A confidential government document containing evidence so critical it had the potential to change the course of an American tragedy was kept in the dark for more than a decade. The document, known as a “prosecution memo,” details how government lawyers believed that Purdue Pharma, the maker of the powerful opioid, OxyContin, knew early on that the drug was fueling a rise in abuse and addiction. They also gathered evidence indicating that the company’s executives had misled the public and Congress.
There has been a recent wave of lawsuits against opioid makers and members of the Sackler family, which owns Purdue Pharma. Opioid abuse has ravaged America over the past two decades. According to the Centers for Disease Control and Prevention (CDC), from 1999 to 2017 more than 700,000 Americans have died from a drug overdose. Approximately 68% of the more than 70,200 drug overdose deaths in 2017 involved an opioid. In 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 6 times higher than in 1999. On average, 130 Americans die every day from an opioid overdose.
The confidential Justice Department “prosecution memo” represents a missed opportunity that might have changed the course of the opioid epidemic. It also suggests that Purdue Pharma and members of the Sackler family knew far earlier than they admitted that OxyContin was being abused. The memo had the potential to change the course of the opioid crisis but was kept from circulation for more than a decade. The report states that Purdue Pharma executives were implicated in the crisis.
The Department of Justice chose not to pursue felony charges against those executives, paving the way for a settlement that ended a four-year investigation. The settlement did not produce any vital changes to industry behavior regarding the prescribing of narcotic painkillers. Secrecy surrounding the memo is emblematic of a legal process that favors the suppression of corporate information. If disclosed, this information could benefit the public’s health and safety. It is truly extraordinary to see after all these years that the opioid industry is finally being held to account.
Analysis of the DEA database obtained by the Washington Post reveals that a relatively small number of pharmacies—15 percent—distributed roughly half of prescription opioids nationwide from 2006 to 2012. It seems the DEA wasn’t paying attention to its own data, instead relying on drug companies and pharmacies to police themselves. In one engaging multimedia story, the Post took a close look at a southwestern Virginia area that was flooded with 74 million opioid pills over seven years—enough for 106 pills per resident every year. Journalists from over 30 states have now published over 90 separate articles based on the previously undisclosed DEA data.
It’s unbelievable that millions of oxycodone and hydrocodone pills flooded poor communities in Appalachia as pharmaceutical companies and the DEA failed to heed signs of large-scale inappropriate prescribing. Yet there is a certain liberation in being able to point to specific data, which might help assign responsibility for what may be U.S. health care’s most fateful systemic failure in recent history.
It is bad enough that many doctors and pharmacies were little more than “pill mills” supplying untreated addicts with their drug of choice rather than treating legitimate pain patients. It is quite another to know that nearly 35 billion opioids — about half of all distributed pills — were handled by just 15 percent of the nation’s pharmacies between 2006 and 2012. A single drugstore in tiny Albany, Kentucky purchased nearly 6.8 million hydrocodone and oxycodone pills during that period, equivalent to 96 a year for all 10,000 or so men, women and children in surrounding Clinton County. This was the most on a per capita, per county basis in the United States.
There is always a tension between discretion and disclosure—between keeping the public informed about the workings of large medical treatment systems and permitting specialists who operate them to handle delicate matters in private. Nowhere is that tension more relevant than in health care, where medical expertise, proprietary information and patient privacy are all at a premium. Like all good things, however, those may be taken to an extreme or turned into excuses for unwarranted concealment.
Any ordinary person who learned that a single pharmacy in small-town Kentucky was handling millions of potentially addictive pills over a seven-year period might have sounded an alarm, even if government bureaucracy, industry leaders, and doctors did not. Unfortunately, no ordinary person could know—until now.
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