Pubdate: Fri, 24 Jun 2016
Source: Washington Post (DC)
Column: Federal Insider
Copyright: 2016 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491
Author: Joe Davidson

DOES THE DEA SHARE BLAME IN THE OPIOID FIGHT?

Chuck Rosenberg, acting administrator of the Drug Enforcement 
Administration, had a fairly easy time at Wednesday's Senate 
Judiciary Committee hearing, where his efforts to change the opaque 
culture of the agency won praise.

Then it was Sen. Richard J. Durbin's time to ask questions.

The Illinois Democrat wasted little time with niceties. He wanted to 
know whether the DEA is one of the bad guys in the fight against 
opioid addiction.

"Who is responsible when it comes to decisions made that have created 
this and made it worse?" he asked. The DEA, according to Durbin. He 
quoted Rosenberg's testimony about the DEA's enforcement activities 
against "the violent cartels and drug trafficking gangs responsible 
for feeding the heroin and prescription drug epidemic in our 
communities." But that strategy has "one key element missing, and it 
is an element that you have responsibility for," he told Rosenberg. 
"That is the overproduction of opioids by the pharmaceutical 
industry." The numbers are staggering. In 2014 alone, the industry 
put 14 billion opioid pills on the market with DEA approval, "enough 
for every adult in America to have a one-month prescription," Durbin 
said. More than 28,000 people overdosed and died from prescription 
opioid and heroin, an illegal opioid, that year. Many heroin addicts 
started with prescription opioids.

The DEA sets annual production quotas for opioids, which is a class 
of pain relievers. Between 1993 and 2015, oxycodone production jumped 
from 3.5 tons to 150 tons, according to Durbin. During that same 
period, he said, the production of hydrocodone increased 12-fold, 
hydromorphone 23-fold and fentanyl, the drug that killed Prince, 25-fold.

"You've said all the right things, after the fact," Durbin told 
Rosenberg. "What your agency has failed to concede is that they have 
been the gatekeepers who have opened the gate wide. . . . Do you 
accept responsibility as an agency for being part of the problem?"

"I think we're part of the problem," Rosenberg said, with the 
directness that characterized much of his testimony.

But he pushed back when Durbin said the DEA "has decided to flood 
America with opioid pills, far beyond any medical purpose. Why?"

Rosenberg said the agency is trying to meet legitimate industry needs 
that are fueled by physician requests. Durbin wouldn't back down, 
saying the 14 billion pills went beyond pain management: "We are 
feeding the beast we are trying to kill."

There's lots of blame to go around, but the DEA decides "to red-light 
or green-light production. Look at what's happened," Durbin said. "It 
starts with your decision."

Does some of the fault rest with the DEA? "Yes, it does," Rosenberg 
acknowledged. "Can we do better? We will."

Durbin has introduced legislation to fight opioid abuse. One section 
of the bill would require the DEA to consider opioid addiction when 
setting production quotas. If annual quotas increase, the DEA would 
be required to justify that in writing, explaining why the bump 
outweighs the risk of having more addictive drugs available.

Opioid death stats demonstrate the ravages of the epidemic. About 
47,000 people died from overdoses in 2014, Rosenberg said. That's 129 
every day. About 61 percent of the deaths were due to prescription 
opioids or heroin.

At the same time the DEA authorizes the production of the drugs, it 
also tries to take them back. It sponsors a National Drug Take Back 
Initiative that Rosenberg said collected 1.6 million pounds of 
unwanted medication during take-back events in September and April.

"The illicit drug market is constantly evolving," he said. "We are 
increasingly encountering counterfeit prescription drugs laced with 
fentanyl and fentanyl derivatives, as well as heroin laced with 
fentanyl." The number of fentanyl evidence items jumped 1,392 percent 
in two years, Rosenberg said, from 934 in 2013 to 13,002 in 2015.

"The trafficking of this drug, which is significantly more potent 
than street-level heroin, presents a significant risk of overdose to 
users," Rosenberg said, "and to the law enforcement personnel who may 
come into contact with the substance during the course of their work."

Durbin said he recognizes the appropriate role opioids play in relief 
and the need for medicine makers to turn a profit.

But "we need drug companies," he added, "who for years pedaled these 
dangerous drugs, misrepresenting their benefits and underrepresenting 
their risks, to step up. We need doctors - who have been prescribing 
these addictive pain medications in ever greater quantities year 
after year - to step up.

"And we need the DEA - which is responsible for determining how many 
of these opioid pills are allowed to flood the U.S. market every year 
- - to step up."
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MAP posted-by: Jay Bergstrom