The Opioid Epidemic: Who Is To Blame?

Doctors, distributors, drug lobbyists, the FDA — Who is responsible for the
scourge of opioid addictions? "60 Minutes" has spent two years
investigating
Aug 25 by Brit McCandless Farmer

The opioid crisis has so far been the most devastating public health crisis of the 21st
century. In 2017 alone, more Americans died of drug overdoses than in the entire
Vietnam War.

This Sunday on "60 Minutes," correspondent Bill Whitaker takes another look in a series
of reports produced by Ira Rosen and Sam Hornblower that ask: Who is responsible?

Congress and the pharmaceutical lobbyists

In October 2017, "60 Minutes" teamed up with the Washington Post for a Peabody
Award-winning report about how the Drug Enforcement Administration was hindered in
its attempts to hold the pharmaceutical industry accountable.

Whitaker spoke with Joe Rannazzisi, a former high-ranking DEA agent who became a
whistleblower. Rannazzisi said his investigators at the DEA were aware that an
inordinate number of prescription narcotics were being sent to pharmacies, and they
began to bring cases against the pharmaceutical industry's powerful drug distributors.

But they hit a wall — in the form their own attorneys. Rannazzisi said the drug industry
used its money and influence to pressure the DEA's top lawyers into taking a softer
approach.

Joe Rannazzisi, a former high-ranking DEA agent,

became a whistleblower.

Sometimes that pressure came from familiar

faces. Former DEA attorney Jonathan Novak
told Whitaker he witnessed numerous agency lawyers switch sides and take high-paying
jobs lobbying their former colleagues. Suddenly, Novak said, DEA investigators could
not get their cases through their legal office.
As cases nearly ground to a halt at the DEA, the drug industry began lobbying Congress
for legislation that would limit the agency's enforcement powers. Congress passed a law
that took away the most potent tool the DEA has — the ability to immediately freeze
suspicious shipments of prescription narcotics to keep drugs off American streets.

One of the lawmakers who introduced the bill was Pennsylvania Congressman Tom
Marino. At the time of the "60 Minutes" report, Marino had just been nominated to be
President Donald Trump's new drug czar.

Two days after the report aired, President Trump announced that Marino had
withdrawn his name from consideration for the position.

The drug distributors

"60 Minutes" partnered with the Washington Post again in December 2017 and found
another disturbing story from inside the DEA. After two years of painstaking inquiry,
DEA investigators built the biggest case the agency had ever made against a drug
company: McKesson Corporation, the country's largest drug distributor

"The issue with McKesson was they were providing millions and millions and millions of
pills to countless pharmacies throughout the United States, and they did not maintain
any sort of due diligence," David Schiller, a former DEA assistant special agent, told
correspondent Bill Whitaker.

But Schiller's investigators hit a roadblock in Washington D.C. when they tried to hold
McKesson accountable. Schiller says attorneys for the DEA and the Department of
Justice were intimidated at the thought of going against McKesson and its high-
powered legal team.

In the end, instead of the $1 billion fine that Schiller and his team wanted, McKesson
was fined just $150 million.

"How do you do that?" Schiller told Whitaker. "No. Put them in jail. You put the people
that are responsible for dealing drugs, for breaking the law, in jail. Nobody's in jail.
They wrote a check."

The doctors and the drug manufacturers

Drug distributors have been delivering huge numbers of pills to pharmacies, and
pharmaceutical lobbyists have pressured Congress to let them off the hook. But what
about the doctors who write prescriptions for huge quantities of the highly addictive
drug? And the manufacturers who supply the distributors? Last September on "60
Minutes," Whitaker investigated two additional pieces of the puzzle.
He spoke with Florida physician Barry Schultz, who was sentenced last July to 157 years
for his role in the opioid crisis. Schultz told Whitaker he has become a scapegoat.

"I was one of hundreds of doctors that were prescribing medication for chronic pain,"
Schultz said. "In my mind, what I was doing was legitimate."

But DEA records show that in 2010, Schultz prescribed one patient more than 23,000
oxycodone pills in an eight-month period — more than 100 pills a day to a single
person. During one 16-month period, his in-office pharmacy dispensed 800,000 opioid
pills.

As for the manufacturers, two-thirds of all the oxycodone in Florida came from just one
company: Mallinckrodt. Five hundred million of their oxycodone pills were distributed in
Florida between 2008 and 2012.

Jim Rafalski led a DEA investigation into Mallinckrodt and discovered drug orders from
distributors that the company knew about — and should have flagged as suspicious.
But after the DEA turned over its evidence to the Justice Department, things took a
familiar turn. Fearing an uncertain legal battle, government lawyers decided to settle
with Mallinckrodt and fined the company just $35 million. The penalty amounts to less
than one week of Mallinckrodt's annual revenue.

