How The DEA Blows Big Pharma’s Role In The Opioid Epidemic
October 25, 2016 (Fault Lines) – Unless you live under a rock, you know there is a growing epidemic of opiate abuse. Heroin is back with a vengeance, in large part because of the growing prescription painkiller market. The trip from taking a few extra pills to shooting up in a back alley smack house starts in the friendly confines of your local doctor’s office and typically ends in the morgue.
Who is responsible for this? Turns out there are a number of people to blame, and some not so usual suspects.
To start with, people just want to get high. Doctors are careless with their prescriptions. But people are in pain, and that sucks. And doctors have to work a whole lot harder and faster today to make a buck, which also sucks. So if we look past people wanting to get high, and doctors trying to make a living, who is left out there to blame for the painkiller mess?
All these drugs have to come from somewhere. The Drug Enforcement Administration and the pharmaceutical companies are ultimately responsible for how much dope controlled substance is manufactured in America. The companies apply for manufacturing amounts and the DEA approves those amounts. Seems reasonable.
In 1993, the DEA allowed pharmaceutical companies to manufacture 3,520 kilograms of oxycodone. In 2015, the DEA authorized production of 137,500 kilograms of oxycodone. That’s a 39-fold increase in 22 years, the equivalent of turning two Buicks into four Boeing 737s. Either Americans are in 39 times more pain than we were 20 years ago, or something else is wrong.
That startling increase should be a pretty easy trail for the DEA to follow. If it’s going to enforce the administration of drugs, seems like going straight to the source is a good starting point. Cartels are the target in the regular War on Drugs, right? But this is America, and business is business. Turns out drug organizations that use corporate lawyers and accountants instead of guns and smugglers get treated a whole lot differently.
A recent Washington Post article on the DEA’s role in the opioid epidemic explains how drug companies have managed to bear little of the cost of that epidemic.
A decade ago, the Drug Enforcement Administration launched an aggressive campaign to curb a rising opioid epidemic that was claiming thousands of American lives each year. The DEA began to target wholesale companies that distributed hundreds of millions of highly addictive pills to the corrupt pharmacies and pill mills that illegally sold the drugs for street use.
That makes sense. Go after the source. The addicts and the doctors are probably a drop in the bucket. So figure out why there are too many pills on the market, choke down the supply to reasonable levels, and problem solved at least addressed. But that was not to be, as often happens when Big Government and Big Business hop into bed together.
But the industry fought back. Former DEA and Justice Department officials hired by drug companies began pressing for a softer approach. In early 2012, the deputy attorney general summoned the DEA’s diversion chief to an unusual meeting over a case against two major drug companies.
“That meeting was to chastise me for going after industry, and that’s all that meeting was about,” recalled Joseph T. Rannazzisi, who ran the diversion office for a decade before he was removed from his position and retired in 2015.
“Fighting” is an interesting way to phrase that. Big Pharma convinced a high-level federal prosecutor to call off an agent. That’s not really fighting. It’s something. It starts with an “f”. But it’s definitely not fighting.
Rannazzisi wasn’t scared off by the meeting and continued the hunt. Of course, he learned that when your boss doesn’t want you to do something, there are a whole lot of ways to make you stop. Rannazzisi’s primary method of combating prescription drug abuse was civil actions against pill wholesalers playing fast and loose with supply rules. There’s an easy way to stop that.
“Things came to a grinding halt,” said Frank Younker, a DEA supervisor in the Cincinnati field office who retired in 2014 after 30 years with the agency. “I talked to my fellow supervisors, and we were all frustrated. It was ridiculous. I don’t know how many lives could have been saved if the process was done quicker.”
The slowdown began in 2013 after DEA lawyers started requiring a higher standard of proof before cases could move forward.
Unlike some street drug you can grow in the backyard or concoct in your basement lab, painkillers are actually manufactured by legitimate pharmaceutical companies. They are spread around the country by distributors. Distributors to whom no one has been paying the slightest bit of attention.
For years, the DEA had taken a hands-off approach to the prescription drugs flowing out of the distributors. The companies had been reporting their drug sales inconsistently or not at all. They had been largely left alone as the DEA focused on doctors and pharmacies.
“The distributors had been ignored for years and years and years,” John J. Coleman, the third-ranking administrator at the DEA in the mid-1990s, said in a recent interview.
Maybe these are just innocent businesses. What do companies like Cardinal Health care about painkiller abuse? Somebody else’s problem, right? How on earth could Cardinal be expected to know its pills were not being used for legitimate medical purposes?
Rannazzisi’s office obtained an internal Cardinal email from 2010 showing that the company’s own investigator had warned against selling narcotics to Gulf Coast Medical Pharmacy, an independent drugstore in Fort Myers, Fla., citing suspicions that the pills were winding up on the street.
Despite the warning, Cardinal hadn’t notified the DEA or cut off the supply of drugs.
Instead, the company shipped increasing quantities of pain pills to Gulf Coast. In 2011 alone, Cardinal sent more than 2 million doses of oxycodone to Gulf Coast. The wholesaler typically shipped 65,000 doses annually to comparable pharmacies.
Oh. Well, yeah. That might be a red flag. If you give a damn about the addiction problem you are fueling with 30 times the normal amount of the most powerful painkiller in the world. But this is a $10 billion business, so things are handled a little differently.
Money quickly shut down the investigation into Cardinal. Not dirty forfeitable cash money. Real money. Pharmaceutical money.
Rannazzisi said [high-ranking Justice Department official] Dinan told him: “We’re getting calls from attorneys, former Justice people, that are saying you guys are doing some enforcement action.”
Not just any attorneys. The kind that get shit done.
Among the attorneys representing Cardinal at the time were two former deputy attorneys general, Jamie S. Gorelick, who served in the Clinton administration, and Craig S. Morford, who served in the George W. Bush administration. Both contacted the DEA, records show.
Did they get shit done? Well, yeah. Of course. That was back around 2012. It’s now 2016, but the company hasn’t even been fined.
In the last several years, the situation at DEA doesn’t seem to have improved, as higher-ups continue to block efforts to rein in the pharmaceutical industry. After a clash with Congress, Rannazzisi was removed from his job. The dispute came to a head after he criticized a law that treated drug distributors favorably. A law that was, in part, the result of $13 million in lobbying efforts.
From a pure law enforcement standpoint, the drug problem in America consists of street drugs and prescription drugs. The source of those drugs are overseas cartels and the pharmaceutical industry. One of those runs a billion-dollar industry, thumbs its nose at regulation, buys off politicians, and generally doesn’t give a damn about the harm its drugs cause. The other one is a cartel.