“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
WASHINGTON — Lawmakers and the Drug Enforcement Administration are facing tough questions following an explosive joint investigation by “60 Minutes” and The Washington Post that says Congress helped disarm the DEA.
Drug overdose deaths in the United States have more than doubled over the past decade. The CDC says 188,000 people have died from opioid overdoses from 1999 to 2015.
Joe Rannazzisi used to run the DEA’s diversion control. He told “60 Minutes” correspondent Bill Whitaker that the opioid crisis was aided in part by Congress, lobbyists and the drug distribution industry.
The DEA says it has taken actions against far fewer opioid distributors under a new law. A Justice Department memo shows 65 doctors, pharmacies and drug companies received suspension orders in 2011. Only six of them have gotten them this year.
“This is an industry that’s out of control”
The DEA has issued no suspension orders against a distributor for nearly two years. It says in a statement it will continue to “use all the tools at our disposal to combat this epidemic.”
“During the past seven years, we have removed approximately 900 registrations annually, preventing reckless doctors and rogue businesses from making an already troubling problem worse,” the DEA said in a written statement. “Increasingly, our investigators initiated more than 10,000 cases and averaged more than 2,000 arrests per year.”
CBS News’ Paula Reid reports the Justice Department, which overseas the DEA, does not dispute any of the “60 Minutes” reporting. It says the drug crisis is a top priority for the Trump administration.
“One of the president’s and the attorney general’s highest priorities is ending the devastating and unacceptable drug crisis in America that saw 64,000 deaths in 2016, many of them caused by opioids,” Ian D. Prior, principal deputy director of public affairs at the Justice Department, said in a written statement. “From street dealers to corrupt doctors to the distributors that allow diversion of deadly pills, this administration is absolutely committed to reversing this disturbing and heartbreaking trend and will use every tool available to do so.”
But as the “60 Minutes” report detailed, the DEA’s efforts may have been undermined by the so-called “revolving door” culture in Washington.
At least 46 investigators, attorneys and supervisors from the DEA, including 32 directly from the division that regulates the drug industry, have been hired by the pharmaceutical industry since the scrutiny on distributors began.
Did the government and drug industry fuel America’s opioid epidemic?
Among them is Linden Barber, former associate chief council at the DEA. He’s now a senior vice president at Cardinal Health, one of the nation’s top drug distributors.
Mike Gill, chief of staff for the former acting DEA administrator, was hired by one of the country’s largest healthcare law firms.
And most recently, Jason Hadges, a senior DEA attorney overseeing enforcement, joined the pharmaceutical division of a high-powered D.C. law firm.
CBS News reached out to former acting DEA administrator Chuck Rosenberg, who oversaw the agency from May 2015 until earlier this month when he stepped down. He said he has not seen the “60 Minutes” story and does not intend to do so.
“Joe Rannazzisi is not gonna give this fight up,” says Whitaker. “He’s like a dog with a bone. He’s going to pursue this until he gets some satisfaction.”
In the video player above, watch the full Overtime interview (produced by Will Croxton, Lisa Orlando, and Ann Silvio) or read the transcript below:
CREW: Speeding, We’re good, Let’s go…
BILL WHITAKER: Okay. Well, Joe, if you would first of all please state your name, so we have it at the top of your interview?
JOE RANNAZZISI: Okay. My name is Joseph Rannazzisi—
BILL WHITAKER: My story on 60 Minutes this week is about a former DEA agent who saw the opioid epidemic growing, and tried to stop it, and ran into a brick wall in the form of Congress.
JOE RANNAZZISI TO CONGRESS: 16,651 people in 2010 died of opiate overdose, ok? Opiate-associated overdose. This is not a game.
BILL WHITAKER: Are you the most high-level whistleblower to come out of the DEA?
JOE RANNAZZISI: As far as this? Yes. As far as pharmaceutical opioid abuse and the way we’ve handled it? Yeah, I’m pretty much the highest-level person that’s come out.
60 MINUTES OVERTIME: Joe Rannazzisi is in your story called one of the most important whistleblowers ever to be on 60 Minutes. What’s your sense of what drives him?
BILL WHITAKER: He is a no-nonsense principled man. He saw this crisis and wanted to stop it. What he zeroed in on was the distribution of the pills. So he started to put pressure on the distributors. And the distributors pushed back.
JOE RANNAZZISI: This is an industry that 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.
BILL WHITAKER: This story was like a continuation of the two previous stories we did on the opioid crisis. That one was personal.
