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Opioids and the State of The Union, 2017

Photo by Me | CC by 2.0


THE STORY

“In April 2016, at the height of the deadliest drug epidemic in U.S. history, Congress effectively stripped the Drug Enforcement Administration of its most potent weapon against large drug companies suspected of spilling prescription narcotics onto the nation’s streets.”

(Quotations and facts in this article are from a segment of an October 15, 2107 60 Minutes and Washington Post article by Scott Higham and Lenny Bernstein.)

Major pharmaceuticals produced opioids, and sold them to distributors  knowing there was no possible legitimate use for them in the amounts they were being produced.

Large pharma distributors sold the opioids to internet and local pharmacies and to doctors knowing there was no conceivable way in which there was a legitimate market for them in the number they were being sold.  McKesson, “the fifth-largest corporation in the nation,” is among them.

Doctors wrote the prescriptions; retail pharmacies sold them.

At the time this was going on, 200,000 people—more than three times the number of U.S. military deaths in the Vietnam War—died of overdoses.

Not one big pharma executive, not one big distributor executive, not one local pharmacist, not one doctor who wrote a prescription for an addict spent one day in jail.  Nor did any stockholder raise a question about these practices.

Fines levied against the distributors—the target on which the Drug Enforcement Agency (DEA) focused to bring a halt to these practices—were not sufficient to stop the practice.  These fines are considered a “cost of doing business”.

Joseph T. Rannazzisi ran the DEA “division responsible for regulating the drug industry and led a decade-long campaign of aggressive enforcement (despite, he says, efforts (denied of course) from President Obama’s Justice Department to get him to back off) until he was forced out of the agency in 2015.”  He was the whistle-blower on “60 Minutes,” and was visibly angry at the pharmaceutical industry and the politicians.   He said, “The manufacturers, wholesalers, distributors and chain drugstores (including Walgreen’s) have an influence over Congress that has never been seen before.”

With Rannazzisi out of the way, the pharmaceutical industry got DEA to accept a piece of legislation to recommend to Congress that “it did not want” that was “completely unnecessary.”  Among those arguing with DEA were numerous lawyers and lobbyists who formerly had been DEA staffers who knew intimately vulnerabilities in DEA strategy, and members of Congress who received tens of thousands of dollars from the drug industry.   “Dozens of top officials from the DEA and Justice Department have stepped through Washington’s revolving door to work for drug companies.”

Early in the legislative process, then-Attorney General Eric Holder said, “A recently passed House bill would severely undermine a critical component of our efforts to prevent communities and families from falling prey to dangerous drugs.”  That was the last time the Department opposed the industry.  (Once winning DEA approval, no one else in the Executive Branch opposed the bill—after all it was coming from their own staff.  That includes President Obama, then-Justice Department head Loretta Lynch, then-DEA head Chuck Rosenberg, or several officials who spoke on condition of anonymity.

Congressman Tom Marino, a Pennsylvania Republican “spent  years trying to move the law through Congress.”  Until this story broke, he was “President Trump’s nominee to become the nation’s next drug czar.”

“Political action committees representing the industry contributed at least $1.5 million to the 23 lawmakers who sponsored or co-sponsored four versions of the bill, including nearly $100,000 to Marino and $177,000 to Sen. Orrin G. Hatch (R-Utah) who “negotiated a final version with the DEA”.

Why DEA finally went along with the new bill is not specifically identified, though it is obvious that big pharma and its political allies brought lots of pressure to bear on the agency.  The new law “makes it virtually impossible for the DEA to freeze suspicious narcotic shipments…[which had been] the powerful took to immediately prevent drugs from reaching the street.”

In a draft article provided to The Post by the Marquette Law Review editorial board, DEA Chief Administrative Law Judge John J. Mulrooney II wrote, “‘At a time when, by all accounts, opioid abuse, addiction and deaths were increasingly markedly’ the new law ‘imposed a dramatic diminution of the agency’s authority’.”

“On March 17, 2016, the Senate passed the bill by unanimous consent.  On April 12, the House approved the Senate version, also by unanimous consent…On April 19, Obama signed the bill.”  Congressman Marino and industry groups “thanked Obama”.

In his article, Administrative Law Judge Mulrooney said, “If it had been the intent of Congress to completely eliminate the DEA’s ability to ever impose an immediate suspension on distributors or manufacturers, it would be difficult to conceive of a more effective vehicle for achieving that goal.”  “He ‘likened [a provision] to allowing bank robbers ‘to round up and return ink-stained money and agree not to rob any more banks’.”

The Post story lists more than a dozen individuals who moved from DEA enforcement positions to industry-related jobs (lobbyist, law firm, direct employee).

