Ring of Fire’s Sam Seder is joined by Attorney Peter Mougey to discuss the ongoing opioid addiction in America and how it is impacting the communities that have had these prescription drugs poured into.
Transcript of the above video:
Seder: So Peter, there’s been and particularly and of course during the course of this week’s revelation of Trump Care if you want or Republic Care 2.0 opioid addiction has gotten a decent amount of attention. An extra $45 billion going in to treatment to deal with opioid addiction because this is such a massive problem in this country and particularly in states like Ohio and West Virginia but across the nation. And this has been ongoing. In some respects we’re at maybe the peak or maybe not. But this has been building for year hasn’t it?
Mougey: It has. I mean more than a decade since really OxyContin came on the market from Purdue in 1996 it’s been escalating ever since. And now there’s just a complete mess that needs to be cleaned up.
Seder: Just to go over some of the statistics. In 2015, which is the latest year on which the Centers for Disease Control has data that is released, more than 33,000 people died of overdoses that involved an opioid including more, and this is what really shocked me, more than 15,000 who had taken a prescription narcotic, 13,000 more were killed by overdoses of heroin which in many ways and I would imagine and we have no way of knowing for sure. But at the very least there’s significant study that suggests that at least a percentage of those were a function of an earlier prescription painkiller addiction. But the idea that more people died involving prescription narcotic versus heroin is shocking.
Mougey: Oh yeah. And there’s no question. There’s epidemiology studies being conducted as we speak to make the link between prescription opiates and the move into heroin. It doesn’t take a PhD MD to figure out that there’s a causal connection between the two and it’s a step from prescription opiates to heroin. No one starts off by putting a needle in their arm with a rubber band and cooking the heroin down in a spoon to inject into their arm. It’s a sequential step from opioids depending on how you started, whether it was a prescription to get your wisdom teeth out. Whether it was a hernia application. Whether it was an injury from football and spring practice as a high school football player and you get a sheet of opiates to take for a month and then you’re addicted.
And then over time more and more pills. Longer and longer periods of time and then the pills get either too expensive or scarce to find and you move into heroin. And that story’s been told over and over again across the country.
Seder: I mean there seems to be two sort of parallel stories about the prescription pain killing opioids that have caused this crisis. One track seems to be off label marketing of this drug through doctors. The other track seems to be producers, distributors who are selling this stuff and it’s getting out there in other ways that are dubious let’s say. Right? So you have the one where it’s been pushed as some type of medical solution and the other one where it’s like pushed and it just sort of goes out the door and you close your eyes as to how it’s going out there.
Let’s start with the former and then we’ll talk about the latter. And then we’ll talk about the troubles the government has had really it seems to me in sort of policing both those tracks and what you as a plaintiff’s attorney could do about it. But let’s start with that off label marketing. Just explain to us what that is and walk us through the scenario in which that painkiller ends up in somebody’s system.
Mougey: Absolutely. Let’s start off with that heroin has been around for decades. Hundreds of years. We fought wars over opium addiction. We’ve never seen a heroin epidemic like we have now. So how did we get here?
Well in 1996 as I mentioned earlier, Purdue Pharma introduced OxyContin into the market. Almost identical to heroin at the end of the day. It’s a prescription form of heroin that became commonplace. The paradigm was changed with the marketing from the pharmaceutical companies that what was once an end of life extreme pain management short term like coming out of surgery end of life pain management that’s how opiates were used. And over time beginning in 1996 on, Big Pharma changed the paradigm with going to doctor’s offices, pushing “educating” doctors that opiates could be used safely like for example through time release capsules that the pain was released … I’m sorry that the opiates were released over time. Those are just a couple of examples.
And that’s how this started with Big Pharma “reeducating” doctors that opiates were safe for longer term pain management when they knew they were ridiculously addictive. That’s how this started with more and more and more of the opiates being prescribed. That was where this crisis started beginning with the manufacturers. But as you mentioned and we can-
Seder: Well let me just see if I … So to understand that dynamic the analogy would be if I was a maker of X-rays and I started telling doctors, “Hey you know it’s not just … You don’t have to use it so sparingly. I know you’re worried about radiation poisoning of people-
Mougey: That’s a good analogy.
Seder: … but you can use this for all different types of things. You don’t have to worry so much about the lead sheet. That is the old way of doing things. Now you can use these things for fun pictures for your clients.”
Mougey: Right. That’s a great analogy. You’re exactly right. At the end of the day you saw kids coming out of dentist’s offices with hydrocodone. The opiates were prescribed on a regular basis for longer term pain management where young adults, older, anyone with short-term pain issues. Short term meaning like 30 days, were being prescribed some form of opiates for non-live threatening. Toothaches, literally toothaches. Knee injuries. Back injuries. And that’s where you saw this problem being started. But that’s a good analogy.
Seder: And did the producers of these opioids, did they understand the risk? We all understand the risk of using X-rays too easily and making the wrong cost benefit analysis.
Mougey: Right.
Seder: Did they understand the risks?
Mougey: What they understood was big money. And they understood big profits and they understood billions of dollars. And that bottom line focused on make money, line our pockets. Stock prices took precedent over the risks to the users. And quite frankly there never any peer reviewed significant studies that went through and said long term pain management with opioids is a safe practice. If it wasn’t bought and paid for by the industry, it didn’t occur. And the studies they did cite didn’t say what they said. The doctors and the re-education programs. It was an absolute travesty what happened and how this was marketed.
But quite frankly, while the manufacturers are responsible, I feel like the bigger culprits here, the ones that were charged with monitoring and identifying and reporting and holding suspicious activity with opiates that that was their job. That was their role. They were the beat cops. They were the ones that-
Seder: Who were those beat cops?
Mougey: … let caution go to the wind. Pardon?