Health & Science
The Heroin Epidemic
[Excerpt from “The Heroin Epidemic“: ANGIE PELFREY: We call this the “death wall.” BILL WHITAKER: The death wall? ANGIE PELFREY: Yes. BILL WHITAKER: Why is that? ANGIE PELFREY: Majority of the people on this wall have died of drug overdose. BILL WHITAKER: I thought of those people we met and the people who died– all the time. MAN: There’s 23 in there on the wall from my hometown. BILL WHITAKER: Is it a small town? MAN: Yeah.]
BILL WHITAKER: It seems that some investigators with the DEA were aware that these pills were getting out of the pharmacies and into the streets, and they tried to ring the alarm bells. But not only did no one pay attention to them, it seems that members of Congress took steps to try to limit the DEA’s abilities to stop this. And the result was a bill in Congress that actually ended up taking away the most potent tool that the DEA had to go after the distribution of so many drugs.
JOE RANNAZZISI: This bill is going to protect defendants that we have under investigation, that we are investigating. And it restricts or prevents us from filing immediate suspension orders to stop– to stop the hemorrhaging of drugs downstream.
CONGRESSMAN TOM MARINO: It is my understanding that Joe Rannazzisi, a senior DEA official, has publicly accused we sponsors of the bill of –quote supporting criminals –unquote. This offends me immensely.
BILL WHITAKER: You know you have a reputation. And even people who support you tell us that you can be a bit of a hothead. True?
JOE RANNAZZISI: Yeah, I do get angry. I get angry when people don’t do their jobs. I get angry when people don’t do their jobs well.
BILL WHITAKER: And this crisis that he saw happening in front of his eyes enraged him.
JOE RANNAZZISI: I– I– I’m guilty. I’m guilty of being passionate. I’m builty of b– guilty of being angry. But I think anybody else in that situation would’ve done the exact same thing.
BILL WHITAKER: “People are dying.” He would say that to us over and over and over again. “People are dying.” So he was trying to figure out what he could do about it. And every time he ran into a roadblock, he got angrier and more forceful. And it depends on who ya talk to what his reputation is. If you talk to his investigators, the people who worked in the field for him, they love him. You talk to some people in Washington– at the DEA– his higher-ups at the DEA or at the Justice Department, certainly in Congress, they think he was too aggressive, to the point of being boorish.
JOE RANNAZZISI: What I needed was support. And it infuriated me that I was over there, trying to explain what my motives were or why I was going after these corporations. And when I went back to the office, and I sat down with my staff, I basically said, “You know, I just got questioned on why we’re doing– why we’re doing what we’re doing. This is– now this is war. We’re going after these people, and we’re not gonna stop.
BILL WHITAKER: He’s not the most diplomatic person you’ve ever come across.
60 MINUTES OVERTIME: No, but he makes a good whistleblower.
BILL WHITAKER: He makes a great whistleblower, and he’s got a reason to be upset.
JOE RANNAZZISI: It just hurts when somebody says, “Well, DEA should be doing more.” DEA was doing everything it could. DEA ran into a wall.
60 MINUTES OVERTIME: Do you think this investigation by 60 Minutes and The Washington Post will make waves?
BILL WHITAKER: I sure hope so. This is a terrible crisis. What I would hope would happen from this story is that Americans get angry.
60 MINUTES OVERTIME: It doesn’t look like Joe Rannazzisi’s gonna let this go.
BILL WHITAKER: Joe Rannazzisi is not gonna give this fight up. He’s like a dog with a bone. He’s going to pursue this until he gets some satisfaction.
CONGRESSMAN TOM MARINO: You know before coming to Congress, I was a prosecutor and an United States Attorney.
BILL WHITAKER: Congressman Marino has been nominated to be the next drug czar. What was your reaction when you heard that?
JOE RANNAZZISI: Total disbelief. Total disbelief. He’s just not qualified to do that job. Besides the fact that he pushed through a bill that’s curtailing the ability of DEA to do their job, I don’t understand how you could look at a congressman who’s done all of this and then decide he would be a great drug czar– to basically set policy for the United States; drug policy for the United States.
BILL WHITAKER: We will soon have a hearing with Congressman Marino. I would think that this would be an issue that will be brought up in his hearings.
JOE RANNAZZISI: The bill was bad. Him being the drug czar is a lot worse.
Could this “whistle blower” just be unhappy that those in the medication distribution system “pooled money from their deep pockets” to beat the DEA at their own game.