When Whitaker asked what role he feels Mallinckrodt has played in the opioid crisis,
Rafalski was unambiguous in his response: "They're responsible."

The FDA
Responsibility for the opioid epidemic may ultimately point to the Food and Drug
Administration — and a fateful decision the FDA made all the way back in 2001.

Drug manufacturer Ed Thompson spent decades producing opioids for the

pharmaceutical industry. He told "60 Minutes" that, when the FDA first approved
Oxycontin in 1995, science only showed that the drug was effective when used in the
short term.

But Thompson said the pharmaceutical industry pressured the FDA. Six years later in
2001, the FDA decided to change the label for Oxycontin, expanding the use for almost
anyone with chronic pain.

"60 Minutes" obtained a court order to get the minutes to secret meetings in 2001
between the FDA and Purdue Pharma, the maker of Oxycontin. The documents reveal
that the FDA bowed to Purdue Pharma's demands to ignore the lack of science
supporting long-term use and changed the Oxycontin label to "around the clock ... for
an extended period of time." This gave big pharma the green light to push opioids to
tens of millions of new pain patients nationwide.

Does Thompson now believe the FDA ignited the opioid crisis?

"Without question," he told Whitaker, "they [started] the fire."

© 2019 CBS Interactive Inc. All Rights Reserved.

Only opioid 'crisis' is not enough opioids?

FDA approves drug 10x stronger than deadly
fentanyl
3 Nov, 2018 04:03

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© Reuters / Brian Snyder

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The FDA has approved the rollout of a new opioid drug up to 1000 times stronger than morphine,
despite the opioid crisis that is currently killing more Americans than any other cause of accidental
death.

The agency sided with its Anesthetic and Analgesic Advisory Panel, which voted 10-3 to
approve Dsuvia, a sublingual tablet form of sufentanil, against the recommendation of its
chairman. At 5-10 times the strength of fentanyl, sufentanil is 500-1000 times stronger than
morphine, and will supposedly only be administered to treat acute pain in medically-supervised
settings.

Read more

‘A form of warfare’: Senate

passes anti-opioid bill as overdoses ravage America

Fentanyl, too, is available only by prescription, yet a significant quantity is manufactured in

illegal labs or diverted to the street, where it regularly kills opioid addicts who aren’t even aware
they are taking it.

Dsuvia is fulfilling an “unmet need,” says Dr Pamela Palmer, chief medical officer of AcelRx,
which makes the drug. Because the drug dissolves under patients’ tongues, it provides quick
relief without the use of an injection. Still, because it must be delivered in a medical setting and
doctors and nurses are trained to give injections, there are relatively few situations in which it
offers an advantage that outweighs the risk of unleashing a powerful new narcotic onto an
already drug-saturated populace.

The Department of Defense had a hand in funding the research that produced Dsuvia, which
could replace morphine on the battlefield due to its ease of administration. AcelRx projects $1.1
billion in annual sales and hopes to have its product on hospital shelves by early 2019.
Dsuvia tablet and applicator © AcelRx

Palmer claims the drug will be subjected to much stricter audits and monitoring than earlier
opioids like Oxycontin, which became so ubiquitous in rural America after it was introduced by
Purdue Pharmaceuticals that it earned the nickname “hillbilly heroin.” Drug manufacturers
flooded small towns with millions of pills, filling huge pharmacy orders out of proportion to the
population of the surrounding areas.

With 200 million prescriptions already written for opioids every year in the US, many argue
Americans don’t need another drug. Dr. Sidney Wolfe, senior adviser to Public Citizen’s Health
Research Group, dismisses Palmer’s claims about the fast action of Dsuvia: two studies indicated
patients only felt “meaningful” pain relief after 54 minutes and 78 minutes, making the new drug
no better than swallowing a pill.

Over 72,000 Americans died of drug overdoses last year – a new record – and among the drugs
causing overdose, the largest increase was in fentanyl and fentanyl-like synthetics.

Opioid crisis: Aberration, or logical

outgrowth of for-profit US healthcare
system?
21 Oct, 2019 21:13
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© Global Look / Erik McGregor

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Four major drug companies have reached a partial settlement over their role in the opioid epidemic,
dodging a federal trial. The drug plague is less of an accident than an inevitable consequence of a for-
profit healthcare system.

US drug distributors AmerisourceBergen Corp., Cardinal Health Inc., and McKesson Corp. – as
well as Israel-based drug manufacturer Teva Pharmaceuticals – have tentatively settled suits with
two Ohio counties for $260 million, over charges they misled the public about the addictive
potential of their drugs. The deal narrowly avoids a federal trial that was set to start on Monday,
but does not address some 2,600 other suits nationwide against those companies and others –
including Purdue Pharma, the company that kicked off the epidemic with its blockbuster opioid
OxyContin.

