With a Little Help From My Friends

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And This Time It's Legal

The thing that must be understood first is that our cyclical drug 'epidemics' are ALWAYS driven by supply. That is to say, there is not a pent-up demand for a certain drug waiting for the underground economy to supply it to broad portions of the population. Instead, somebody finds a way to bring very large supplies of a certain drug into the US and widely distribute that drug to cities and towns across the nation. Whether it was the Crack Cocaine epidemic of the 80s, the Methamphetamine epidemic of the Oughts, or the still ongoing Opioid epidemic, the underlying economic principle is backwards from most markets. It is the supply itself that creates the demand. The thing that makes the Opioid epidemic so pernicious is that the supply is not created by criminal elements, and there is no smuggling required. No, these drugs, and the demand for them that is killing and immiserating so many Americans are perfectly legal. They are produced very cheaply in massive numbers by regular pharmaceutical companies, and distributed through the normal channels to hospitals, doctors and pharmacies in every community in the US.

In many cases, I will often take the position that what the federal government does is unimportant and only marginally effective. Federal incarceration, is only a small percentage of overall incarceration, and nothing done at the federal level will have any impact on how criminal justice is meted out in the states. Similarly, in the case of education, while the federal government provides some funding, states by far have the most to say about how educational institutions are operated, and at what cost.

But this is a different matter. The FDA has complete control on how these drugs are manufactured and distributed, and working through the DEA they can prevent at least the most egregious misallocation of these kind of highly addictive drugs through the system. One of the most problematic parts of the supply chain is a local pharmacy that seeks to profit from the sales of Opioid drugs like Oxycontin, rather than to act in a manner that is responsible to the people of their community. Their greed is destroying communities all over the US. But at least we have the Government to step in and control these kinds of abuses, right?

Not so fast. When Donald Trump nominated Rep. Tom Marino (R-PA) to be Drug Czar, the press started looking into his history, especially with the Pharmaceutical industry. And sure enough, it turns out that he took over a hundred thousand dollars from Big Pharma, and acted on those contributions. Working directly with industry lobbyists - many of them former FDA and DEA inspectors and investigators, hired by the industry for huge salaries - Marino drove the passage of a law that brilliantly concealed its ultimate purpose. The law seemed so benign that it passed congress by unanimous consent - no voting required. It was only after its passage that the DEA discovered how it tied their hands when they discovered excesses that were clearly criminal.

One of the small-town pharmacies they detected as being a criminal drug distribution center was in Kermit, West Virginia, population 392. That single pharmacy ordered - and received - 9 MILLION pills in just two years. The DEA saw the reports, and wanted to investigate that pharmacy, but Tom Marino's law blocked them from doing so. And people died.

Of course, Marino, once exposed, could never be confirmed as 'Drug Czar', so he took himself out of the running. But we still need effective federal action to limit the greed-driven excessive shipments without limiting access to necessary treatment for pain. Big pharma - especially McKesson, Cardinal Health, and AmerisourceBergen - makes tens of billions of dollars on these drugs, and will resist anything that reduces those profits. Just like the gun lobby, the pharmaceutical industry has concluded that the profits are worth the loss of life, and the ruination of so many peoples lives, and will continue to push for ways to put MORE opioids into circulation, not less.

Watch congress closely. There is a lot of talk about the 'Opioid Crisis', but not a lot of action. Any action will take immense political courage, because the industry is a powerful foe. And if we've learned anything over the last ten years, it is that congress can bloviate and pose with the best of them, and at the end of the day do nothing. Once again, the personal risk to the individual lawmakers is of much deeper concern than the millions of American lives at risk.
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