He was obsessed that a claimed 200 million people died of opiate OD’s in TWO DECADES… It takes Nicotine use/abuse on SIX MONTH to kill that many and Alcohol TWO YEARS .. and medical errors SIX to TWELVE MONTHS to kill that many people.
Abortions kill that many in abt THREE MONTHS… the questions has to be asked… is abortion necessary because all too many people are “addicted to sex”… and have no personal control over their “urges” ?
And those are just the LARGE NUMBERS of deaths caused by various substances or actions
Medical examiners in New York and Florida made significant errors when they attributed the recent deaths of two young men to the herbal supplement kratom, according to a new analysis commissioned by the American Kratom Association, a pro-kratom consumer group.
At issue are the sudden deaths of Matthew Dana in upstate New York in August and Christopher Waldron in Hillsborough County, Florida in July. Both men were 27.
A medical examiner listed Waldron’s cause of death as “intoxication by Mitragynine,” one of the active ingredients in kratom. The coroner who performed the autopsy on Dana blamed his death on a hemorrhagic pulmonary edema (blood in the lungs) caused by high levels of kratom.
“In both of these cited cases, the conclusions reported by the coroner and medical examiner citing ‘kratom overdose’ and ‘kratom intoxication’ appear to add to the long list of mistaken, inaccurate, and now discredited reports implicating kratom,” wrote Jane Babin, PhD, a molecular biologist and lawyer.
“These two cases, where it appears there was a rush to judgment to align with a political narrative promoted by the Drug Enforcement Administration on kratom use, undermine the credibility of the search for the actual cause of death for the benefit of the decedent’s family and the public.”
Babin said mitragynine has never been found to cause a pulmonary edema, and the medical examiner erred in not analyzing Dana’s blood for drugs such as anti-anxiety medication or anabolic steroids. Dana was a police sergeant and bodybuilder, who reportedly used steroids as part of his bodybuilding program.
Babin said the medical examiner in Florida also “rushed to judgement” in blaming Waldron’s death on kratom. Two prescription medications used to treat depression and muscle spasms, Citalopram and Cyclobenzaprine, were also found in Waldron’s blood. Labels on both drugs warn they can cause coma or death when taken together. Waldron also had ventricular hypertrophy, an enlarged liver and thyroid disease, which may have contributed to his death, according to Babin’s report.
“What I see here are very troubling indications that these deaths may have been incorrectly attributed to kratom in the face of other causes, including possible anabolic steroid use in one case and contraindicated prescription medication interactions that could kill on their own,” said Karl Ebner, PhD, a toxicologist who reviewed the report.
“These families are owed the best evidence about what happened to their loved ones, not what would appear to be some conclusions that are incompletely supported by the current evidence.”
Millions of people use kratom to treat chronic pain, depression, anxiety and addiction. Last year, the DEA attempted to list kratom as a Schedule I controlled substance, which would have made it a felony to possess or sell. The DEA said kratom was linked to several deaths, as well as psychosis, seizures and an increased number of calls to poison control centers
The DEA suspended its plan after an outcry and lobbying campaign by kratom supporters.
“Last year, the DEA tried to demonize kratom. In 2017, the kratom community finds itself in the same situation all over again,” said David Herman, chair of the American Kratom Association (AKA). “This time, we are being told that two deaths were supposedly the result of kratom use. Let me be very clear about this: We do not believe that kratom caused these deaths. That’s what the science tells us.
“Given that there are millions of kratom consumers in the U.S., if this botanical was dangerous it would stand to reason that there would be thousands … or even tens of thousands of deaths … and that is absolutely not the case.”
The AKA backed another study last year that found kratom has little potential for abuse and dependence. Most kratom users say the herb has a mild analgesic and stimulative effect, similar to coffee.
Former CDC director Tom Frieden, MD, and Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University in Waltham, Mass., shared 10 actions the federal government should take to address America’s opioid overdose crisis in a paper published Thursday in JAMA.
The two “experts” open the paper by describing the nation’s ongoing opioid crisis as the worst drug addiction epidemic in the country’s history. Opioid deaths quadrupled between 1995 and 2010, according to the paper. By 2015, more than 33,000 people died of an opioid-related overdose in the U.S. More than 90 million people were issued an opioid prescription in 2015.
Here are the 10 steps Dr. Frieden and Dr. Kolodny laid out in the paper.
1. Improve surveillance of opioid addiction with real-time assessment of data, patterns and trends.
2. Improve quality and timeliness of response to opioid-related overdoses and fatalities by delivering better data to law enforcement and increasing funding for coroners and medical examiners.