Also on rt.com OxyContin maker files for bankruptcy faced with over 2,000 lawsuits over opioid
epidemic

More than 20 years and 400,000 deaths after the debut of the devastatingly popular drug, it’s a
relief that authorities are finally getting around to holding some of the perpetrators responsible.
Opioids kill more Americans every year than car crashes, and have singlehandedly decreased the
average US lifespan. However, the crisis is less due to especially evil schemes by those
particular companies, and more of the inevitable outcome of a healthcare system where curing
the patient pays less than keeping them coming back, again and again.

Opioid manufacturers and distributers merely took advantage of a corrupt and broken business
model, where pharmaceutical companies were able to collude with medical authorities to elevate
“pain” to the level of a vital sign alongside blood pressure, temperature, respiratory rate and
pulse, presenting their product as the only truly effective solution to the problem. When Purdue
unleashed OxyContin on the market in 1996, they simply lied and claimed their product had an
addiction rate in the single digits. The other companies followed their lead: by the time
OxyContin was reformulated to make it less appealing to addicts, there were Vicodin, Lortab,
and fentanyl, waiting in the wings.

Hand in hand with the American Academy of Pain Medicine, the American Pain Society, and
other authoritative-sounding groups, Purdue seduced doctors with an irresistible one-two punch.
First they were told they were remiss in not checking all their patients for pain, the fifth vital
sign. Then they were told that OxyContin is the only opioid painkiller that has managed to
overcome the addictive factor, so they should overcome “opiophobia” and start writing
prescriptions.
© Global Look / Erik McGregor
Doctors saw dollar signs in every patient who walked in with a sore back – unlike pulse or
temperature, “pain” is a subjective sensation – and if the drug wasn’t addictive, who gets hurt in
the case of excessive prescription? Drug reps were showering them with gifts, from hats to
branded plush toys. Who could have guessed the stuffed gorilla would turn into a monkey on
their back?

By the time doctors figured out they had patients for life – some of whom became hopelessly
addicted, after coming in with nothing more than temporary discomfort caused by an accident or
injury at work – they had become complicit in addicting huge numbers of Americans to a drug
that was actually even more habit-forming than its opioid peers. Purdue paid a measly $635
million in 2007 for misleading doctors with its marketing – a small price to pay for over $35
billion in Oxy profits.

Drug-maker obviously did not think it is wrong to create a hugely addictive drug for the purposes
of dramatically expanding one’s customer base, ensuring a lifetime flow of profits. If one takes
morality out of the equation, their actions look merely like a series of intelligent business
decisions.

Opioid addiction is big business, even beyond the opioids themselves. Following up on the Oxy
debacle, the Sackler family that owns Purdue Pharma patented a novel form of delivery for
buprenorphine – a long-acting synthetic opioid used to treat opioid addiction – last year.
Buprenorphine itself is addictive, and detoxing from it can take months (while OxyContin detox
takes a few weeks). Teva Pharmaceuticals’ donation of $20 million worth of suboxone – another
formulation of buprenorphine – as part of Monday’s settlement looks much less charitable in this
light.

Naloxone is the overdose reversal drug that is now ubiquitous across American cities, with
pictographs in store windows allowing the panicked companions of dying addicts to recognize a
potential lifesaver from afar. It has more than sextupled in price from 2014 to 2016, going from
$690 to $4500. Some $274.1 million worth of naloxone was sold in 2016, according to IQVIA.

Also on rt.com Doctors & drugs FOR LIFE: Big Pharma’s profit on the transgender craze

The US healthcare system rewards doctors the more they see their patients, disincentivizing
quick and easy cures in favor of lifetime treatments. Opioids are just the tip of a pharmaceutical
iceberg that includes psychiatric drugs, statins, blood pressure drugs, insulin and other
medications – many with serious side effects – meant to be taken for life. Chronic diseases are on
the rise even as the cost of treating them skyrockets. As a result, two thirds of Americans who
file for bankruptcy do so because of medical issues. Healthcare is a $3.5 trillion industry in the
US, and the quality of that care is dead last in the developed world.

Hauling the drug companies into court is a good place to start, but without looking at the system
that profits handsomely from sickness – but not from cures – it’s virtually guaranteed that
tragedies like the opioid epidemic will keep happening.

