Missouri’s Struggle with Opioid Addiction Detailed in New Report
A congressional report titled “Fueling an Epidemic” was released this month by the U.S.Senate Homeland Security and Governmental Affairs Committee and Senator Claire McCaskill, D-Mo. It detailed the fact that three companies – McKesson Corp., AmerisourceBergen, and Cardinal Health – shipped an estimate 1.6 bill doses of prescription opioids to Missouri’s pharmacies between 2012 and 2017. According to the report, that is the equivalent of 260 pills for every person in the state over the six-year time span.
All suspicious orders are required to be reported to the Drug Enforcement Administration (DEA). McKesson and AmerisourceBergen each shipped an estimated 650 million opioids. McKesson reported 16,714 suspicious orders from 2013 to 2017, while AmerisourceBergen report 224 from 2012 to 2017. Cardinal Health shipped 325 million and reported 5,125 suspicious orders.
“The disparities exist despite the fact that each company employs similar strategies to prevent diversion,” the report states. McCaskill added, “Something is wrong here. There is no way you have this divergence of reporting between the three major distributors.”
In 2008 Cardinal Health was fined $34 million to resolve allegations that it failed to report suspicious orders of narcotics. The company was again fined $44 million in 2016 to resolve the same issue. McKesson was fined $13 million in 2008 and $150 million January 2017.
The DEA issued only twelve immediate suspension orders to distributors in the decade between 2007 and 2017. Former DEA officials have stated the “revolving door between the agency and the distribution industry created an institutional resistance to issuing immediate suspension orders,” according to the report.
McCaskill’s report also included detailed data on suspicious ordering and potential underreporting from 2012 to 2017 by four generic manufacturers including Allergan, Mallinckrodt, Endo, and Teva. Mallinckrodt reported 905 suspicious orders from 2012 to 2017, while Endo did not report any. It is unclear whether the others reported any suspicious orders.
Last year, Mallinckrodt paid $35 million for failure to report suspicious orders and record-keeping violations. The company issued a statement indicating it “has invested millions of dollars in a comprehensive initiative to address opioid abuse and misuse.”
John Gray, president and CEO of the Healthcare Distribution Alliance, which represents distributors, said the recent “report from Sen. McCaskill detailed inaccurate statements without acknowledging the need for broader reforms across the pharmaceutical supply chain.”
McCaskill, however, stated, “This report confirms what many of us believe, that we have a welcome mat out for drug dealers from surrounding states. That’s the only thing that would explain this type of density of opioids being shipped. Certainly, the fact that we have not had a statewide system” is an issue “because people who are trying to acquire these drugs on the black market know they have much less of a chance of getting caught up in this process in Missouri than they do in Arkansas or Kentucky or Illinois or Iowa.”
She added, “It’s easy sometimes to forget that these are real people and real families that are struggling both with overdose deaths and addiction and it’s easy to make this about data. When you’re traveling around the states and visiting with people one on one, you’re constantly reminded what a big deal this is…The opioid crisis these pills have fueled is a failure of policy and oversight by the government and a failure of basic human morality on the part of many pharmaceutical companies and distributors — a failure that has destroyed families and communities all over our state.”