The House Energy and Commerce Committee, chaired by Rep. Greg Walden (R-OR), concluded its 18-month investigation into opioid distributors and wholesalers in West Virginia just before Christmas, 2018. The committee’s bipartisan report, to say the least, is shocking. (Read it [HERE].)
WV is the state struck hardest by the opioid crisis that has gripped the nation for the last several years. While the source of the problem could only be speculated before now, the report confirms what experts have been suspecting: Many of the issues in WV have been caused by systemic failures on part of opioid distributors and wholesalers. Most shockingly, however, is the revelation that the Drug Enforcement Administration has contributed to what is the worst public health crisis in American history. Over 42,000 Americans died from opioid overdoses in 2016, according to the report. That is more than died from car accidents, gun violence, and many other sources of untimely death.
The report chronicles the three largest opioid wholesalers in the United States and their role in WV’s opioid trade, legal or not — McKesson Corp., Cardinal Health and AmerisourceBergen. This investigation started in March of 2017, along with the probe of the DEA. Two distributors, Miami-Luken and HD Smith, were investigated in that September. The three wholesalers are, as of now, all facing lawsuits from various municipalities all over the country. McKesson just settled a $150 million lawsuit in California federal court for failing to report suspicious opioid orders. It is currently banned from selling in Florida, Colorado, Michigan, and Ohio.
The report found incredible levels of apathy and carelessness from all of the parties involved, which lead to suspicious activity going unnoticed. Wholesalers fill the orders that are given to individual pharmacies. Many of the amounts of narcotics ordered were odd but not reported to the DEA. For example, since 2005, over 900,000,000(!) doses of Hydrocodone and OxyContin have been filled in the state, much of them from rural areas. McKesson shipped nearly 10,000 pills per day to a now-closed pharmacy in the rural town of Kermit, which has a population of 400, in 2007. (Yes, you read that correctly.) This is nearly 36 times the limit the monthly dosage threshold the wholesaler had created that year. By not reporting such behavior, the report states that the wholesalers are complicit in growing black markets, trafficking, and the amount of overdose deaths.
If the wholesalers were to have reported this blatantly-illegal behavior to the DEA, the agency would not have been properly equipped to deal with the situation. As mandated under the Controlled Substances Act, the DEA is required to keep a database of illicit or suspicious orders sent to wholesalers and distributors. The report states that the DEA was not actively using this database until 2010. Additionally troubling, the DEA has not set up a standardized reporting method in order to assess the claims. This means that if the claims are reported at all, they are reported to local offices, which have different, oftentimes haphazard procedures of dealing with them.
The accusations are, on the surface, troubling only for WV, but the report is explicit in stating that the issues found in this state can likely be generalized for the country at large.
Upon the report being released in December 2018, the entities targeted by the investigation released statements ranging from denying responsibility to accepting their culpability in the epidemic. DEA spokesperson Wade Sparks stated that the report was eye-opening and that they want to “make sure what happened in West Virginia never happens again.” McKesson stated that it is working to address the crisis without mentioning its role in the report. Finally, Cardinal Health noted its “limited but vital role” in the opioid supply chain and that it is taking the report’s suggestions seriously.
The reactions from other companies involved were far less graceful. AmerisourceBergen downplayed its responsibility, stating that it has “virtually no interaction with physicians and limited legal ability to gather information on their practices and prescribing behavior.”
The committee suggests many courses of action to fix the abovementioned problems. Highlights include creating a DEA database of prescriptions collected from pharmacies that highlight suspicious doctors. Another is the review of pharmacies that have common ownership with ones with policy violations. (Read a condensed list written by the committee [HERE].)
The committee notes that this problem is multifaceted, and while this is one piece of the chain that must be fixed, there is still much work to do on the opioid crisis on part of the federal and state governments, as well as pharmaceutical corporations.