By Helen Buyniski, RT
OxyContin maker files for bankruptcy faced
with over 2,000 lawsuits over opioid epidemic
16 Sep, 2019 03:41

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Bottles of prescription painkiller OxyContin, 40mg pills, made by Purdue Pharma L.D. sit on a shelf at a
local pharmacy, in Provo, Utah, U.S., April 25, 2017. © REUTERS/George Frey

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Purdue Pharma, accused of fostering the US opioid crisis with its drug OxyContin, filed for bankruptcy
protection in a New York court, after a tentative settlement deal faced opposition from multiple states.

The company filed for chapter 11 bankruptcy in White Plains, New York on Sunday evening, as
part of its efforts to finalize a settlement with state and local governments, which sued the
pharmaceutical giant en mass for its role in the nation’s deadly opioid crisis.

The much-anticipated filing aims to help the company to shield itself from 2,600 lawsuits,
including from 26 states.

Also on rt.com Sackler family behind OxyContin busted trying to hide $1bn as lawsuits over opioid crisis
pile up

“This settlement framework avoids wasting hundreds of millions of dollars and years on
protracted litigation,” Steve Miller, chairman of Purdue’s board of directors, said, adding that
the company will keep on working with plaintiff representatives to thrash out the settlement
agreement “as quickly as possible.”

Numerous plaintiffs accused the company of making huge profits from selling the painkiller, first
introduced in 1996, while downplaying its addictive qualities, thus fueling the US opioid
crisis, which has seen over 200,000 people dying as result of overdoses with prescription
drugs from 1999 to 2017.

The bankruptcy announcement comes several days after the Sackler family behind the
controversial drug maker reached a tentative multi-billion-dollar settlement with 23 states, which
envisages it paying the sum over seven years while not admitting guilt.

Also on rt.com ‘Senseless death must stop’: Five states sue Purdue Pharma for driving opioid crisis

Overall, Purdue is set to fork out nearly $12 billion to state and local authorities under the deal,
including $3 billion that would come directly from the Sacklers, who would also give up the
control of the company.

The proposed settlement requires the company to file for bankruptcy, which it ultimately did on
Sunday. Not everybody is, however, on board, with some states arguing that the company must
also offset the costs of treatment and incarceration.

Half of the states have not yet signed on to the deal, and several states, including New York,
Massachusetts, Connecticut, and Wisconsin, have rejected it outright, vowing to push for the
litigation to go forward.

There have been concerns that the billionaire family, faced with mounting lawsuits,
could attempt to hide theirs assets from the court. On Friday, New York’s attorney general
uncovered over $1 billion in wire transfers routed through several Swiss banks by the family,
accusing them of trying to “shield their financial misconduct.”

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Personal Finance

This is the real reason most Americans file

for bankruptcy
Published Mon, Feb 11 201911:32 AM ESTUpdated Mon, Feb 11 20192:20 PM EST

Lorie Konish@LorieKonish

Key Points

 Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their
financial downfall.
 While the high cost of health care has historically been a trigger for bankruptcy filings, the
research shows that the implementation of the Affordable Care Act has not improved things.
 What most people do not realize, according to one researcher, is that their health insurance
may not be enough to protect them.

SIphotography | Getty Images

Filing for bankruptcy is often considered a worst-case scenario.

And for many Americans who do pursue that last-ditch effort to rescue their finances, it is
because of one reason: health-care costs.

A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to
medical issues —either because of high costs for care or time out of work. An estimated 530,000
families turn to bankruptcy each year because of medical issues and bills, the research found.

Other reasons include unaffordable mortgages or foreclosure, at 45 percent; followed by

spending or living beyond one's means, 44.4 percent; providing help to friends or relatives, 28.4
percent; student loans, 25.4 percent; or divorce or separation, 24.4 percent.

While the findings are consistent with past studies on bankruptcy, the data also highlight a key
new factor: whether the Affordable Care Act has reduced the burden of medical debt for people.

"Despite gains in coverage and access to care from the ACA, our findings suggest that it did not
change the proportion of bankruptcies with medical causes," an article on the study published in
the American Journal of Public Health states.

More from Personal Finance:

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The number of debtors who cited medical issues as a contributing reason for their bankruptcy
actually increased slightly after the law's implementation — 67.5 percent in the three years
following the law's adoption versus 65.5 percent prior.

The culprit for the lack of improvement was inadequate health-care insurance, according to a co-
author of the research, Dr. David U. Himmelstein, a distinguished professor at Hunter College
and founder of advocacy group Physicians for a National Health Program.
"Unless you're Jeff Bezos, people don't have very good alternatives, because the insurance that is
available and affordable to people, or that most people's employers provide them, is not adequate
protection if you're sick," Himmelstein said.

Most families do not have enough saved for a simple emergency, let alone thousands of dollars
in unexpected medical costs. A recent study from personal finance website Bankrate found that
only 40 percent of Americans have enough saved to cover a $1,000 emergency expense.