Summing up his experience as DEA Detroit program manager, Jim Geldhof said, “Greed always trumped compliance.  It did every time.  It was about money, and it’s as simple as that.”

MONEY TALKS

Much of what is told in this 60 Minutes/Washington Post story is par for the course in today’s business world:

+ Big business seeks to maximize profit—the only stakeholders of significance these days are the investors and the executives’ incomes.

+ Middle men and advertising connect the companies to their markets. The brokers (wholesalers, distributors) understand their income and wealth depend upon how well they do for their patrons.

+ Bottom feeders do the same, scurrying around at the edges of what’s legal, and sometimes just being illegal. They depend upon regulators not reaching them, and local government either not caring or being on their payroll.

At whichever level, money buys influence. Politicians are for sale.

Further, the government-corporate world revolving door gives business detailed “intelligence” that makes its influence look legitimate.  Dozens of former DEA staffers are now working directly for Big Pharma, or for the law firms and public relations organizations that represent it.

What is striking about the Post/60 Minutes story is how totally effective Big Pharma and its minions were.  There were no Congressional dissenters to the motion to pass the bill that gave the industry what it wanted.

This is where most analysis seems to stop.  I think that’s a mistake.  To simply say the above is to abandon hope and the possibility for change unless someone else brings it about.  That’s too easy.

QUESTIONS

Assuming there are no major omissions in the Post or 60 Minute accounts, there are unasked questions that should be asked.  Here are a number of them, with comments to follow.

Why was there no public interest DC-based lobbying organization waving the alarm banner?

Why didn’t a Congressional staffer who works for a decent member of Congress on one of the committees that looked at the legislation before it went to the House and Senate floor, voice objection to his or her boss?  Why was there no voice on the floor of Congress opposing this legislation?

Why didn’t the United Mine Workers Union or any other union whose members, members’ families, and members’ communities that are affected by the opioid crisis speak up?

Why didn’t the American Federation of Government Employees, or whichever union represents DEA employees say anything?

Why didn’t any professional association that is supposed to be the bearer of the values its members claim to profess speak up?  Here, for example, is what the New York Bar Association says about the responsibilities of a lawyer:

New York Lawyer’s Code of Professional Responsibility

PREAMBLE

The continued existence of a free and democratic society depends upon recognition of the concept that justice is based upon the rule of law grounded in respect for the dignity of the individual and the capacity of the individual through reason for enlightened self-government. Law so grounded makes justice possible, for only through such law does the dignity of the individual attain respect and protection. Without it, individual rights become subject to unrestrained power, respect for law is destroyed, and rational self-government is impossible.

Lawyers, as guardians of the law, play a vital role in the preservation of society. The fulfillment of this role requires an understanding by lawyers of their relationship with and function in our legal system. A consequent obligation of lawyers is to maintain the highest standards of ethical conduct.

In fulfilling professional responsibilities, a lawyer necessarily assumes various roles that require the performance of many difficult tasks. Not every situation which the lawyer may encounter can be foreseen, but fundamental ethical principles are always present for guidance. Within the framework of these principles, a lawyer must with courage and foresight be able and ready to shape the body of the law to the ever-changing relationships of society.

Here’s what the American Pharmacists Association says on the ethics of the profession:

Code of Ethics

PREAMBLE

Pharmacists are health professionals who assist individuals in making the best use of medications. This Code, prepared and supported by pharmacists, is intended to state publicly the principles that form the fundamental basis of the roles and responsibilities of pharmacists. These principles, based on moral obligations and virtues, are established to guide pharmacists in relationships with patients, health professionals, and society.

1. A pharmacist respects the covenantal relationship between the patient and pharmacist.

Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.

And what about the idea “first do no harm” that is supposed to guide doctors?  Here’s what the American Medical Association says is its code:

Preamble

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self.

And this is from the “modern Hippocratic Oath”:  “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.”

Why did no religious denominational body or local church whose members and communities are affected speak up?

The Media.  First of all, congratulations to “60 Minutes” and The Washington Post.  They did what the news media in a free society are supposed to do, and they did it well.  But why only them?  Why hasn’t the Newspaper Guild picked this story up and rushed it out to its members so they could bring it up with their editors?  What aren’t other editors picking it up on their own and seeing if there’s an application in their local markets?  What aren’t publishers asking their editors “Why aren’t we covering this story?”

WHO’S LEFT?

After describing the corruption of Ancient Israel in Old Testament times, Rev. Robert C. Linthicum engages in a brilliant exegesis on what the people are supposed to do when the religious, governmental and the economic institutions fail to live out their Godly-intended purposes.  (See “Systems As God Intends and Humanity Corrupts;” Rev. Robert C. Linthicum.  Social Policy Magazine.  Autumn, 2001.)

