Opioid Distributer Concealed Diverted Shipments

McKesson hid security flaws that fueled opioid epidemic, the lawsuit alleges – by ALEX KACIK  – Dec 2019

McKesson Corp. allegedly concealed security flaws in its supply chain, which fueled the opioid epidemic, according to a recently unsealed whistleblower case.

Former employees at the wholesale drug distribution giant claim that McKesson would hide the extent of its security issues from the federal government and falsely represented that it would comply with two settlement agreements. Millions of the addictive pain pills were diverted to the black market as a result, according to the lawsuit.

This is the source of all the opioid medications that flooded the black market. (I’ve been pointing this out for years.)  

Drug Diversion in Hospitals

Drug Diversion: New Approaches to an Old Problem – Gregory Burger, MS, RPh, FASHP, and Maureen Burger, MSN, RN, CPHQ, CPPS, FACHE – Feb 2016

Regulations for hospitals have changed little since the Controlled Substance Act of 1970.

DEA investigators conduct scheduled investigations and unannounced visits to DEA registrants, ensuring that correct recordkeeping is being followed.

The agency has conducted several high-profile investigations in the last few years, resulting in multi-million dollar fines and organizationally significant corrective action plans. 

Pharmaceutical Supply Chain Thefts

Pharmaceutical Supply Chain Thefts – CA State Board of Pharmacy – Virginia Herold, Executive Officer – Aug 2013

This text from a PowerPoint Slide Presentation gives a view into a high impact, but little-discussed, type of drug diversion: from the supply chain where huge amounts of pills are shipped and stored in various warehouses.

Changes in Controlled Substance Loss Profile

2000 – TEN YEARS AGO

• manufacturing losses rare
• wholesale losses rare, usually losses within the wholesale premises
• pharmacy losses – varied and small some self use.

Prescription Opioid Diversion by Theft

Prescription Opioid Diversion & Abuse – a powerpoint presentation by John J. Coleman, PhD, DEA Assistant Administrator for Operations – Mar 2016

This is an interesting glimpse into how the DEA sees the “opioid crisis” as arising from diversion of medication prescribed to pain patients, instead of being fueled by the massive thefts from the supply chain.

The workers handling all those pills aren’t as monitored and scrutinized nearly as carefully as individual patients, who have to submit to random pill counts.

Drug Diversion: How It’s Done…

Doctor Shoppers (casual & pro): Probably account for more diversion than estimated

No: PDMP’s have shown there are fewer “doctor shoppers” than expected.

DEA: No Guidance for Opioid Wholesalers

The DEA expects opioid supply-chain wholesalers to report “suspicious” orders without the necessary information which is collected, but not shared, by the DEA itself. Below is a statement given by an opioid wholesaler to the House of Represenatives in May 2018 that explains the problem:

“WRITTEN STATEMENT OF JAMES CHRISTOPHER SMITH FORMER PRESIDENT AND CHIEF EXECUTIVE OFFICER, H.D.SMITH LLC BEFORE THE SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS COMMITTEE ON ENERGY AND COMMERCE U.S. HOUSE OF REPRESENTATIVES PRESENTED MAY 8, 2018″

H.D.Smith was only one part of a complex supply chain, and we could not see all the information up and down the chain that could flag a potential problem.  

The Opioid Crisis Is About More Than Corporate Greed

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.

Clinical Drug Diversion Costly

Clinical Drug Diversion Costly to Health Care Organizations – Clinical Pain Advisor – Mar 2019

U.S. health care organizations lost nearly $454 million due to clinical drug diversion in 2018, according to the 2019 Drug Diversion Digest, released by Protenus Inc.

This article is written from the viewpoint of “Practice Management”, which nowadays isn’t about “practicing medicine” but about how to make money from it. These folks measure opioids by money gained/lost.

THE DEA always brags about how many pills/doses of opioids they confiscate in their raids, but here opioids aren’t counted by the pill of the MME, but by the mighty dollar. 

Diversion of Opioids from Pharma Supply Chain

Diversion of opioids from supply chain –  by Alex Kacik  | September 16, 2017

For years, opioid tablets in the pharmaceutical supply chain have been diverted in massive batches of hundreds of thousands of pills.

This brings to mind that when Slick Willie Sutton was asked why he robbed banks (as opposed to bank customers), ihe said: “because that’s where the money is”. The pharmaceutical supply chain is where the most opioid pills are.

there has been a major push to pinpoint the vulnerabilities in a fragmented pharmaceutical supply chain to stem the flow of illicit prescription drugs.  

Cutting Rx Opioid Supply Is Not Stopping Diversion

Cutting Rx Opioid Supply Is Not Stopping Diversion — Pain News Network – by Roger Crhiss – Oct 2018

Drug diversion is an increasingly important factor in the opioid overdose crisis.

A new report from Protenus found that 18.7 million pills, valued at around $164 million, were lost due to drug diversion in the United States during the first half of 2018. This represents a vast increase over 2017, when 20.9 million pills were diverted during the entire year.

I’ve posted before about my suspicions that it’s large scale diversion in the supply chain that’s feeding the availability of prescription opioids on the black market, not pain patient prescriptions. These huge numbers of diverted pills make clear that these diverted prescription opioids are not from grandma’s medicine cabinet, but these events don’t “make the news”. 

Lessons from ‘Prescription Drug Diversion and Pain’

Lessons from ‘Prescription Drug Diversion and Pain’ — Pain News Network – September 28, 2018 – By Roger Chris

The new book“Prescription Drug Diversion and Pain” is a textbook treatment of pain management and drug policy amid the opioid crisis.

Written and edited by experts, the book is a scholarly, rigorous and evenhanded examination of the benefits and burdens of opioid pain medication.

Each chapter is written by specialists who address a particular aspect of the opioid crisis, with extensive footnotes justifying every statistic and claim. Much of that data, however, is admittedly flawed.