VIDEO03:33

Emergency savings

To help combat this problem, Physicians for a National Health Program is advocating for a
national Medicare for All program that would broaden insurance coverage for Americans.

"Health insurance is only very partial protection," Himmelstein said. "I liken it to a hospital
gown that looks like coverage until you actually inspect it."

The research included 910 Americans who filed for bankruptcy between 2013 and 2016.

‘Senseless death must stop’: Five states sue

Purdue Pharma for driving opioid crisis
16 May, 2019 20:09

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Fives US states have filed lawsuits against OxyContin producer Purdue Pharma for the company’s role in
driving the opioid epidemic. They join some 1,600 other lawsuits brought against Purdue in recent years.

The suits were filed Thursday by the state governments of Kansas, Iowa, Wisconsin, West
Virginia and Maryland, who claim the company pushed the highly addictive drug using
deceptive marketing. With the exception of Kansas, the states also sued former Purdue president
Richard Sackler.

Also on rt.com MILLIONS of pills: 60 doctors & pharmacists caught up in largest federal opioid bust in US
history

“This lawsuit reveals many years of painstaking investigation,” West Virginia Attorney General
Patrick Morrisey said in a statement, adding “the senseless death and ruined lives of untold
thousands must stop,” and that Purdue “must be held accountable.”

Purdue, in March, reached a $270 million settlement to end a previous suit filed by the state of
Oklahoma, which also accused the company of misleading marketing, yet another in a flurry of
suits filed against the company.

Also on rt.com Big Pharma spent $10mn promoting opioid drug use to patients

Nearly 218,000 Americans have died from prescription opioid overdose between 1999 and 2017,
according to the US Centers for Disease Control and Prevention (CDC). Oxycodone, known by
Purdue’s brand name ‘OxyContin’, was involved in a significant number of the deaths.

MILLIONS of pills: 60 doctors &

pharmacists caught up in largest federal
opioid bust in US history
18 Apr, 2019 00:25

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© Reuters / Bryan Woolston

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Sixty doctors and other medical professionals across seven US states are facing federal charges for illegal
opioid sales, in what prosecutors say is the biggest pill bust in American history.

The doctors gave out more than 350,000 prescriptions for 32 million pills – which could provide
a dose of opioids to “every man, woman and child,” in the states of Ohio, Kentucky, Tennessee,
Alabama and West Virginia, according to Assistant Attorney General Brian Benczkowski.

The Department of Justice (DOJ) assembled a special team of 300 agents to handle the
investigation. This Appalachian Regional Prescription Strike Force started making arrests on
Wednesday across eleven states, mostly in rural areas of Appalachia.

Also on rt.com Pharma exec gave doctor lap dance while pushing addictive painkiller

"You can rest assured, when medical professionals behave like drug dealers, the Department of
Justice is going to treat them like drug dealers," Benczkowski added.

Most of the defendants are charged with the unlawful distribution of controlled substances, but
the accusations range from handing out pills to Facebook friends to trading drugs for sex. The
methods employed differed from doctor to doctor, prosecutors said, but all had the same goal: to
provide patients with dangerous and unnecessarily large amounts of narcotics.

The indictments were levied against pharmacists, orthopedic specialists, dentists and podiatrists,
as well as general and nurse practitioners.

“This is extreme outlier behavior,” Benczkowski said. “We’re targeting the worst of the worst
doctors in these districts.”
Also on rt.com Opioid overdoses surpass car crashes among leading causes of death in US -
report

One doctor is accused of giving out 1,500 fentanyl patches, 300,000 oxycodone pills, 500,000
hydrocodone pills – all opioids – and more than 600,000 benzodiazepine pills, used to treat
anxiety, over the course of three years.

In another case, a 30-year-old patient suffered a fatal overdose after being given 800 oxycodone
pills in just two months. The doctor who prescribed them then directed the patient’s husband to
dispose of all pill bottles before police arrived.

Also on rt.com Only opioid 'crisis' is not enough opioids? FDA approves drug 10x stronger than
deadly fentanyl

DOJ was working with several federal and local agencies to ensure patients who arrive at the
shuttered pain clinics get “proper” treatment options, said US Attorney for the Southern District
of Ohio, Benjamin Glassman.

Opioid overdoses surpass car crashes among

leading causes of death in US - report
15 Jan, 2019 21:13

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Opioid overdose rescue kit (file photo) © Reuters / Andrew Kelly

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Americans have a greater chance of dying from an opioid overdose than in a car accident, according to
the newest statistical analysis. Suicide remains the leading cause of death not related to a disease.

Andrea Woo | 鄔瑞楓

✔ @AndreaWoo

For the 1st time, Americans now more likely to die of an opioid OD than of a car crash,
according to new report from National Safety Council.

