EDITORIAL

Attack opioid crisis from all angles: Editorial

A Journal News editorial

National outrage over the opioid epidemic, which continues to take lives day after day, now has investigators correctly focusing more attention on the source of those millions of pain pills: pharmaceutical manufacturers and the powerful national distributors that push the pills. New Yorkers and all Americans must demand answers and accountability from the faceless corporate giants that make and distribute pills that have created a generation of addicts and revived heroin as a national scourge. 

A trash bag full of unused or expired prescription drugs turned in to the Drug Enforcement Administration at a 2011 drop-off in White Plains.

New York State Attorney General Eric Schneiderman and a coalition of regional counties, including Westchester and Rockland, are among the many forces that are essentially "following the money" back to Big Pharma and a federal bureaucracy that may favor corporate dollars over protecting Americans from a deadly epidemic.

Many were disgusted by last week's "60 Minutes" report about how three national distributors of pharmaceuticals have ignored suspicious drug orders from pop-up "pain clinics" and over-prescribing doctors. The federal Drug Enforcement Agency was all over the distributors, nailing them with millions in fines, until the DEA started pulling back, according to former high-ranking DEA official and now whistleblower Joe Rannazzisi, as well as several of his former colleagues. Of course, a major problem is that dozens of former DEA officials have flipped to work for the drug industry, and now lobby their former colleagues to weaken federal enforcement powers.

The report explained how Congress quietly passed legislation last year, signed by President Obama, that made it far more difficult for the DEA to interfere with suspicious drug shipments. How could the whole thing become more outrageous? One of the chief sponsors of the legislation, Pennsylvania Congressman Tom Marino, was chosen by President Trump to be the nation's drug czar before the 60 Minutes report forced him to withdraw his name.

Prescription drugs.

It's taken years for communities, counties and states to come to terms with the pain-pill epidemic — how easily people become addicted after ordinary injuries or surgeries and how maddeningly accessible pain pills, heroin and fentanyl are. Ultimately, public awareness has soared because so many people know of someone who has been directly hurt by the epidemic. About 60,000 Americans died from drug overdoses in 2016. Today, local communities, and communities across the country, are increasingly focused on prevention through awareness and education, improving access to treatment for addicts, and the cracking down on illegal distribution.

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Still, beds are lacking and so is insurance coverage. President Trump's opioid commission met on Friday and addressed the health coverage hole left by insurers who limit addiction treatment. That finding aligns with a report issued last year by President Obama's opioid task force. Both panels' findings come despite the Mental Health Parity and Addiction Equity Act of 2008 that requires health insurers to treat mental health and substance abuse disorders the same as any other disease, without additional limits, co-pays or deductibles. 

But investigators must also go after the source. Schneiderman is among 41 attorneys general who have launched a multi-state investigation of drug manufacturers and distributors. They have served subpoenas on major manufacturers — Endo, Janssen, Teva, Allergan. And they're seeking documents from the three national distributors — AmerisourceBergen, Cardinal Health and McKesson — that Schneiderman says control 90 percent of opioid distribution, a $500-billion-a-year industry. “Too often, prescription opioids are the on-ramp to addiction for millions of Americans. We’re committed to getting to the bottom of a broken system that has fueled the epidemic and taken far too many lives,” New York Attorney General Eric Schneiderman said in announcing the jointly filed subpoenas.

Westchester, Rockland and Dutchess counties have also joined at least six other New York counties in suing pharmaceutical companies. They accuse the companies of using deceptive marketing practices to push their products. "So how did the most advanced country on the planet develop this problem like no other part of the entire planet?" Rockland DA Thomas Zugibe said in April. "Well, you can thank in large part profit motives that got us here, like many of the drug dealing that you see on an ongoing basis."

Zugibe also noted that "doctors drank the Kool-Aid and accepted it." Anyone who has seen pharmaceutical reps buzzing in and out of their doctor's offices knows how connected drug companies are to those who write out our prescriptions.

Thanks to a federal database called Open Payments, which was required by the Affordable Care Act, we know that New York doctors were paid $164 million last year by pharmaceutical and medical-device companies, ostensibly for marketing and research. While there may be good reasons for relationships between drug companies and doctors — like to promote research and education on quality drugs and devices — the medical community must acknowledge that the opioid epidemic has raised legitimate and frightening questions about the power of Big Pharma's financial incentives.

According to The Journal News/lohud's David Robinson, who analyzed data from Open Payments: some New York doctors may not have disclosed payments from drug companies when speaking about their products and some doctors were quoted in the media praising drugs and devices made by companies that paid them. While we can't be sure that such actions were unethical, the opioid crisis shows that it's time for authorities to be far more vigilant about tracking these relationships.

A naloxone kit, used by the Ramapo Police Department, to revive a person who has overdosed on heroin or other opioids.

Meanwhile, New York has taken key steps in curbing the opioid plague. Painkiller prescriptions are limited for acute treatment, cutting down on long-term use that can lead to addiction and curbing "leftover" medications sitting around that can feed an addiction. The state's I-STOP electronic prescribing laws, which mandate that doctors electronically order pain meds, are another way to cut down on prescription medications becoming street drugs.

According to the Medical Society of the State of New York, incidents of doctor-shopping for prescriptions has dropped by 86 percent due to I-STOP's Prescription Monitoring Program. It mandates that physicians check a controlled substance registry before prescribing such drugs. New York also continues to expand programs that get lifesaving naloxone into the hands of anyone who may need it, no questions asked. 

It is painfully obvious, though, that more needs to be done. One way to fast-track action would be for President Trump to fulfill his promise and declare the opioid crisis a national emergency, a pledge he first made two months ago and recently stated would occur next week. We await more action, and additional resources, to fight this epidemic.