencies or international agencies such as the World Health Organization who question the danger posed by the use of opioids. At the same time, the company invests in the dissemination of statistics suggesting that a large number of people need drugs to treat chronic pain. Regarding Mexico, Brazil, and Colombia, the conglomerate declared that 28, 80, and 22 million citizens, respectively, experience what they call the “epidemic silence” of pain (Ryan, Girion, and Glover 2016).

A study based on data from the National Health Surveillance Agency in Brazil suggests that these strategies are having an effect. The country recorded a 465 percent increase in the sale of prescription opioids between 2009 and 2015, reaching more than 9 million prescriptions. These are medicines based on codeine, oxycodone, and fentanyl produced by transnational pharmaceutical corporations and subject to little control by inspection agencies, which increases the risk of diversion and inappropriate use in the same way as in the United States beginning in the mid-1990s (Krawczyk et al., 2018). Given this context, the Public Prosecutor’s Office in Brazil has demanded clarification of the agency’s policy for monitoring opioid drugs such as OxyContin, the main concern being that the U.S. scenario will be reproduced in Brazil within a few years (MPF, 2018).

Conclusion

Drawing on process tracing of opioid use in the United States, this article exposes the relationship between drugs and capitalism and the strategies of pacification that result for Latin American populations. Reflecting the articulation identified by Foucault between the expansion of the pharmaceutical industry and the deepening of the medicalization of bodies, there was a huge expansion in the prescription and consumption of opioid drugs prescribed in the United States over almost 25 years. In this context, the political mechanism of the revolving door with government actors was decisive. This expansion had two perverse effects. On the one hand, this licit market generated high rates of overdoses among the U.S. population. On the other hand, indirectly it encouraged the expansion and diversification of the illicit market for opioid drugs. The U.S. government described this situation as a threat to national security, which, given the importance of Mexican and Dominican criminal groups in the operationalization of the illicit opioid market, is largely Latin American.

The resulting actions, adopted as emergency measures, have emphasized traditional policies based on the pursuit of a “drug-free society.” They are characterized by a coercive contribution in terms of violence and relativization of rights. These are policies based on the reinforcement of the law in the domestic sphere, interdiction of drugs, and international partners centered on the reduction of supply, which structure a cycle of repression and violence between the domestic and the international, a mark of the “pacification security job” as designated by Neocleous. In addition, they guarantee both the maintenance and the strengthening of the power of the state apparatus responsible for the logic of combating drugs.

The dynamics of the opioid market, in turn, also expanded to Latin America. With the drop in the sale of these drugs in the United States because of the public exposure of the problems related to them, as well as government measures to restrict their medical prescription, countries like Brazil and Mexico have become the focus of investment by large pharmaceutical corporations. This process expresses in a particular way the “capitalist imperialism” that Harvey discusses.

The context of the so-called Latin American opioid threat concerns the violence directed at Latin American populations within and outside the United States that are considered to be linked to the illicit opioid market. By reaffirming the distinction between licit and illegal, this violence protects actors in the social field considered legal and encourages a new space for the expansion of this market, designed by pharmaceutical corporations for certain Latin American countries. By this logic, the Latin American population fulfills two roles in the “solution” of the opioid threat. The first is to make it possible to reaffirm the authority of the state in the distinction between legal and illegal to guarantee the legitimacy of pharmaceutical corporations in the production and circulation of drugs. The second is to start consuming opioids produced in the legal sphere, thus guaranteeing the gains of transnational opioid drug corporations and the general process of capitalist accumulation. Both strategies export to the “foreign” the contradictions inherent in opioid control policy, exposing a complementary aspect of the relationship between capitalism and the war on drugs in addition to the expropriation theme emphasized by Paley.

Finally, drug-related capitalist accumulation has encouraged the instrumentalization of Latin American populations to “oppose” the opioid threat, either as a focus of violence by the state or as a focus of consumption by the market. This is the approach that makes it possible to eliminate the insecurity of capitalist accumulation in the sale of opioid drugs in an environment of formal peace that presupposes wide-ranging violence directed at the socially and economically most vulnerable. Such is the uneven pacification process that characterizes drug war capitalism.

Footnotes

Notes

Paulo Pereira is a professor of international relations and coordinator of the Transnational Security Studies Center at the Pontifical Catholic University of São Paulo (PUC-SP). He thanks the journal editors and the anonymous reviewers for their thoughtful comments toward improving this manuscript. The research was partly funded by the National Council for Scientific and Technological Development (CNPq) and by the PUC-SP’s Research Incentive Plan (PIPEq). Sean Purdy is professor of the history of the Americas at the Universidade de São Paulo.