"The nation’s opioid crisis is fueling the Council’s grim probabilities and that crisis is worsening
with an influx of illicit fentanyl."
41

11:26 PM - Jan 14, 2019

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The number of deaths resulting from opioid overdose tripled in the last 20 years, reaching over
43,000 in 2017, according to the new report from the National Safety Council, a nonprofit
chartered by Congress. By comparison, there were just over 40,000 Americans killed in car
crashes in the same year.

According to NSC’s statistical analysis, this translates to a 1 in 93 chance of an American dying

from opioid drugs, compared to 1 in 103 from car accidents – for the first time in US history.

“We are dying from things typically called accidents at rates we haven't seen in half a century,”
said Ken Kolosh, manager of statistics at the National Safety Council. “We cannot be
complacent about 466 lives lost every day.”

Other statistics regarding the opioid crisis are just as grim. It is estimated that 62 Americans a
day die from opioid overdoses – that’s 22,630 a year, more than a third of the entire US death
toll in the Vietnam War. The overwhelming majority of deaths are caused by a synthetic opioid
called fentanyl, often mixed with heroin.

Also on rt.com Trump: China should use death penalty for distributors of Fentanyl, ‘results will
be incredible’

During the year the study was conducted, President Donald Trump declared the situation a
“national emergency.”

Another grim statistic shows that suicide was the leading singular disease-unrelated cause of
death in 2017, ahead of both opioids and car accidents with over 47,000 reported cases in 2017.
By contrast, there were 17,284 reported cases of murder and other non-negligent homicide.
Trump: China should use death penalty for
distributors of Fentanyl, ‘results will be
incredible’
5 Dec, 2018 14:56

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Bags of Fentanyl seized at a mail facility at O'Hare Airport in Chicago © Reuters / Joshua Lott

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President Trump suggested that

China crack down on the exports of
deadly synthetic opioid Fentanyl by
using the death penalty, saying the
results would be “incredible”

After a meeting between the two

leaders at last weekend’s G20 summit
in Argentina, Chinese President Xi
Jinping promised to stop the flow of
Fentanyl into the US. “If China
cracks down on this ‘horror drug,’”
Trump tweeted on Wednesday, “using
the Death Penalty for distributors and
pushers, the results will be
incredible!”

Fentanyl is a synthetic opioid that can be 50 to 100 times stronger than morphine. Imported
Fentanyl, some from China, has fueled the US’ opioid crisis and was responsible for nearly
30,000 of America’s 72,000 overdose deaths in 2017.

China did not say exactly what penalty it would apply to Fentanyl distributors, and has not hinted
that it would execute the pushers. However, White House Press Secretary Sarah Sanders said in a
statement that China would punish distributors with the “maximum penalty under the law,”
which in China is death.

Trump’s recommendation that China execute its drug pushers is a highly unusual one, more
reminiscent of the language used by Filipino strongman Rodrigo Duterte than the leader of the
free world. Since taking office, Duterte’s extrajudicial killing of drug dealers and distributors has
claimed more than 20,000 lives and drawn international condemnation.

While a US president calling for executions in a foreign country is highly unorthodox, Trump
suggested the death penalty for other criminals via Twitter before entering politics. “Got to do
something about these missing chidlren (sic) grabbed by the perverts,” he tweeted in 2012. “Too
many incidents -- fast trial, death penalty.”
Doctors in seven states charged with
prescribing pain killers for cash, sex
By

Sari Horwitz and

Scott Higham

April 17, 2019 at 5:47 PM EDT

Dozens of medical professionals in seven states were charged Wednesday with participating in
the illegal prescribing of more than 32 million pain pills, including doctors who prosecutors said
traded sex for prescriptions and a dentist who unnecessarily pulled teeth from patients to justify
giving them opioids.

The 60 people indicted include 31 doctors, seven pharmacists, eight nurse practitioners and
seven other licensed medical professionals. The charges stem from the government’s largest
prescription-opioid takedown. It involves more than 350,000 illegal prescriptions written in
Alabama, Kentucky, Louisiana, Ohio, Pennsylvania, Tennessee and West Virginia, according to
indictments unsealed in federal court in Cincinnati.

“That is the equivalent of one opioid dose for every man, woman and child” in the region, Brian
Benczkowski, an assistant attorney general in charge of the Justice Department’s criminal
division, said in an interview. “If these medical professionals behave like drug dealers, you can
rest assured that the Justice Department is going to treat them like drug dealers.”

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The Fentanyl Failure

The charges include unlawful distribution or dispensing of controlled substances by a medical

professional and health-care fraud. Each count carries a maximum 20-year prison sentence, and
many of the defendants face multiple counts. One doctor in Tennessee is charged in connection
with an overdose death caused by opioids, officials said.

