DEA or DOA?

Over the last decade, in frequently futile attempts to stem abuse and misuse of painkillers, the Drug Enforcement Administration (DEA) has heavy-handedly employed a number of tactics with only limited success. They have arrested hundreds of doctors on criminal charges and pre-emptively closed dozens of pharmacies. Now, they’ve found another hard target.

Between Big PHARMA which makes drugs, physicians who prescribe them, and pharmacists who dispense them, lies the drug distribution wholesaler system. A sprawling behemoth involving 800 companies ranging in size from a few giants like Cardinal, McKesson and Amerisource Bergen to hundreds of small firms.

Wholesalers help perform a useful service in terms of controlling drug costs by negotiating down the costs with discounts for large customers. (Except for the largest buyer of drugs of all, the federal Medicare Part D program. Which is prohibited from negotiating the costs of drugs. Meaning you, the taxpayer, is stuck with the full bill.)

For wholesalers, the profits on medications may be small—sometimes only pennies a pill. So, like the Mafia, wholesalers go where the money is—narcotics. Narcotic painkillers are now the most widely prescribed drugs in the United States, with sales last year of $8.5 billion. And even at pennies a pill, those total profits are large.  

But the DEA expects wholesalers to “snitch” when drug orders should supposedly raise suspicions. The problem is, it’s often difficult for a wholesaler in the middle of the system to determine whether a pharmacy dispensing, or a doctor prescribing, narcotic pain relievers is serving a legitimate medical need or simply supplying the demand for illegal drugs. And the DEA has never issued specific guidelines.

So, wholesalers operate in a Wonderland where DEA won’t do their jobs to develop guidelines. But where the DEA is all too eager to pounce. After all, the DEA knows where the money is too.

In 2008, the wholesale company Cardinal turned over $34 million to the government because it failed to alert the DEA to suspicious orders for millions of pain pills that it was shipping to Internet pharmacies. That same year, McKesson paid $13 million. 

Of course, neither company admitted to any wrongdoing but handed over the penalty funds to the government so they could continue to do business.

So now, to avoid these penalties, the big wholesalers are now beginning to hold back on supplies. Of course, the net effect of all this is that more pharmacies in more states are unable to get narcotic drugs at all. Which means that patients who legitimately need these pain medications can’t get them. And, despite the reputation they’ve been given, it is a simple fact that narcotics are the best drugs for pain. As they have been for centuries. 

When I served as a Medical Examiner in Miami-Dade County Florida (literally, in the days of “Miami Vice”), a big clamor always ensued after messy “shoot-outs” between drug dealers and DEA cowboys. And I remember local law enforcement officials telling me they wish the DEA would just get out of the way. And perhaps they should do just that.

Prohibition didn’t work in the 1920s, and it doesn’t work now. It only breeds crime. And the innocent suffer while we all pay the price.


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