References

Ainsley

Julia

2017 “Trump border ‘wall’ to cost $21.6 billion, take 3.5 years to build: internal report.” Reuters, February 9. https://www.reuters.com/article/us-usa-trump-immigration-wall-exclusive-idUSKBN15O2ZN (accessed September 28, 2020).

Andreas

Nadelmann

2006 Policing the Globe: Criminalization and Crime Control in International Relations. Oxford: Oxford University Press.

Bagley

Bruce

1988 “US foreign policy and the war on drugs: analysis of a policy failure.” Journal of Interamerican Studies and World Affairs 30 (2/3): 189–212.

Bennett

Andrew

2010 “Process tracing and causal inference,” Chapter 10 pp. 207–219 in Brady

Henry E.

Collier

David

(ed.), Rethinking Social Inquiry: Diverse Tools, Shared Standards. London: Rowman and Littlefield.

Boudreau

Denise

et al. 2009 “Trends in de-factor long-term opioid therapy for chronic non-cancer pain.” Pharmacoepidemiology and Drug Safety 18: 1166–1175.

Buxton

Júlia

2006 The Political Economy of Narcotics: Production, Consumption and Global Markets. London: Zed Books.

CCDA (Commission on Combating Drug Addiction) 2017 Final Report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Washington, DC: CCDA.

CDC (Centers for Disease Control and Prevention) 2019 “Annual surveillance report of drug-related risks and outcomes.” https://www.cdc.gov/drugoverdose/pdf/pubs/2019-cdc-drug-surveillance-report.pdf (accessed September 28, 2020).

CDC (Centers for Disease Control and Prevention) 2020a “Understanding the epidemic.” https://www.cdc.gov/drugoverdose/epidemic/index.html (accessed September 28, 2020).

10.

CDC (Centers for Disease Control and Prevention) 2020b. “Opioid Data Analysis and Resources.” https://www.cdc.gov/drugoverdose/data/analysis.html. (accessed September 28, 2020).

11.

CRP (Center for Responsive Politics) 2020a “Pharmaceuticals/health products: money to Congress.” https://www.opensecrets.org/industries/summary.php?cycle=2020&ind=h04 (accessed September 28, 2020).

12.

CRP (Center for Responsive Politics) 2020b “Pharmaceuticals/health products: lobbying.” https://www.opensecrets.org/industries/lobbying.php?cycle=2020&ind=h04 (accessed September 28, 2020).

13.

Christie

Nils

1998 A indústria do controle do crime: A caminho dos GULAGs em estilo ocidental. Rio de Janeiro: Forense.

14.

Correa-Cabrera

Guadalupe

2017 Los Zetas Inc.: Criminal Corporations, Energy, and Civil War in Mexico. Austin: University of Texas Press.

15.

Davies

Jonathan

2013 “Rethinking urban power and the local state: hegemony, domination and resistance in neoliberal cities.” Urban Studies Journal 51: 3215–3232.

16.

DEA (Drug Environment Administration) 2017 National Drug Threat Assessment. Washington, DC: Drug Enforcement Administration.

17.

Elkins

Jeremy

2010 “The model of war.” Political Theory 38 (2): 214–242.

18.

Epstein

Louis

2017 “The opioid crisis in America and Mexico.” Council on Hemispheric Affairs, August 1. https://www.coha.org/the-opioid-crisis-in-america-and-mexico/ (accessed September 28, 2020).

19.

Foucault

Michel

1982 Microfísica do poder. Rio de Janeiro: Graal.

20.

Foucault

Michel

1995 Discipline and Punish: The Birth of the Prison. New York: Vintage.

21.

Foucault

Michel

2009 Security, Territory, Population: Lectures at the Collège de France, 1977–78. London: Palgrave Macmillan.

22.

GAO (Government Accountability Office) 2017 Drug Control Policy: Information on Status of Federal Efforts and Key Issues for Preventing Illicit Drug Use. Washington, DC: GAO.

23.

Garland

David

1996 “The limits of the sovereign state.” British Journal of Criminology 36: 445–471.

24.

Grau

Lauretta

et al. 2007 “Illicit use of opioids: is OxyContin1 a ‘gateway drug’?” American Journal on Addictions 16: 166–173.

25.

Hall

P. A.

2003 “Aligning ontology and methodology in comparative politics,” pp. 373–404 in Mahoney

Rueschemeyer

(eds.), Comparative Historical Analysis in the Social Sciences. Cambridge: Cambridge University Press.

26.

Harvey

David

2004 “The ‘new’ imperialism: accumulation by dispossession.” Socialist Register 40: 63–87.

27.

Huysmans

Jef

2006 The Politics of Insecurity; Fear, Migration and Asylum in the EU. Abingdon: Routledge.

28.

