Death by Congress

On October 15th, 2017, The Washington Post published a story detailing the myriad ways that the pharmaceutical industry, in this instance, the subgroup of drug distribution companies, had lobbied Congress to draft and pass legislation that made it harder for the Drug Enforcement Agency to seize suspect shipments of prescription pain pills, as well as allowing companies to explain their actions and submit corrective action plans before facing any sanctions from the Drug Enforcement Agency. I encourage you to read the piece, as it is excellent reporting, but I will summarize it briefly and add my two cents as someone working directly downstream.

The real life translation of the above reality is this: Drug distribution companies fill orders that come in from pharmacies such as Walgreen’s, CVS, or other smaller shops. As they fill these orders, they have a responsibility to ensure that they are not filling illegitimate orders, which could be used to divert prescription opioids (i.e. oxycodone). A series of illegitimate orders might look something like a single county in West Virginia with a population of 25,000 people receiving shipments of more than 11 million doses of oxycodone and hydrocodone in a five year span, which is what happened in Mingo between 2007 and 2012, per the Post’s report.

In years gone by, the DEA had the capacity to seize shipments from drug distributors that appeared suspect, a tool to combat the unscrupulous doctors and pharmacies that make up what many people call “pill mills”. In 2014, Representative Tom Marino (R-PA) introduced a bill that essentially neutralized the power of the DEA to stop these shipments, something that the industry was in favor of because it kept them from being fined, and kept their shipments moving forward with fewer obstacles; which translates in both cases to higher profits.

It will come as no surprise to you that Tom Marino has received industry donations totaling $92,500 since 2013, or that many of the other co-sponsors of his bill, Democrats and Republicans alike, are also willing recipients of industry money.

What may surprise you-as it surprised me-is that the chief architect of Rep. Marino’s bill, the Ensuring Patient Access and Effective Drug Enforcement Act, was just three years removed from his position as DEA associate chief counsel. D Linden Barber had been one of the key people involved in the formulation of the DEA’s cases against the industry, and in 2011 he left the DEA to enter private practice as a lawyer representing drug companies facing DEA compliance issues. He is one of the 56 DEA and Justice Department officials who have left to join the pharmaceutical industry since 2000, according to the Post. That date is important, as it is the year commonly understood to be the starting point of the opioid epidemic.

If you want more detail on the extent of the depravity and neglect of the Executive and Legislative branches of the federal government in handling this specific area of the opioid crisis, I encourage you to read the article. It perfectly underscores why a populist movement can take root in America, and why those who are complicit in these sorts of operations have their voices of morality falling on deaf ears.

The bureaucracy of the United States is such that the opportunities to protect consumers abound. In a case like this, the structure put in place to protect Americans was operationalized to advance the causes of an industry that was doing nothing short of contributing to the wanton manslaughter of American citizens. By the time Marino’s bill was drafted, 121,468 Americans had died from a prescription opioid overdose since 2000. To say nothing of those who had died of a heroin overdose, an addiction brought on by prescription opioid use at a rate of nearly 80%.

The bill passed unanimously in the House and Senate, and was signed into law by President Obama on April 19th, 2014, met by cheers from the pharmaceutical industry, who have done everything in their power to ensure that they can sell their pills, pocket their money, and protect their interests, despite absolutely damning evidence that their products cause more harm than good. Harm that manifests as emotional pain of families who have lost sons and daughters, physical pain in the form of addiction and withdrawal, harm in the form of exorbitant costs that have been and will continue to be borne by the American taxpayer to address the issue at hand. These pills do not, by and large, address the pain concerns they are purported to address. They do not come without demonstrative and catastrophic risks. They have not, and will not, be stopped by the “good will” or common sense of our elected officials because our elected officials have had the opportunity, time and again, and have punted on the responsibility of standing up to their funders and shouting them down. Tom Marino comes from a district in Pennsylvania that encompasses Lycoming County, where 106 people have died of opioid overdoses since he first introduced his bill in 2014. But to Tom Marino, $92,500 and the promise of more to come down the line is a much bigger number than 106. And the same can be said for the majority of Congress.

It breaks my heart, and infuriates me to my core, that as I work in Juneau, Alaska to address the community-specific causes of the opioid epidemic here, I read about people in all levels of power in the United States government who have spit in the face of the work that I’m doing here. And the work of a family therapist in Tennessee, or a chemical dependency counselor in Ohio. If we want to be kind, we can say that the people in power, those elected and not, do not understand the realities of the opioid epidemic as it unfolds in real ways. How else could they justify their actions? More importantly, how else can they justify their inaction, in the face of the absolute destruction many communities have faced?

But I don’t want to be kind. I’m pissed off, and I’m sick of the pretense that people involved here are by and large good folks who don’t know better. They aren’t. The people involved are bad people. Or perhaps good people, who are engaged in terrible, unforgivable things. Every bit of the Washington Post article confirms that to me. The inclusion of the term “Ensuring Patient Access” confirms that to me. That term is a misnomer, a plant by the opioid industry to scare people into thinking that the government is going to take away their pain pills. The pain pills that the same industry has lied to them about regarding their effectiveness and their addictive properties. It’s a red herring, and a blaring trumpet all in one, saying right off the bat, “I know how to play you dumbasses like a fiddle, and by God, me and my $92,500 are gonna do it.” No sane person looks at the state of opioid prescribing in America, with its tripled output since 2000, and its death toll of over 200,000 Americans and says, “We better make patient access a priority.” Only someone protecting an interest would make that argument.

It is the job of Congress and the government, et al. to know the issues and protect their constituents. They are not doing their job. I think it’s time that they answered for that.