The indictments are part of a broader effort by the Justice Department to combat the nation’s
prescription pain pill epidemic, which claimed the lives of nearly 218,000 Americans between
1999 and 2017, according to the Centers for Disease Control and Prevention.

Over the past two years, Justice Department officials said they have targeted doctors, health-care
companies and drug manufacturers and distributors for their roles in the epidemic. Last year, the
department charged 162 defendants, including 76 doctors, for their roles in prescribing and
distributing opioids and other dangerous narcotics.
AD

Justice Department to target opioid manufacturers, distributors in new push to curb deadly
epidemic

Benczkowski said he created the Appalachian Regional Prescription Opioid Strike Force late last
year to target the region, which has been devastated by the epidemic. The department analyzed
several databases to identify suspicious prescribing activity and sent 14 prosecutors to 11 federal
districts there.

“The opioid epidemic is the deadliest drug crisis in American history, and Appalachia has
suffered the consequences more than perhaps any other region,” Attorney General William P.
Barr said in a statement.

Once they had the data indicating suspicious prescriptions, investigators used confidential
informants and undercover agents to infiltrate medical offices across the region. Cameras and
tape recorders were rolling as they documented how medical professionals used their licenses to
peddle highly addictive opioids in exchange for cash and sex, officials said. The arrests began
early Wednesday morning.

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In one case, a doctor operated a pharmacy in his office, just outside the exam room, where
patients could fill their prescriptions for opioids immediately after receiving cursory exams,
according to the Justice Department. In another, prosecutors said, patients consented to having
their teeth pulled so they could obtain opioid prescriptions from a dentist and then paid in cash.

In a number of cases, according to the indictments, doctors across the region traded prescriptions
for oxycodone and hydrocodone for sexual favors. Some physicians instructed their patients to
fill multiple prescriptions at different pharmacies. Prosecutors also documented how patients
traveled to multiple states to see different doctors so they could collect and then fill numerous
prescriptions.

“What these doctors have done is pretty remarkable in its brazenness,” Benczkowski said.

AD

In Dayton, Ohio, which has been hit particularly hard, a doctor who authorities say was the
state’s highest prescriber of controlled substances, along with several pharmacists, was charged
with operating a “pill mill.” Prosecutors say that the health-care professionals dispensed more
than 1.7 million pills between October 2015 and October 2017.

In Tennessee, a doctor who branded himself the “Rock Doc,” allegedly prescribed dangerous
combinations of opioids and benzodiazepines, sometimes in exchange for sexual favors. Over the
course of three years, prosecutors say he prescribed nearly 500,000 hydrocodone pills, 300,000
oxycodone pills, 1,500 fentanyl patches and more than 600,000 benzodiazepines.
In Alabama, a doctor allegedly recruited prostitutes and other young women to become patients
at his clinic and allowed them to use drugs at his home, prosecutors said. Another Alabama
doctor allegedly prescribed opioids in high doses and charged a “concierge fee” of $600 per year
to be one of his patients.

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Prosecutors allege that a doctor in Kentucky prescribed pain killers to his Facebook friends who
would come to his home to pick up their prescriptions in exchange for cash.

Prosecutors also said some health-care professionals prescribed opioids for themselves. An
orthopedic surgeon in West Virginia allegedly wrote fraudulent prescriptions for pain pills using
the name of a relative and a stolen driver’s license from a colleague. In Pennsylvania, a state
outside the targeted region, prosecutors say a nurse filled out phony prescriptions for oxycodone
in her name and in the names of others to obtain pills for herself.

The arrests could leave thousands of addicts and legitimate pain patients without access to their
doctors and health-care professionals. Federal and local public health officials say they are
working together to “ensure continuity of care.”

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“It is also vital that Americans struggling with addiction have access to treatment and that
patients who need pain treatment do not see their care disrupted,” Health and Human Services
Secretary Alex Azar said in a statement.

The opioid indictments come as more than 1,500 cities, counties, Native American tribes and
unions are suing drug companies in one of the largest and most complicated civil cases in U.S.
history.

A federal judge in Cleveland is overseeing the cases, which accuse some of the biggest names in
the industry of fueling the opioid epidemic by failing to report suspicious orders of narcotics and
falsely marketing opioids to pain patients. The companies have blamed the epidemic on corrupt
doctors and pain management clinics and say the epidemic is too complicated to attribute to their
actions.

AD

Justice officials Wednesday did not discuss the companies that have supplied opioids to the
seven states. Benczkowski said this investigation targeted medical professionals because they
were “the gatekeepers to the patients.”