Jasso-Aguilar

Rebeca

Waitzkin

Howard

2011 “Multinational corporations, the state, and contemporary medicine.” Health Sociology Review 20 (3): 245–257.

29.

Kearney

Melissa S.

Harris

Benjamin H.

Jacome

Elisa

Parker

Lucie

2014 “Ten economic facts about crime and incarceration in the United States.” Policy Memo, the Hamilton Project. https://www.brookings.edu/wp-content/uploads/2016/06/v8_thp_10crimefacts.pdf (accessed September 15, 2020).

30.

Kienscherf

Marcus

2016 “Beyond militarization and repression: liberal social control as pacification.” Critical Sociology 42: 1179–1194.

31.

King

Gary

Keohane

Robert O.

Verba

Sidney

1994 Designing Social Inquiry: Scientific Inference in Qualitative Research. Princeton: Princeton University Press.

32.

Knaul

Felicia Marie

et al. 2017 “Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission Report.” October 13. https://www.thelancet.com/commissions/palliative-care (accessed September 15, 2020).

33.

Krawczyk

Noa

Greene

M. Claire

Zorzanelli

Rafaela

Bastos

Francisco I.

2018 “Rising trends of prescription opioid sales in contemporary Brazil, 2009–2015.” American Journal of Public Health 108: 666–668

34.

Labate

Beatrice Caiuby

Cavnar

Clancy

Rodrigues

Thiago

(eds.) 2016 Drug Policies and the Politics of Drugs in the Americas. Berlin: Springer.

35.

Linthicum

Kate

2017 “More and more people are being murdered in Mexico—and once more drug cartels are to blame.” Los Angeles Times, March 3. https://www.latimes.com/world/mexico-americas/la-fg-mexico-murders-20170301-story.html

36.

Lopes

German

2018 “Senate Republicans’ new plan for the opioid crisis: the same old war on drugs.” Vox, April 12. https://www.vox.com/policy-and-politics/2018/4/12/17226680/senate-republicans-opioid-fentanyl-bill (accessed September 28, 2020).

37.

McAllister

William B.

2000 Drug Diplomacy in the Twentieth Century. New York: Routledge.

38.

McMichael

Christopher

2017 “Pacification and police: a critique of the police militarization thesis.” Capital and Class 41 (1): 115–132.

39.

Manjiani

Deepak

Paul

D. Baby

Kunnumpurath

Sreekumar

Kaye

Alan David

Vadivelu

Nalini

2014 “Availability and utilization of opioids for pain management: global issues.” Ochsner Journal 14 (2): 208–215.

40.

Mars

Sarah G.

et al. 2014 “‘Every ‘never’ I ever said came true’: transitions from opioid pills to heroin injecting.” International Journal of Drug Policy 25 (2): 257–266.

41.

Meghani

Zahra

Kuzma

Jennifer

2011 “The ‘revolving door’’ between regulatory agencies and industry: a problem that requires reconceptualizing objectivity.” Journal of Agricultural and Environmental Ethics 24: 575–599.

42.

Meldrum

Marcia

2016 “The ongoing opioid prescription epidemic: historical context.” American Journal of Public Health 106: 1365–1366.

43.

Morrell

Axel

2015 “The OxyContin clan: the $14 billion newcomer to Forbes 2015 List of Richest U.S. Families.” Forbes, January 7. https://www.forbes.com/sites/alexmorrell/2015/07/01/the-oxycontin-clan-the-14-billion-newcomer-to-forbes-2015-list-of-richest-u-s-families/?sh=3c902ba575e0

44.

MPF (Ministério Público Federal) 2018 Ofício No. 306/2018/PFDC/MPF. Brasília: MPF.

45.

Muhuri

Pradip K.

Gfroerer

Joseph C.

Davies

M. Christine

2013 “Associations of nonmedical pain reliever use and initiation of heroin use in the United States.” CBHSQ Data Review, August. https://www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.htm (accessed September 15, 2020).

46.

Mundipharma n.d.a “About Mundipharma.” https://mundipharma.eu/about-mundipharma/ (accessed September 15, 2020).

47.

Mundipharma n.d.b “Global network.” https://mundipharma.eu/about-mundipharma/global-network/ (accessed September 15, 2020).

48.

Mundipharma n.d.c “Descontador.” http://www.descontodor.com.br/cadastro.aspx (accessed January 30, 2018).

49.

Musto

David

1999 The American Disease: Origins of Narcotic Control. Oxford: Oxford University Press.

50.

Neocleous

2011 “‘A brighter and nicer new life’: security as pacification.” Social and Legal Studies 20 (2): 191–208.

51.

Neocleous

2014 War Power, Police Power. Edinburgh: Edinburgh University Press.

52.