[T]he question must now be asked, “What are the people to do about it?” As a reformist force in society, what are we called to do? Obviously, the Bible doesn’t talk about community organizing, labor unions or democratic participation in civic life. These are social inventions of more recent times.

But its core message and narratives tell stories of people gathering themselves together out of their relationships with each other in order to fight for justice. Thus it was that Moses organized Pharaoh’s bricklayers to fight against their exploitation – with God on their side! Biblical leaders like Joshua, David, Jeremiah, Esther, Daniel, Peter, Mary Magdalene, John the Baptist and even the Pharaoh-defying midwives Shiphrah and Puah (Exod. 1:15-20) used tactics of confrontation, nonviolent civil disobedience, agitation, negotiation and holding systems accountable to bring about change. Nehemiah organized the people of Jerusalem to rebuild their city, successfully confronting the unjust systems of their country, and rebuilding their public life in the image of Deuteronomy.

Jesus challenged the Roman and Jewish systems and people of power and was an “in-your-face” agitator on the side of the poor and powerless, calling for a return to the Deuteronomic vision of love, justice and equitable distribution of resources. Defying the traditions of his culture, he gave important leadership roles to women and he spent significant time with lepers, tax collectors and others who were marginalized and excluded. He called those most despised and ostracized by their society (such as Matthew the tax-collector and Mary Magdalene, a reputed prostitute) to become leaders of his movement, declaring to the religious leaders of Israel, “the kingdom of God will be taken away from you and given to a people that produces the fruits of the kingdom” (Matt. 21:43).

The biblical witness is one of society as God intended it to be – a culture in relationship with God and each other, of justice, the equitable distribution of wealth and the engagement of its entire people in the shaping of its public life. The biblical witness is one of society gone awry – of political, economic, social and religious systems in collusion with each other to solidify the power, wealth and authority of those at the top, reducing the people to obedient servants of the powerful or as castaway detritus. The biblical witness is one of the continuing engagement of God’s people in public life, driven by their faith in a just and loving God, their love for each other and their commitment to the building of a shalom community (or “kingdom of God”) in the face of a world of both greedy and self-serving people and collusive, dominating systems.

Whether we are Christians, Jews, other peoples of faith, or those who love democracy and justice, the biblical witness can help us articulate a vision of public life lived at its highest, an analysis which enables us to understand evil as public and systemic as well as private and individual, and the commitment to work together in our public life toward a society which is truly relational and just, seeking a shared stewardship of the earth’s resources “so that there will be no poor among you.” (Deut. 15:4) This is the vision that will enable us to turn our society’s public life “upside-down”!

WHERE ARE REV. LINTHICUM’S “WE”?

For the most part, unions are marginal to any hope we now might have for playing the role Linthicum calls for.  Beyond an occasional resolution of support that isn’t followed up by meaningful action, there’s not much coming from them.  Efforts at revitalization and renewal are taking place.  Occasional reform candidates triumph and bring some change  I hope these efforts are all successful.

Why were there no local community organizations building sufficient counter-weight pressure on their members of Congress (from opioid-hit areas) to act as counter-weights sufficient to overcome money, or at least create a debate?

Why aren’t these same community organizations seeking direct meetings with Big Pharma to negotiate specific agreements that put an end to these practices, with the threat of using the leverage of institutional purchases to make these companies come to the table and negotiate in good faith.  (An example of leverage:  there are hospitals across the country that have choices of what drug brands to purchase for use with patients.)

Why are there no sit-ins and other non-violent demonstrations by militant “moral witness” organizations halting business-as-usual at corporate headquarters, calling unions and professional associations to account, and demanding of the religious community that it shame its members who are engaged in this outrage?

The opioid story is not qualitatively different from any story in which big business buys government to do its bidding.  It tells the story more clearly because of the incredible success the pharmaceutical industry had in buying the government—left, right and center.

More important, however, from my point of view is what this story tells us about what needs to be done at the base of society.  The politicians, we can generally assume, make a calculation between organized money and organized people. When there are organized people, their people power organizations are vehicles to reach voters.  Organized people can be or become citizens who discuss, debate, deliberate, discern, negotiate, compromise and otherwise engage in the conversations that are the hallmark of any meaningful idea of citizenship.

In the absence of organized people, with the potential of becoming citizens who arrive at conclusions on candidates and issues, campaigns must be waged to mobilize voters, who are in this case a market (citizens become consumers) to whom products (candidates and issues) must be sold through mass media.  That requires money to buy media time, which, in this 60 Minutes/Washington Post story, comes from the pharmaceutical industry, but in any other case we might look at comes from a particular sector of the economy with a profit or other stake in the outcome (banks, manufacturers, distributors, retailers, etc).

Organize!

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