60 Minutes on the opioid crisis #2

A question I had -- not at all answered by the 60 Minutes show-- is why any one drug distributor deserves so much blame. Suppose the following. A rogue pharmacy buys drugs from three different distributors. #1 sells the pharmacy N1 thousand pills, #2 sells it N2 thousand pills, and #3 sells it N3 thousand pills, all in the same time span. So the pharmacy buys N1 + N2 + N3 thousand pills. Why should #1 be held accountable for knowing about the N2 + N3 thousand pills? Similar for #2 and #3. Yet apparently Rannazzisi, the other DEA people, and 60 Minutes host Bill Whitaker seem to believe each of the three should be held accountable and far more to blame than the pharmacy, doctors who write the prescriptions, or the people who overdose. Are the people overdosing with opiods entirely innocent? How guilty are the doctors writing the prescriptions, and the pharmacies filling the prescriptions? Such doctors and pharmacies get a little blame, but it is far outweighed by the blame on the big wholesale drug distributors.

Whitaker claims the distributors know how exactly how many pills go to every drug store they supply (5:29), and the show cites large numbers of pills relative to the local population. Does that mean N1 or N1 + N2 + N3? Are some drug stores buying large quantities in order to supply other drug stores who can get lower prices this way?

Is it much easier for the DEA to go after the drug distributors and going after them is considered more newsworthy? There are thousands of doctors and hundreds of pharmacies and pain clinics, so many that it would be difficult to pursue massive arrests. On the other hand, there is a tiny number of large wholesale drug distributors. The DEA could slap a big fine on a big wholesale distributor company, but that could be chump change to the company and wouldn't be hugely newsworthy. That makes a high-level executive of a big drug distributor an easy target for scapegoating or maybe prosecution. Prosecuting such an executive would also likely be considered very newsworthy.

The drug distributors are supposed to report cases of a pharmacy that makes big orders to the DEA. McKesson and Cardinal Health did under-report and pay a big fine. Regardless, why assume they have obligations beyond that, e.g. knowing what a pharmacy buys from other distributors? Shouldn't any action beyond that be the DEA's responsibility?

The DEA zealots call the drug distributors greedy, non-caring killers. Would they accuse heroin or crack dope dealers of wanting to kill their customers? I doubt it. I don't doubt the distributors like their profits. On the other hand, I am confident that DEA folks dislike their actions being subject to limits. They desire their power as much as the drug distributors do their profit.

60 Minutes on the opioid crisis #1

Last Sunday the television show 60 Minutes reran this episode about the opioid crisis. The original made me suspicious of bias; seeing it the second time more so. It strikes me as very biased about who deserves blame, and it tries to make a likely overzealous bureaucrat into a hero. Joe Rannazzisi is an ex-agent of the Drug Enforcement Administration (DEA). He and the story are very critical of wholesale drug distributors. The story alleges that Rannazzisi exposed the DEA's failure (due to congressional interference, unwarranted in his opinion) to hold Big Pharma accountable in the opioid epidemic.

The story blames a few doctors, a few pharmacies, a few pain clinics, and Congress, but the most blame is for the three largest wholesale drug distributors -- McKesson, Cardinal Health, and Amerisource Bergen. They are the choke point selected by the critics. Rannazzisi gets lots of air-time to give his side of the story. Some other DEA agents or ex-agents, with opinions similar to Rannazzisi, get much air-time. Lobbyists for the drug distributors get some blame. Many of them are ex-DEA lawyers. The critics of the distributors don't appreciate such well-informed people thwarting the DEA's efforts.

There are only two spokesman on behalf of drug distributors, and they get very little air-time. Some media such as here gives the drug distributors' side, but 60 Minutes put very little effort towards that. One of the two was a Congressman who criticized the DEA's aggressive enforcement tactics, but that criticism is pooh-poohed by others. Of course, Congressmen like law enforcers to take it easy on their campaign contributors. On the other, law enforcers sometimes act like they are above the law and morally superior.

Near the end of the episode Rannazzisi makes his main motive very clear -- to put a high-level drug industry executive in jail. Such an executive gives him a scapegoat, and putting one in jail would fulfill his goal of making a big headline, whether or not it is a substantive remedy, and regardless of the degree of objectively determined guilt.