Netherland

Hansen

2017 “White opioids: pharmaceutical race and the war on drugs that wasn’t.” Biosocieties 12 (2): 217–238.

53.

NSS (National Security Strategy) 2017 National Security Strategy of the United States of America. The White House. Washington, DC.

54.

Paley

Dawn

2015 Drug War Capitalism. Oakland, CA: AK Press.

55.

Pereira

Paulo

2015 “Os Estados Unidos e a ameaça do crime organizado transnacional nos anos 1990.” Revista Brasileira de Política Internacional. 58 (1): 84–107.

56.

Pharma Boardroom 2014 “Mundipharma Mexico—Francisco Rodriguez, General Director.” https://pharmaboardroom.com/interviews/mundipharma-mexico-francisco-rodriguez-general-director/ (accessed September 15, 2020).

57.

Pharma Boardroom 2016 “Interview, Francisco Rodriguez—General Manager Mexico & Latin America, Mundipharma.” https://pharmaboardroom.com/interviews/interview-francisco-rodriguez-general-manager-mexico-latin-america-mundipharma-2/ (accessed September 15, 2020).

58.

Pharma Boardroom 2017 “Interview, David Leclercq—General Manager, Mundipharma Colombia.” https://pharmaboardroom.com/interviews/interview-david-leclercq-general-manager-mundipharma-colombia/ (accessed September 15, 2020).

59.

Reiss

Suzanna

2014 We Sell Drugs: The Alchemy of US Empire. Oakland: University of California Press.

60.

Rueschemeyer

Dietrich

2003 “Can one or a few cases yield theoretical gains?” pp. 373–404 in Mahoney

Rueschemeyer

(eds.), Comparative Historical Analysis in the Social Sciences. Cambridge: Cambridge University Press.

61.

Ryan

Harriet

Girion

Lisa

Glover

Scott

2016 “OxyContin goes global.” Los Angeles Times, February 28. https://www.latimes.com/projects/la-me-oxycontin-part3/ (accessed September 15, 2020).

62.

Schuchat

Anne

Houry

Debra

Guy

Gery P.

Jr.

2017 “New data on opioid use and prescribing in the United States.” Journal of the American Medical Association 318: 425–426.

63.

Stagnitt

M. N.

2015 Trends in Prescribed Outpatient Opioid Use and Expenses in the U.S. Civilian Noninstitutionalized Population, 2002–2012. Statistical Brief 478. Rockville, MD: Agency for Healthcare Research and Quality.

64.

Timmer

Doug

1982 “The productivity of crime in the United States: drugs and capital accumulation.” Journal of Drug Issues 12: 383–396.

65.

Trachtenberg

Marc

2006 The Craft of International History: A Guide to Method. Princeton: Princeton University Press.

66.

United States 2017a “National drug control budget, FY 2018 funding highlights.” May. https://www.state.gov/national-drug-control-strategy/ (accessed September 20, 2018).

67.

United States 2017b “Remarks by President Trump on combatting drug demand and the opioid crisis.” October 26. https://www.whitehouse.gov/briefings-statements/remarks-president-trumpcombatting-drug-demand-opioid-crisis/ (accessed September 29, 2020).

68.

United States, White House Office 2002 “Securing the homeland, strengthening the nation.” https://www.jsd.org/?abstract&did+855 (accessed September 15, 2020).

69.

UNODC (United Nations Office on Drugs and Crime) 2017 World Drug Report. Vienna: UNODC.

70.

Van Zee

Art

2009 “The promotion and marketing of OxyContin: commercial triumph, public health tragedy.” American Journal of Public Health 99 (2): 221–227.

71.

Vargas

E. V.

2008. “Fármacos e outros objetos sócio-técnicos: notas para uma genealogia das drogas,” pp. 41–64 in Labate

Beatrice Caiuby

Cavnar

Clancy

Rodrigues

Thiago

(eds.), Drogas e cultura: novas perspectivas. Salvador: Editora da Universidade Federal da Bahia.

72.

Wacquant

Loїc

2003 Punir os pobres: A nova gestão da miséria nos Estados Unidos. Rio de Janeiro: Editora Revan.

73.

Wayne

Earl Anthony

Olson

Eric L.

2017 “Mexico and the U.S. agree on a vision for fighting drugs.” Wilson Center, May 23. https://www/wilsoncenter.org/article/mexico-and-the-us-agree-vision-for-fighting-drugs (accessed September 15, 2020).

74.

World Bank n.d. “Intentional homicides (per 100,000 people)—Mexico.” https://data.worldbank.org/indicator/VC.IHR.PSRC.P5?locations=MX (accessed September 29, 2020).