Seder: Who are they? The FDA?
Mougey: Let me back up for a second. In 1970 Congress created the CSA, the Controlled Substance Act. And Congress in infinite wisdom in 1970 said, look this isn’t capitalism at its finest. The more drugs we sell, the better. We need a different system than we do for cars or milk or coke or whatever and Coca-Cola. Whatever. We need a different system. This isn’t capitalist. Demand should control. So instead Congress said we need a closed system. So manufacturers should not sell directly to their customers meaning pharmacies and doctors. Instead, it needs to go through what were called wholesale distributors.
Wholesale distributors, there’s 800 but three companies primarily dominate the market. Amerisource, Cardinal and McKesson. They have 85% of the market share. And these 800 distributors license were like a golden ticket from Willy Wonka’s Chocolate Factory. If you had a golden ticket and you were a distributor, it was a license to make money. And Congress through the CSA charged these distributors with you have got to look and monitor at every single shipment from the manufacturers to the pharmacies and to the hospitals. You’ve got to monitor. You’ve got to identify suspicious activity. You’ve got to report it to the DEA through an ARCOS database. And you’ve got to halt shipment, stop shipment if there’s problems. So when you saw millions of pills coming into the communities is when they were supposed to jump up and stand up and say, “Enough’s enough.” And they didn’t.
Seder: And I think people are aware at this point of places like counties in West Virginia where there were pills like millions of pills per person prescribed supposedly. So what’s happening there? This is just like … They getting black marketed? Are they falling off of trucks? What’s going on?
Mougey: Let me give you a little bit of the background. The distributors like I said earlier were supposed to be reporting these suspicious activities. So no one saw this data. It was all under the cover of darkness. It went to the DEA it’s called the ARCOS database and it wasn’t open to the public. State regulators didn’t see it. The only ones that got it were the DEA. So a few years ago the West Virginia AG filed suit against these distributors. And as part of that suit had access to at least the summaries of this ARCOS database. Well the Charleston Gazette which is the paper in Charleston, West Virginia, the reporter asked for the summary from the ARCOS database on a FOIA request, a Freedom of Information Act.
So the court said no, subject to a protection order. Well the Charleston Gazette actually intervened in the lawsuit and ultimately got access to the ARCOS. It’s the only state in the country that’s actually seen this ARCOS database. And on the front page of the West Virginia papers, through the Charleston Gazette for several days in a row it came out that there were 780 million pills over a six-year period. Now on average it’s 130 million pills a year. Keep in mind the population in West Virginia is 1.8 million people. Now think about that for a second. The reason why we haven’t been able to arrest our way out of the problem. We haven’t been able to stop the spigot because every time we shutter a pill mill down another one popped up was because the distributors had an open valve. The damn was open. They were open for business and these drugs just flowed through their operations when their entire job was to stop and halt and identify all the suspicious activity.
In the Charleston Gazette 780 million for 1.8 million residents and that’s over a six-year period. So what became abundantly clear is that the government, the DEA, could not fix this problem subject to the regulators. And you and I have talked about this before. It doesn’t matter if it’s environmental. It doesn’t matter if it’s Wall Street. It doesn’t matter if it’s Big Pharma. At the end of the day the private attorney generals which are the plaintiff’s bar and as it happened in West Virginia that we’ve now filed suit on behalf of seven counties that have had to take taxpayer resources for health, safety and welfare. EMS, police, the education component. Everything is coming out of our local county coffers while Big Pharma through McKesson, Amerisource Bergen and Cardinal have lined their pockets. The CEO from McKesson last year made $130 million while local taxpayers are footing the bill for this mess.
Seder: So to extend the analogy it’s as if the guy who sold the X-ray machines sent it around as a photo booth for everybody and then just let society deal with the implications of all the cancer.
Mougey: That’s exactly right.
Seder: And so this is a theory that was very similar to the tobacco theory as well. And we only got a minute left or two minutes, sorry.
Mougey: It is very close. And what the industry is saying now is now we’ve got it in check that they’ve had their licenses suspended or revoked. They’ve been fined $250 million. But the problem is what they’ve left in our community is a generation of people that are addicted to opiates and now they’re got it under control. They didn’t do their job over the last 20 years but hey now we’ve kind of cut off the spigot. But now we have a heroin epidemic because these people can’t get the pills so now they’ve turned to heroin.
Now we have people dying. I mean the deaths right now are off the charts because we have so many people doing heroin. I don’t care if it’s small town, rural America or big city. Heroin is a significant problem at levels never seen in our country and it’s all related back to the initial prescription opiates that were being poured into our community. Think West Virginia. 780 pills over a six-year period for 1.8 million people. I am confident those numbers are going to be consistent as this is rolled out across the country.
Seder: I imagine that in representing these counties that it’s about we need money for treatment.
Mougey: Absolutely. And abating the nuisance. Fixing the problem is what we’re up to. Absolutely and that’s what our jobs are.
Seder: In the meantime we’re starting to see some diminishment in prescriptions but it feels like it’s just about a drop in the bucket.
Mougey: It is. It’s like the hurricane that blows through and leaves mud and debris and problems everywhere. Once the hurricane’s gone that doesn’t mean the problem’s over. There still has to be cleanup. There still has to be a fix and that’s what we’re holding the distributors accountable to come back into our communities with all the billions of dollars they’ve made and fix the problem through treatment. Fix the addicts that they created by dumping these pills into our community and help us clean up the problem. Don’t take the profit out of our communities and then leave us with the mess of a hurricane to clean up just like the profits were taken out of our community just like in tobacco. Come back in and help these communities fix the problem. It’s a simple equation.
Seder: Classic case of privatizing the profits and socializing the costs. Peter Mougey, thanks so much for your time today. Really appreciate it.
Mougey: Thanks for having me, Sam.