3. Promote cautious opioid prescribing for acute pain by pushing the Food and Drug Administration to change opioid labels to reflect the CDC acute pain prescribing recommendations, which suggest a three-day supply is ample for acute pain, but exceptions of seven-day prescriptions will sometimes be warranted.
4. Greatly restrict or completely eliminate opioid prescriptions for chronic pain.
5. Expand insurance coverage and access for nonopioid and nonpharmacological pain medications.
6. Coordinate efforts between legal and public health officials to stem the international influx of heroin and deadly synthetic opioids like fentanyl into the U.S.
7. Incentivize states to identify possible opioid addiction in patients early and provide them access to treatment for substance use.
8. Expand access to medication-assisted opioid addiction treatments.
9. Promote harm reduction measures like access to naloxone and clean needles.
10. Consider banning ultra-high-dose opioids from the marketplace.
“The opioid addiction epidemic has worsened over the course of a generation and will not end overnight,” the “experts” wrote. “Rapid implementation of the 10 steps outlined here could enable tracking and reduction of both new opioid addiction and fatal overdoses … the healthcare system has a responsibility to support actions … that could prevent addiction and save lives.”
Two Wisconsin political figures were swept up Wednesday in apparent drug overdose cases in the latest examples of how drug addiction plagues the state despite a myriad of legislative efforts to curb it
GREEN BAY, Wis. (AP) — Two Wisconsin political figures were swept up Wednesday in apparent drug overdose cases in the latest examples of how drug addiction plagues the state despite a myriad of legislative efforts to curb it.
In one case, Cassandra Nygren, the 28-year-old daughter of Republican state Rep. John Nygren, was booked into the Brown County jail early Wednesday on suspicion of first-degree reckless homicide/deliver drugs and manufacture/delivery of heroin, among other potential charges. She has not yet been formally charged.
Separately, word surfaced that authorities searched former state Democratic Party Executive Director Jason Sidener’s Fitchburg home after a woman died from a drug overdose. A search warrant filed this week said Sidener told police he woke up Sept. 12 to find a 30-year-old woman in his house “breathing really weird.” He took her to the hospital, suspecting heroin use, the Wisconsin State Journal reported.
“Stories today are another reminder that addiction crisis knows no boundaries,” Republican Gov. Scott Walker tweeted. “Prayers for all in the fight.”
Brown County Sheriff’s Department Chief Deputy Todd Delain told USA Today Network-Wisconsin that Cassandra Nygren and a 33-year-old man were arrested in a recent drug death. Delain would not say who overdosed.
Cassandra Nygren’s arrest is the latest chapter in her long battle with drugs. She spent two years prison after a near-fatal overdose. She was released in 2014, becoming an advocate for sobriety, but was convicted again in 2015 of drug possession and admitted to drug court, an alternative program aimed at helping participants fight addiction.
Nygren’s struggles spurred her father to offer multiple bills aimed at curbing opioid addiction over the years. Walker has signed nearly 30 bills sponsored by Rep. Nygren since 2013 dealing with opioids, but they’ve had little effect so far.
According to state data, 1,524 people died of opioid-related overdoses between 2013 and 2015, compared with 1,381 people over the previous three-year period. The data show 622 people died in 2014 and 614 in 2015, the two highest annual death totals since 2003. Last year, 837 people died of opioid overdoses. An additional 204 people died from overdosing on other drugs.
John Nygren said in a statement that his daughter’s arrest is another example of “the disastrous and destructive consequences” of addiction.
“Cassie has publicly struggled with addiction and recovery for several years. This is a strong reminder of how fragile the road to recovery is. We will continue to support and pray for her recovery,” the lawmaker said in a statement.
Rep. Nygren also extended condolences for the loss of life. “There are no words that we as a family can offer to give any real comfort for this tragic loss,” he said.
Sidener, the former Democratic Party leader, told police he picked up Monique Allen at a motel the night of Sept. 11 and brought her home, according to the search warrant affidavit. They used marijuana and she was fine when he fell asleep, he said. He woke up at 5 a.m. and her body “was like a pile of mush.”
Sidener said in text messages to Allen sent between Sept. 9 and Sept. 11 that he was doing the “hard stuff,” which police said meant heroin or cocaine. Allen said it would be fun to do that with him.
