The Opioid Crisis Is About More Than Corporate Greed – By Zachary Siegel – Jul 2019
Nearly every step of the pharmaceutical supply chain is implicated in the soaring death rate.
But the companies claim to have been acting legally and in compliance with federal regulators like the Drug Enforcement Administration (DEA).
Was it all, technically, legal?
Of course, it was legal; pharmaceutical companies are enjoying their legal scheme of profiteering and wouldn’t do anything to endanger that privilege.
What the opioid crisis illustrates is not that there are a few bad apples in the pharmaceutical industry, but that the country’s entire health care system is driven by profit at the expense of public health and safety.
This statement sums up our situation correctly. This is not just about pain medication, but about the whole medical-industrial complex.
- Drug manufacturers,
- pharmacy chains,
- drug distributors, and
- insurance companies
got rich while people, especially people lower down the income ladder, suffered—and the DEA, through neglect or incompetence or a mix of both, watched it all happen.
…opioids, which are, theoretically, tightly controlled substances that pass through a dizzying array of actors and regulators.
Opioids are only “tightly controlled” at the final end-user, as patients are harassed more and more about needing these medications that provide them their only effective pain relief.
First, a doctor must write a prescription, which must be filled at a pharmacy, and is likely paid for by an insurance company.
Depending on the needs of their customers, pharmacies place orders for these drugs (customers, it turns out, need a lot of them). Shipping companies then go between the pharmacy and the drug manufacturers.
Overseeing this entire system is the DEA, which sets the quota for how many opioids a company is allowed to manufacture, and tracks where those pills go.
If the DEA “tracks where those pills go”, how can we account for all the pills that made their way to the black market? I’m sure they didn’t get there just from grandma’s medicine cabinet.
While politicians are making hay out of Big Pharma’s wanton greed and recklessness, far less attention has been paid to the DEA. Attorneys general suing Big Pharma recently unearthed a database that both the corporations and the government—each for their own self-interested reasons—fought to keep sealed, called the Automation of Reports and Consolidated Orders System (ARCOS).
Mammoth in size and granular in detail,ARCOS tracks the shipments of every single controlled substance, from the company that manufactured it, to the company that shipped it, to the pharmacy that received it. It is the world atlas for how the opioid crisis began.
While drug manufacturers produced more and more opioids (approved by the DEA), and distributors shipped those pills to pharmacies all over the country (tracked by the DEA), drug companies saw record profits—and America’s overdose death rate soared off the charts.
So, the DEA controlled the process for which we’re now suing the opioid manufacturers. If the companies “should have known” their medications were being abused, shouldn’t the DEA have known as well? And, if the DEA knew pain pills were being diverted and abused, why did they keep increasing the quotas? Why didn’t the DEA find the “leads” in the supply chain that were spilling pills into the black market?
What is the DEA’s job, exactly?
- Its first task, and the one most associated with the agency, is the Sicario-esque disruption of illicit flows of drugs coming into the U.S. from abroad, like intercepting speedboats filled with cocaine.
- Its other major responsibility is controlling licit pharmaceuticals.
We’re supposed to believe that the DEA is “on top of” the illicit drug situation (that’s their job, remember?) and at the same time believe they were unable to disrupt the flow of illicit fentanyl. Instead, they started going after doctors, who so helpfully document what they prescribe to whom.
“The whole goal of the prescription system is to make sure that patients are getting their medications, and that medications are not going to those who aren’t patients,” which is called “diversion,” says Bryce Pardo, a drug policy researcher at the RAND Corporation. “That’s the whole point of the system, which was invented a hundred years ago. Clearly, the system broke. The system failed.”
In drug policy scholarship, there is a concept called the “balloon hypothesis.”
When one end of a balloon gets squeezed, the air inside, rather than disappearing, rushes to fill the other end of the balloon. The balloon hypothesis is used to describe, often critically, America’s drug enforcement strategy.
If cocaine production in Colombia is stamped out, production will shift to, say, Peru. If the Dark Web’s Silk Road gets shut down, a new Dark Web market pops up. The air has to go somewhere.
The balloon hypothesis also applies to the ever-shifting demand for drugs.
“Over a period of 20 years, the DEA provided the green light to a 39-fold increase in the oxycodone quota and a 12-fold increase in the hydrocodone quota, even as our opioid epidemic unfolded,” Senator Dick Durbin wrote in a letter to the editor to The Washington Post.
It’s pretty hard to believe this nation needed between 12 times and 39 times as much pain medication than 20 years ago. The DEA essentially “legalized” this volume of supposedly super-addictive medication, but now we’re blaming the companies who followed those rules.
In other words, the prescription balloon expanded, under the DEA’s watch, big time.
But starting in 2011, the prescription market finally began to shrink after Purdue Pharma reformulated its blockbuster drug OxyContin with so-called abuse deterrent technology, and pill mills serving the black market were shut down.
The supply was squeezed. The air still had to go somewhere, and it rushed to deadlier opioids like heroin spiked with illicit fentanyl. With enforcement focused on prescription opioids, the overdose crisis got worse.
Dan Ciccarone, a physician-researcher at the University of California, San Francisco who studies heroin use, says the crisis unfolded in three waves: Prescription painkillers gave way to old-fashioned heroin, which gave way to illicit fentanyl.
“The only solution to the puzzle is to focus on demand,” he adds. “And we’ve been avoiding this for years. We need to structurally reduce demand through a healthier society.”
This truth is becoming ever more painfully clear, and it’s also clear there will be no simple or easy solutions because this crisis of addiction has arisen from the fumes of society’s rot.
We’re focusing on supply because we’ve been told by so many government agencies for so many years that it works, even though we can easily see how this strategy has failed us over and over.
Anyone who understands anything about addiction knows that its major symptom is to do whatever it takes to procure the drug of choice, no matter what the cost. People are willing to risk everything, their money, their friends and family, their freedom and even their lives because they cannot tolerate being without the drug. The compulsion is so strong that even the risk of being shot at and dying doesn’t stop them.
And still, we’re supposed to believe that “punishment”, like putting them in jail, is going to “teach them a lesson” or make them think it’s “too risky” to keep taking their drugs. Who is dumb enough to believe that?
The greatest risk for them is going to jail, not because of the loss of freedom, but because they’ll have to go through agonizing withdrawals.
Author: Zachary Siegel is a writer based in Chicago. His work has appeared in The New York Times Magazine, The Atlantic, Slate, and WIRED, among others. @ZachWritesStuff