“But obviously, if there are doctors or others who give us information working backward up the
chain in the course of this case or any other case we’re going to be interested in hearing what
they have to say,” he said.
Pharma exec gave doctor lap dance while
pushing addictive painkiller
30 Jan, 2019 18:39

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Sunrise Lee exits the federal courthouse in Boston, Massachusetts. © Reuters/Nate Raymond

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A former stripper who rose up the ranks to become a sales director at Insys Therapeutics gave a doctor a
lap dance as she utilized all her assets to get him to prescribe a dangerous opioid, a court has heard.

In the seedy world of pharmaceutical sales sometimes you just gotta be willing to go the extra
mile for clients. In a classic example of the hard-sell, ex-stripper Sunrise Lee once gave a lap
dance to a doctor the company was pressuring to get his patients on its addictive fentanyl spray,
Subsys, a former Insys employee has testified in federal court in Boston.

Jurors heard the salacious testimony in the first criminal trial of painkiller manufacturer
executives over conduct that authorities say contributed to a US opioid abuse epidemic that has
killed tens of thousands of people a year, Reuters reports.

Also on rt.com Opioid overdoses surpass car crashes among leading causes of death in US - report

Former Insys sales representative Holly Brown said the racy dance took place after Insys began
rewarding the doctor for prescribing its painkillers by paying him to speak at sham events that
were billed as opportunities for other physicians to learn about the drug.
In reality the speaking events were actually just social gatherings for doctors and their friends,
prosecutors say.

READ MORE: 'System is broken’: Medical researchers still routinely hiding funding from
Big Pharma

The doctor, Paul Madison, is just one of many whom Lee and four colleagues, including wealthy
Insys founder John Kapoor, conspired to bribe to boost sales of Subsys, prosecutors allege. They
say the former exotic dancer was hired as a “closer” with doctors targeted by the drug’s
marketing program.

Big Pharma spent $10mn promoting opioid

drug use to patients
13 Feb, 2018 19:43

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Prescription painkiller OxyContin, made by Purdue Pharma L.D., can be seen in this file photo © George
Frey © Reuters

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Drug companies spent nearly $10 million promoting opioid drug use to patient advocacy groups and
other nonprofit organisations between 2012 and 2017. More than 42,000 Americans died from opioid
overdoses in 2016.

Physicians affiliated with patient advocacy groups accepted more than $1.6 million in payments
from five manufacturers between 2013 and 2018, according to a new report released Monday by
a Senator Claire McCaskill (D-Missouri), top Democrat on the Homeland Security and
Governmental Affairs Committee.

The report exposes financial connections between opioid manufacturers and advocacy groups,
and points to close alignment between “medical culture and industry goals,” regarding narcotic
painkiller distribution.

“The fact that these same manufacturers provided millions of dollars to the groups described
below suggests, at the very least, a direct link between corporate donations and the advancement
of opioids-friendly messaging”, the report states.

Read more

‘Same big pharma that

hooked people on opioids now profits again from addicts’ switch to heroin’

The report centres on the expenditure of five drug companies: Purdue Pharma L.P., Janssen
Pharmaceuticals, Inc., Mylan N.V., Depomed, Inc. and Insys Therapeutics, Inc., as well as 14
patient advocacy groups "working on chronic pain and other opioid-related issues."

Purdue Pharma, a manufacturer of the leading drug OxyContin, made the largest donations, with
$4.15 million given to 12 groups.

“We have restructured and significantly reduced our commercial operation and our sales
representatives will no longer promote opioids to prescribers,” said Purdue Pharma L.P in a
statement issued on Tuesday, a day after the release of the report.

McCaskill said she will draft legislation requiring greater disclosure of the financial links
between drug companies and medical groups. “The public has a right to know. Doctors have a
right to know what is behind these organizations, who is paying the bills,” she said in an
interview.
The report also highlights the role played by lobbyists seeking to prevent the tightening of laws
on opioids on behalf of advocacy groups. “Advocacy groups have engaged in extensive lobbying
efforts to either defeat legislation restricting opioid prescribing or promote laws encouraging
opioid treatment for pain”, the report states.

The majority of the groups referred to in the report also were hostile to the US Centers for
Disease Control and Prevention (CDC) guidelines issued in 2016. These federal guidelines
aimed to limit prescriptions of opioids for chronic pain. Because the groups expressed
opposition to the guidelines while still pocketing donations from drug companies, this raises the
question “of a direct link between corporate donations and the advancement of opioids-friendly
messaging”, states the report.

In January, it was announced that New York City is suing eight companies that make or
distribute prescription opioids for their role in the opioid epidemic. The suits aim to recover $500
million for current and future costs combating the crisis.