Sidener hasn’t been arrested or charged, but his home and vehicle were searched as part of a death investigation. An inventory shows authorities found crack cocaine, needles and other drug paraphernalia. Sidner’s attorney didn’t immediately return messages from The Associated Press on Wednesday.
Sidener became executive director of the Democratic Party of Wisconsin in December, but court documents show he was recently fired for performance issues.
Party spokeswoman Melanie Conklin said in an email that Sidener took medical and family leave in August. He returned to work briefly in September before leaving, saying that the “road to recovery would be longer than expected.” She said she could not comment further about personnel matters.
The Drug Enforcement Administration’s attempts to curb the opioid epidemic as deaths increased were thwarted by powerful forces in Washington, according to a joint report by “60 Minutes” and The Washington Post.
The report, which airs at 7:30 p.m. Sunday on CBS, was previewed Friday morning on “CBS This Morning.” The story will appear in the Post’s Sunday edition.
Every day in this country, 91 people die in the crisis.
Reporters Bill Whitaker of “60 Minutes” and Scott Higham of The Post talked about the investigation, which makes the point that big companies have been complicit in the drug deaths.
Joe Rannazzisi, a former deputy assistant administrator, blasts distributors for fueling the epidemic and ignoring the deadly toll. “This is an industry that 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,” he tells Whitaker.
How bad is the situation?
“This is an industry that’s out of control,” Rannazzisi said. “What they want to do is do what they want to do, and not worry about what the law is. If they don’t follow the law in drug supply, people die. That’s just it.”
In the preview Friday morning, the reporters said that DEA investigators were running up against a drug industry that’s incredibly powerful in Washington because of lobbying and spending in Congress.
Whitaker said the distributors ship the drugs and are required to keep track of every pill, but one West Virginia town of 300 people received 9 million opioid pills over several years. “The DEA whistleblowers we talked to said that happened again and again and again,” Whitaker said.
The bottom line: The drug companies are more influential with lawmakers than their constituents’ suffering, Whitaker said.
The DEA people saw cases they were building languish and “die on the vine” in Washington because of lobbying, Higham said.
The report on “60 Minutes” will be double in length. The six-month investigation is also the work of Lenny Bernstein of The Post and ”60 Minutes” producers Ira Rosen and Sam Hornblower.
hboedeker@orlandosentinel.com and 407-420-5756.
“This is an industry that 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,
These same DEA licensees were granted licenses to prescribe/dispense controlled substances BY THE DEA… as well as the state medical/pharmacy licensing boards giving them licenses/authority to prescribe/dispense controlled substances. BUT…the DEA/ medical/pharmacy licenses boards have no responsibility or culpability in what happened ?
Like a lot of other things in our country no one accepts personal responsibility for what happens…. it must be the FAULT OF SOMEONE ELSE.
“Interdiction is critically important to increase the cost and reduce accessibility of opioids,” write former Centers for Disease Control chief Thomas R. Frieden and Brandeis University’s Andrew Kolodny in a new paper for the Journal of the American Medical Association. “As with tobacco and alcohol, if heroin and illicitly produced synthetic opioids such as fentanyl are more expensive and more difficult to obtain, use should decrease.”
But we don’t need to extrapolate from alcohol and tobacco policies to figure out what a heroin shortage would do to consumption. The United Kingdom and Australia both experienced heroin droughts in the last decade and a half. It would be wise to look at what happened in those countries before ramping up interdiction efforts in the U.S.
How Heroin Users in the U.K. Responded to the 2010–2011 Heroin Shortage
What happened to users? Mandatory drug testing revealed a large drop in positive heroin tests, from 45 percent before the drought to 21 percent in January 2011. While less heroin meant less heroin use, it didn’t mean less risky drug consumption. According to surveys conducted by researchers at the London School of Hygiene and Tropical Medicine, many users continued to inject drugs sold as heroin. Several users reported an increase in tissue damage caused by cutting agents, leading to infections and loss of limbs. Others reported severe memory loss lasting several days. Some users realized they weren’t buying heroin and adopted “indigenous harm reduction strategies,” such as alternating injections with smoking in hopes of reducing the odds of infection.
Other users simply switched to crack cocaine, often in conjunction with depressants, such as benzodiazepines and alcohol. The researchers write that one heroin user “drank 20-30 cans of high strength alcohol beer a day for the duration of the shortage—a practice which he was unable to cease post-drought and subsequently describe[s] as more problematic than his heroin use.” The transition to alcohol is particularly noteworthy, considering that intravenous drug users are at higher risk for hepatitis c, which is in turn exacerbated by excessive alcohol consumption.
