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Drug Industry, Congress fuel Opioid Epidemic

A DEA whistleblower told CBS News that Congress derailed the DEA’s attempt to keep addictive opioids off U.S. streets.  Joe Rannazzisi ran the DEA’s office of Diversion Control during the worst drug epidemic in American history.  His division regulates and investigates the drug industry.  In a joint investigation by 60 Minutes and The Washington Post, Mr. Rannazzisi revealed how the opioid crisis was allowed to spread.  It was aided by Congress, lobbyists, and a drug distribution industry that shipped hundreds of millions of pills to rogue pharmacies and pain clinics.  Those loads fueled the opioid crisis that has killed some 200,000 people in the last 20 years.

People Die for Drug Profits

“This is an industry that’s out of control,” Mr. Rannazzisi told CBS’ 60 Minutes.  “What they wanna’ do, is do what they wanna’ do, and not worry about what the law is. And if they don’t follow the law in drug supply, people die.  That’s just it.  People die.”

Mr. Rannazzisi said drug distributors turned a blind eye and “allowed millions and millions of drugs to go into bad pharmacies and doctors’ offices, that distributed them out to people who had no legitimate need for those drugs.”

A former DEA deputy assistant administrator armed with law and pharmacy degrees, Mr. Rannazzisi seemed most upset with the distributors, some of them multibillion dollar, Fortune 500 companies.  These blue-blood middlemen ship the pills from makers like Purdue Pharma and Johnson & Johnson to drug stores countrywide.  Mr. Rannazzisi accuses the distributors of fueling the opioid epidemic by pretending not to see pills being diverted for illicit use.

“This is an industry that allowed millions and millions of drugs to go into bad pharmacies and doctors’ offices,” said Mr. Rannazzisi, “that distributed them out to people who had no legitimate need for those drugs.”

The Perps – Cardinal Health, McKesson, AmerisourceBergen

Mr. Rannazzisi said the three largest distributors are Cardinal Health, McKesson, and AmerisourceBergen.  They control some 85-90 percent of the drugs flowing downstream.  Mr. Rannazzisi said these companies knew they were pumping drugs into American communities and killing people.

Opioids Oxycodone, Hydrocodone

Opioids like oxycodone and hydrocodone became a routine medical treatment for chronic pain by the late 1990s.  Drug companies assured doctors and congressional investigators that the pain pills were effective and safe.  A Purdue Executive told Congress in 2001 that addiction was rare in the pain patient properly managed.

Many doctors were apparently convinced the opioids posed few risks (or apparently knew nothing about the long sordid history of opioid abuse); so prescriptions skyrocketed along with addiction.

Many who had become addicted to painkillers turned to what CBS news called “pill mills” – pain clinics featuring rogue doctors who would write fraudulent prescriptions and complicit pharmacists to fill them, one stop shops for legal drugs.

Drug Dealers in Lab Coats

Mr. Rannazzisi said many pain clinics popped up overnight.  The whole fiasco “made the crack epidemic look like nothing.”  He said, “They were just drug dealers in lab coats.”  But despite several arrests, opioids kept flooding the black market while the death toll kept rising.

Mr. Rannazzisi said that prosecuting crooked doctors and pharmacists failed to slow the epidemic, so he moved up the food chain.  He said the DEA saw hundreds of bad orders involving millions of tablets, so the agency started going after the distributors.

Distributors Required to Monitor Suspicious Orders

A distributor’s representative told CBS that doctors who overprescribe pain medication were the problem.  However, the distributors know exactly how many pills go to every drug store they supply.  The Controlled Substances Act requires distributors to report and stop what the DEA calls “suspicious orders.”  These include unusually large or frequent shipments of opioids.  DEA investigators said many distributors simply ignored that requirement.  (The better to profit, my dear.)

Former DEA man Jim Geldhof told CBS, “Their plan was to sell a lotta pills and make a lot of money. And they did both of those very well.  All we were looking for is a good-faith effort by these companies to do the right thing. And there was no good-faith effort. Greed always trumped compliance. It did every time.”

9 Million Pills for 392 People?

A 40-year DEA veteran, Mr. Geldhof ran pharmaceutical investigations from the Detroit field office.  Frank Younker supervised the DEA’s operations in Cincinnati.  Joe Rannazzisi was their supervisor. They saw distributors shipping thousands of suspicious orders. In one example, a pharmacy in tiny Kermit, West Virginia (Pop. 392) ordered nine million hydrocodone pills over two years.

With such obvious signs, Mr. Geldhof finds it ludicrous that the distributors now claim they didn’t see suspicious orders. He says the companies are culpable in the epidemic: “I can tell you with 100 percent accuracy that we were in there on multiple occasions trying to get them to change their behavior. And they just flat out ignored us.”

McKesson, Cardinal Health Fined Millions

In 2008, the DEA slapped McKesson, the country’s largest drug distributor, with a $13.2 million dollar fine. That same year, Cardinal Health paid a $34 million fine.  Both companies were penalized by the DEA for filling hundreds of suspicious orders – millions of pills.

Distributors fines have totaled more than $341 million over the last seven years. The companies complained to Congress that DEA regulations were vague and said the agency was treating them like a foreign drug cartel.  In a letter, the healthcare distribution alliance, which represents distributors, said they wanted to work with the DEA.  Effective enforcement, they wrote, “must be a two-way street.”

Drug Distributors flex Political Muscle

More than 17,000 Americans died from opioid prescription overdoses in 2011, the year Cardinal Health started pushing back at Joe Rannazzisi.  Cardinal’s attorneys called his bosses at the Justice Department, who called in Mr. Rannazzisi to explain his tactics.

Money and Influence

Joe Rannazzisi told CBS he was infuriated at having to explain his motives for going after corporations.  He told his staff they were in a war: “We’re going after these people and we’re not going to stop.”  But he was hamstrung by his own agency.

He said the drug industry used its money and influence to pressure top DEA lawyers to take a softer approach.  Former DEA attorney Jonathan Novak said it divided the litigation office. He said in 2013 that he noticed a sea change in the way prosecutions of big distributors were handled. Cases his supervisors once would have easily approved were no longer good enough.

Mr. Novak told CBS that they had achieved “incredible success in an almost unstoppable wave,” but suddenly his caseload dramatically slowed as his bosses began to scuttle the whole system, demanding unreasonable amounts of evidence.

Big Pharma minions in Congress then moved to further defang the DEA and save corporate profits at the expense of U.S. Citizens.  See the whole story at CBS News.

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