Opioids now kill over 100 Americans every day. In a single year, opioids kill more Americans than died in the entire Vietnam and Iraq Wars. And while the underground drug trade is fueling this epidemic of medicalized self-destruction, the flow of black-market opioids is inseparable from its above-ground counterpart—the pharmaceutical companies that peddle the legal and FDA-approved pain killers like OxyContin and Vicodin. And now workers on the front lines of this crisis are challenging the nation’s biggest pushers to stop pumping deadly drugs into their neighborhoods.

The Teamsters, whose members have struggled with the crisis of both illegal and legal opioid abuse, are wielding their shareholder power to link Big Pharma’s primary distributors to the logistical chain swelling opioid markets to a breaking point. At the August shareholder’s meeting of pharmaceutical wholesaler McKesson, the union leadership, as direct share owners, called for reforms to the company’s supply-chain monitoring and rejected a pay raise for its CEO. They have issued a similar call before the board of drug giant AmerisourceBergen, demanding that the company investigate its sales practices and review its executive-compensation levels.

The Teamsters might be known for a tough blue-collar image, but members have lately been sharing heart-rending stories of how the trauma of opioid addiction has consumed their families. Many of the Rust Belt strongholds where their locals have community ties have seen a surge of overdose deaths, along with the joblessness and dwindling treatment resources that deepen their exposure to the crisis. The Teamsters see the massive opioid death toll as having structural roots in the overprescribing of painkillers. A profit-driven medical industry has for years been feeding medication dependencies that often rapidly spiral into illegal heroin use. The pattern of induced dependency is perpetuated by a severe lack of comprehensive, community-based social supports for treatment, preventive care, and basic economic aid in many struggling working-class regions.

The union’s critiques parallel legal actions by states and counties against pharmaceutical distributors, which accuse the industry of flooding the markets that supply painkiller addiction and overburdening Medicaid-funded treatment programs. McKesson recently reached a $150 million settlement with the Justice Department over its allegedly systematic failure to report suspicious mass deliveries (on top of a $13.25 million civil penalty in 2008 over similar regulatory violations).

Teamsters General Secretary-Treasurer Ken Hall, whose home state of West Virginia has one of the highest opioid-related death rates, says Big Pharma should act to address the nationwide epidemic it helped cause. “Our nation’s health-care companies should be in the business of saving lives, not destroying them,” Hall said in a statement to The Nation. But drug wholesalers “have lavished executives with hundreds of millions in compensation over the past decade and funded industry lobbying efforts to weaken regulatory enforcement as tens of thousands of Americans fatally overdosed on an oversupply of painkillers that they pumped into our communities.”

The “Big Three” drug wholesalers—McKesson, Cardinal Health, and AmerisourceBergen—which collectively control about 85 percent of the market, have repeatedly denied contributing to the crisis. Yet there is ample evidence the industry has repeatedly circumvented reporting rules. Aided by a spigot of campaign cash, the pharmaceutical lobby has kept federal oversight of drug marketing anemic.

At every link in the supply chain, from interstate truck routes to warehouses to neighborhood pharmacies, Teamsters workers both occupy and operate the front lines of the crisis.

Teamsters member and officer Travis Bornstein of Ohio broached the issue of combating the opioid epidemic at the Teamster’s 2016 convention. He spoke publicly about his son Tyler’s death from a heroin overdose, after tumbling from a student-athlete career to addiction to painkillers and then street drugs. He perished after repeated relapses, while facing a devastating wait time for a state-funded treatment program.

Initially, Bornstein recalled feeling “embarrassed of my son,” viewing his death as a reflection of a father’s “moral failure.” He gradually learned that his personal crisis flowed from a wider epidemic afflicting about 200,000 fellow Ohioans. The opioid scourge, he warned, was “in every workplace, craft, or division, that our union represents…this epidemic is having a direct impact on our members.” (Truck drivers, in fact, who operate on exhausting, socially isolating work schedules, are especially prone to narcotics addiction). Moreover, a strong link has emerged between labor-force attrition and opioid prescriptions. According to the Brookings Institution, “Over the last 15 years, the labor force participation rate fell more in counties where more opioids were prescribed.” Whether the painkiller epidemic is a cause or an effect of an eroding economy, it strikes at the heart of the low-wage workforce the Teamsters represent.

There’s work to be done by labor groups on a grassroots level: As worker-led institutions, unions can provide support and resources for workers and campaign to combat stigma. In Ohio, the Teamsters have helped Bornstein launch a community organization promoting drug rehabilitation. In Washington, labor is also denouncing the Trump administration for failing to tackle opioids, among many other public-health issues. Candidate Trump cynically coddled addiction-stricken voting districts by promising to fix the crisis, and although Congress has recently moved to tighten medication regulations, Trump’s campaign-trail vow has foundered. His push to smother the Affordable Care Act and defund the Centers for Disease Control threaten to destroy efforts to develop a systematic public-health response.

Beyond mutual aid and campaigning, labor is leveraging its role as financial stakeholder by hammering executives of the top drug distributors, who collectively draw hundreds of millions a year from legal drug trafficking. There may be a political pivot ahead: McKesson’s board recently voted in favor of the Teamsters’ proposal to establish an independent commission to investigate marketing practices and review CEO compensation. In response, Hall hailed the move, but noted that reforming the industry had to be paired with “real executive pay reform that establishes accountability and promotes responsible, sustainable business practices over the long term.”

While the opioid industry can’t police itself, workers’ communities bear witness to the social disaster plaguing the distribution and consumption ends of the gray market in painkillers. In workplaces, schools, and emergency rooms, rehab programs alone won’t quell the rising death toll. The health-care system manufactures its own pathology, because the corporate and political institutions driving the market fail to see that every dose of painkillers they push could lead to immeasurable pain in communities across the country.