Many of the heroin users surveyed by the London School researchers were also participating in methadone treatment. As in the U.S., it was not uncommon pre-draught for users to sell their methadone in order to buy heroin. Illicit methadone selling all but disappeared during the drought as users needed the drug to stave off withdrawal symptoms. The U.K.’s experience suggests that reducing heroin and fentanyl importation to the U.S. (a longshot, considering the resources Washington currently expends on such efforts) without an accompanying increase in access to medication-assisted therapy would lead to disastrous unintended consequences. (Frieden and Kolodny, to their credit, call for dramatically expanding access to methadone and buprenorphine for people with opioid use disorders.)
How Heroin Users Reacted to the Australian Heroin Shortage of 2000–2001
Australia’s heroin shortage, which began around Christmas in 2000, is probably the most studied drug drought of the last century. As in the U.K., heroin use dropped, but with a slew of adverse consequences that make it difficult to declare it a win for public health.
According to a 2003 report published by the Australian Institute of Criminology and the New South Wales Bureau of Crime Statistics and Research, heroin prices during the shortage increased dramatically for quantities of half a gram and a gram, but only mildly for a quarter gram or less. Users who preferred to purchase quantities of a quarter gram or less told researchers that the drugs were heavily diluted with cutting agents. The Australian government’s drug survey confirmed that purity during the drought decreased from approximately 62 to 51 percent. Meanwhile, the price for a single gram of pure heroin increased 112 percent.
At the user level, researchers looked at trends in New South Wales, Australia’s most populous state. From July 2000 to June 2001, overdoses plummeted 74 percent in Cabramatta, a suburb of Sydney with the highest rate of heroin use, and 53 percent in New South Wales overall. Drug arrests in Cabramatta declined 64 percent during the drought. Among users who purchased heroin by the gram, median weekly expenditures declined from $550 to $350.
That may sound like a success, but as in the U.K. many users simply found other ways to get high. Of the 56 percent of survey respondents who said they began using other drugs during the heroin shortage, 79 percent substituted cocaine, 33 percent substituted cannabis, 30 percent substituted benzodiazepines, and 17 percent substituted amphetamines. Positive urine tests for cocaine also increased dramatically during this period. Intravenous drug users who began using more cocaine said that they had taken the drug on 90 of the previous 100 days. Prior to the drought, the figure had been 12 days out of 100.
Most troublingly, the Australian drought led to an increase in robberies and other property crimes. Forty-nine percent of respondents told researchers that they had committed crime to support their habits. During the drought, 42 percent said, they committed more crimes to compensate for increased prices. Arrest data confirmed that there were upticks in robbery and in breaking and entering at the height of the drought.
That increase didn’t last. The researchers offer several possible explanations for this; the most compelling is that the shift from depressants to stimulants “caused former heroin users to engage in behaviour that brought them to police attention more frequently,” and they were quickly arrested and incarcerated. This might also explain why drug possession arrests dropped over the same period even as many heroin users continued buying and consuming illegal substances.
The Australian researchers concluded that demand for heroin is price-elastic, but that isn’t necessarily true for America in the era of fentanyl, which is easy to import, harder to interdict, and much more potent in small doses. And it’s definitely belied by the number of users who substituted other substances, both in the U.K. and Australia. While substitution may suggest elasticy in heroin prices, the infrequency with which users become completely sober suggests that drug use itself is inelastic. An interdiction strategy that might work for heroin, which comes from only four regions on the planet, won’t work for a synthetic drug that can be shipped in small, undetectable packages. And without a nationwide expansion of evidence-based treatment programs, interdiction will do very little to prevent heroin users from substituting with alcohol, which is uniquituous and cheap.
The Teamsters union is calling on shareholders of drug giant Cardinal Health to strip the company’s top executive of his duties as board chairman, saying the firm is “in the midst of a corporate crisis” over its role in the opioid epidemic that has ravaged West Virginia and other states.
The Teamsters accuse Cardinal Health CEO George Barrett of poor leadership while the company has become “entangled in the opioid epidemic” and faces investigations and dozens of lawsuits. The union urged investors to vote to appoint an independent board chairman at Cardinal Health’s annual shareholder meeting Nov. 8 in Columbus, Ohio.
Cardinal Health’s board opposes the Teamster’s actions, saying Barrett’s leadership as board chairman has set a “powerful tone from the top” on “compliance and reputation,” the Teamsters told shareholders in a letter Friday.
