Are We Surprised Congress Helped Further the Opioid Crisis?
By: Jen Jordan
President Trump tweeted Tuesday morning that Representative Tom Marino withdrew from consideration for drug czar. Shocking given that 60 Minutes & the Washington Post just exposed him and the entire federal government for the hypocrites they are in our war against opioid abuse. While hundreds of thousands of U.S. citizens died of prescription drug overdoses, our government has been protecting drug manufacturers and distributors. The government was slow to acknowledge the opioid crisis and only did so after it became impossible to ignore any longer, mainly because Prince died. Now we see that the government has been protecting the supply chain. And coincidentally it was Trump’s proposed drug czar, Rep. Marino, who was the chief advocate for legislation that gutted the DEA’s ability to control illegal opioid drug distribution.
Put forth as an effort to “guarantee patient access” to needed drugs, the “Ensuring Patient Access and Effective Drug Enforcement Act of 2016” (S. 483) was passed to amend the Controlled Substances Act to redefine the DEA’s authority to register manufacturers, distributers and dispensers of controlled substances. Because the DEA could suspend a registration to prevent imminent danger to the public health and safety, the bill prevented overzealous DEA actions to crack down on diversion that were getting in the way of patients filling needed prescriptions. The bill expanded the required elements of an order to show cause issued by the DEA before it could deny, revoke or suspend a registration for a Controlled Substances Act violation, effectively gutting the DEA’s ability to shut down bad pharmacies and pill mills. The Marino Bill sailed through Congress without debate, was unanimously passed and ultimately signed into law by President Obama without a second thought.
In work comp, physicians have told us that they can’t refuse a patient treatment, so we end up paying for things we shouldn’t because they don’t want to be sued. Occasionally our PBMs catch diversion and shut it down and we take that as a win. But the industry has been unfairly held hostage to financing more than its fair share of this epidemic due to factors outside its control. So to find out that the DEA was trying to identify pill mills and to shut them down before Congress stripped it of that power, we have to wonder if it was really access to needed pain medication that Congress was protecting. The types of problematic investigations the DEA initiated that Congress felt compelled to stop identified situations such as a mid-sized pharmaceutical distributor that had shipped more than 28 million pain pills to pharmacies in West Virginia over five years, 11 million pills of which ended up in a county with a population of 25,000. Another was a pharmacy in Kermit, WV, population 392, that ordered nine million hydrocodone pills over two years. If that does not rise to the level of suspicious behavior that we would hope our Drug Enforcement Agency could control, then what does? But instead investigations like these were viewed by Congress as interfering with patients access to needed pain medication, almost as if it threatened Obamacare itself. Can $106 million in lobbying expenses over two years really buy that much denial? I guess it is naïve to believe that the federal government exists to protect its citizens.
In April, the Trump administration announced the first federal grant to combat the opioid crisis [https://www.hhs.gov/about/news/2017/04/19/trump-administration-awards-grants-states-combat-opioid-crisis.html]. While billions of dollars have gone into prescription sales that enabled the addictions in question, $485 million was supposed to help fix the problem? The stated aim of the grant was to increase access to treatment, reduce unmet need, and reduce overdose related deaths – not slow the manufacturing or distribution. Of the total grant, West Virginia was slated to receive $5,881,983, an amount that likely pales in comparison the state’s monthly pharmaceutical sales revenues. And while this sadly inadequate amount of money cannot possibly treat the amount of addiction that exists in this country today, new addicts will continue to join the ranks as vast quantities of these drugs remain readily accessible on the open market.
There is one observation with regard to “access” to medication and our government’s desire to control it that hasn’t received enough attention as everyone scurries to lay blame for the epidemic. Did anyone happen to notice that spikes in overdose deaths seem to coincide with increased access to health care? In this chart provided by NIH [https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates], there are noticeable increases following 2006 and 2010. I think it is no coincidence that those spike follow the implementation of the Medicare Modernization Act’s Part D prescription drug coverage on January 1, 2006 which suddenly provided prescription drug coverage to 60+ million elderly and disabled citizens, and the implementation of the Affordable Care Act which increased, among other things, Medicaid enrollment, employer paid health plans and subsidized coverage to many previously without insurance. Another coincidence is the DEA identification of Amerisource Bergen as one of its top three distributors that did not appreciate the agency’s oversight and invested nearly $5 million towards lobbying efforts that included support for the Ensuring Patient Access and Effective Drug Enforcement Act. Yes, that would be the same Amerisource Bergen that invested rather heavily in the work comp space back in 2006 and purchased an MSA company for $83 million just after future drug allocations were added to MSAs in order to gain access to the post-settlement prescription drug market. There’s no such thing as coincidence – more insurance with less control equals more sales and they clearly want as much unfettered market share as possible.
So as we anxiously await Trump’s next pick for the person who will head the White House Office of National Drug Control Policy, let us hope that person is not already in the pocket of big pharma.