During the past decade, the company has paid more than $100 million in fines and settlements to end allegations that it distributed an excessive number of painkillers and neglected to report suspect drug orders from “pill mill” pharmacies. At the same time, Cardinal’s board awarded top executives with lavish pay raises and bonuses, the union said.
“Under the current governance structure, Cardinal Health’s board has repeatedly fallen down on these priorities as the pertain to the company’s core business mission: the safe and secure distribution of controlled substances,” said Teamsters Secretary-Treasurer Ken Hall, who is also president of Teamsters Local 175 in South Charleston.
Cardinal Health distributes more prescription drugs than any other wholesaler in West Virginia. The Teamsters have pension funds that invest in the company, which is headquartered in Dublin, Ohio. A Cardinal Health spokeswoman did not respond to a request for comment Friday.
Between 2007 and 2012, Cardinal Health shipped 241 million doses of hydrocodone and oxycodone – two powerful and potentially lethal painkillers – to pharmacies and hospitals across West Virginia, according to Drug Enforcement Administration data.
Lawsuits against the company have spotlighted large shipments of pain pills to small communities. Over two years, Cardinal Health shipped more than 309,000 prescription opioids to the town of Van in Boone County, according to state lawsuit that’s since been settled. About 200 people live in Van.
In January, Cardinal Health agreed to pay $20 million to the state of West Virginia to settle a 2012 lawsuit that alleged the company acted “negligently” and “recklessly” by distributing an excessive number of painkillers to the state. Cardinal Health denied any wrongdoing.
In 2008, the company paid a $34 million penalty to resolve allegations that it failed to notify the DEA of suspiciously large orders of hydrocodone in Florida.
At the time, Barrett, who was then over Cardinal Health’s Supply Chain Services, stated, “We are working [our] tails off to restore our reputation with the DEA and gain back the ability to distribute controlled drugs from all of our facilities,” according to a company earnings call cited by the Teamsters.
But four years later, Cardinal Health was back in hot water. The DEA again investigated the company for turning a blind eye to suspicious orders of prescription opioids. In response, Cardinal Health’s board set up an independent committee to review shareholder concerns about the investigation. The panel concluded that “robust systems were in place” to flag suspect orders for painkillers,” according to the Teamsters.
“And yet, as allegations against the company’s distribution and compliance practices continue to mount, the board has been steadfast in its refusal to pursue a new independent investigation of these concerns,” Hall wrote to shareholders Friday. “This is profoundly troubling.”
In December 2016, the wholesaler paid a $44 million fine to settle the DEA’s latest investigation.
“Allowing failures in the company’s core compliance and business functions to fester for over a decade is a damning indictment of the current leadership structure,” Hall said.
Hall also criticized Barrett for his recent remarks on the opioid crisis, saying the CEO’s “tone was notably off-pitch.” During an August earnings call, Barrett said the “search for blame” in the opioid problem is the “enemy of the search for solutions,” according to the Teamsters. Such remarks undermine corporate accountability, Hall said.
The Teamsters’ letter also skewers Cardinal Health’s compensation committee, which gave a bonus to the company’s chief compliance officer each of the past six years. Barrett has received $127 million in compensation over the past three years.
This isn’t the first time the union has targeted a drug wholesaler.
In July, McKesson shareholders voted down a Teamster’s proposal to create an independent board chairman, so the company’s CEO kept both jobs. However, the board announced it would have a separate CEO and chairman, starting with the chief executive who follows its current chief executive. The board would continue its practice of evaluating at least annually whether its leadership structure continues to be in the best interest of the company and its shareholders, McKesson said a the statement.
In May, congressional committee started investigating Cardinal Health’s painkiller shipments to West Virginia. The inquiry also targets three other drug wholesalers – McKesson, AmerisourceBergen and Miami-Luken. The panel has directed the companies to turn over internal records.
Connecticut will join other states in a lawsuit against the Trump administration after the White House announced its intention to end key payments to insurance companies that sell plans on Affordable Care Act exchanges.
“President Trump’s latest action is incredibly mean-spirited,” state Attorney General George Jepsen said Friday. The lawsuit accuses Trump of violating President Barack Obama’s signature health care law as well as a law that governs the way presidential administrations can establish new regulations.
The more than 40,000 people in Connecticut who qualify for cost-sharing reduction payments will continue to receive them, but the move is anticipated to further destabilize insurance markets with the brunt of any premium increases borne by higher-income Obamacare customers, some of whom may choose to stop buying health insurance.
Insurers who sell Affordable Care Act plans — including Anthem and ConnectiCare in Connecticut — faced months of uncertainty over whether the Trump administration would continue the cost-sharing reduction payments, which offset the expense to insurers to sell silver-level plans with reduced deductibles and copays to low-income customers.
President Donald Trump for months has decried the billions of dollars in payments, which go to about 6 million Americans, as a “bailout” for the insurance industry. But the nonpartisan Congressional Budget Office warned premiums — and the federal deficit — would increase if the payments were cut off.
Anthem and ConnectiCare receive about $50 million in cost-sharing reduction payments for Connecticut customers. An Anthem spokeswoman referred to a joint statement from America’s Health Insurance Plans and Blue Cross Blue Shield Association.
“These benefits help real people every day, and if they are ended, there will be real consequences,” the two insurance groups said. “These payments are not a bailout – they are passed from the federal government through health plans to medical providers to help lower costs for patients who see a doctor to treat their cancer or fill a prescription for a life-saving medication.”
A spokeswoman for ConnectiCare also panned the discontinuation of the payments.
“While we prepared our rates accordingly, the impact will still undoubtedly be felt by thousands of people in Connecticut who benefited from this commitment by the federal government,” said Kimberly Kann, ConnectiCare’s public relations and corporate communications director. “These payments are not intended to help insurance companies. They are first and foremost to provide financial support for low-income beneficiaries, ensuring they have access to the health care they need.”
Lt. Gov. Nancy Wyman, chairman of the board that oversees Access Health CT, the state’s health insurance exchange, said Friday: “The prices of health care are going to go up, the uninsured rate is going to go up. This is a terrible move by the president.”
But Wyman noted that the state Insurance Department had anticipated the payments coming to an end when it approved average rate increases next year of 31.7 percent for Anthem customers and 27.7 percent for ConnectiCare customers.
“Connecticut was proactive in anticipating this possible change,” said Access Health CT CEO Jim Wadleigh. He noted that 2018 plans and rates would not be affected by the payments coming to an end.
Members of Connecticut’s congressional delegation said Congress should move quickly to pass legislation to continue the payments.
“This shouldn’t be a surprise to anyone in Congress, and it’s why many of us have been racing to come up with a bipartisan health care bill to prevent this exact sort of blatant sabotage,” said Sen. Chris Murphy, who serves on the Senate’s health committee.
Customers who qualify for tax credits to help pay their premiums will see those subsidies increase as rates rise. But the 25 percent of Access Health CT enrollees who receive no federal assistance will be on the hook for higher premiums as a result of the cost-sharing payments coming to an end.
Sen. Richard Blumenthal said Trump was effectively “punishing the American people for his loss in the Senate” on legislation to repeal and replace the Affordable Care Act.
“The ultimate solution is to bring down the cost of health care,” Blumenthal said. “As long as those costs are as high as they are now, the insurance market will depend on some kind of support or subsidies for people who need and deserve health care insurance.”
Rep. Rosa DeLauro said Trump was “dead wrong” to refer to the cost-sharing reduction payments as a bailout.
“The truth is that they help people with modest means reduce their out-of-pocket healthcare costs,” she said. “This action hurts the working and middle class Americans that President Trump promised to advocate for.”
Supporters of the Affordable Care Act worry that Trump’s action will create more uncertainty in the marketplace and cause young, healthy consumers to turn away from Obamacare exchanges, believing they will be financially out of reach. Gov. Dannel P. Malloy said Trump has created “great confusion” about the individual insurance market heading into enrollment season for 2018.
“This latest move to cut off cost-reduction subsidy payments is vindictive and deliberately designed to sabotage healthcare insurance markets throughout the nation,” Malloy said.
It has been reported that Pres Obama – via executive action – authorized these subsidies … unfortunately according to our CONSTITUTION… money can’t just be “given away” without it being an approved appropriation of CONGRESS… So all these paid out subsidies – that states are suing over the fact that they are losing… are ILLEGAL SUBSIDIES…
Does it sound strange that the person – Obama – one time taught CONSTITUTIONAL LAW at Harvard University and is the same person that authorized these UNCONSTITUTIONAL payments and the House of Representatives who “hold the purse strings” of the Federal Budget… DID NOTHING…
Only in America, can politicians/bureaucrats do things that are unconstitutional/illegal and then when someone tries to undo the illegal activity… there is a law suit filed to reinstate the ILLEGAL PAYMENTS ?
