A couple of old friends left this morning. I’m in a brown defunkit. (Cf.* )
Erics’s an engineer who just retired, and they are making the rounds visiting friends and family over the southeast and Florida. (cf. ^)
Always curious about how things work, as engineers tend to be, he taught me some tricks with my iPhone about adding effects to text messages – like writing in invisible ink (something I’ll never use) – and some tricks with photography and how to air drop pictures from one apple device to another. (something I’ll use a lot.) These friends are “easy”; easy to travel with (four cruises) and easy to have as guests. They are making the trek in a sports car, so they are traveling light, something they learned in their days riding a Hawg.
They don’t watch T.V. or keep up with the news. It just upsets Debbie and, since there is nothing she can do about things, her practical nature says don’t hear it. They get an amazing amount of things done.
As I was looking at some of the new tricks on my phone I got a notification that“60 Minutes” had done a scorching expose on Congress’s systematic disarming of the DEA and how that had resulted in far fewer fines and suspensions of distributors of opioid drugs.
I couldn’t help myself; I had to go look, and there it was.
Several former deputy DEA attorneys revealed how the revolving door put former DEA lawyers, now working for the drug distributors in a position to stop progress of any actions against opioid distributors. Additionally: "The drug industry, the manufacturers, wholesalers, distributors and chain drugstores, have an influence over Congress that has never been seen before," Joseph Rannazzisi, the former chief of the DEA's Office of Diversion Control, told The Post.”
We get some inkling of that influence in Senator Orin Hatch’s vigorous defense of the drug distributors.
Orin Hatch has the linked response to the charges.
The truth is somewhere between claims by former DEA attorneys that they were kneecapped by Congress and Congress’s assertion that these were rogue agents exercising draconian measures against innocent opioid distributors.
This morning I saw that in light of the “60 Minutes” piece Tom Marino, Trump’s pick for drug czar had taken his name from consideration.
Somewhat later the Attorney General announced that the DOJ has a new plan to address the opioid crisis.
“Attorney General Jeff Sessions today announced the formation of theOpioid Fraud and Abuse Detection Unit, a new Department of Justice pilot program to utilize data to help combat the devastating opioid crisis that is ravaging families and communities across America.”
So, Jeff Sessions, Attorney General announces the formation of a new Fraud and Abuse department designed to look specifically at opioid use and abuse. It will be an analytical department designed to detect oversue and go after the doctors who over-prescribe drugs.
In danger of stating the obvious, this is what the DEA did and found inadequate. Once again, the distributors get away scot free.
For much of my career I worked in laboratory and hospital quality control and quality assurance programs, respectively. In the 1990s QA was completely reworked through the efforts of what is now JCAHO. Up until that point programs were designed to catch physicians doing things that were not in the best interests of patients and punishing them. What was found was that errors kept being made at the same rate and not by the same doctor. Analysis revealed that, although there were bad actors, they were few, and most errors were caused by some fault in the system.
From that point on we looked for systemic problems because fixing those sources of error had a much greater chance of protecting patients than punishing a variety of well-meaning physicians and nurses.
Opioid over prescription is, unfortunately, a problem with multiple points where the system is broken. At the contact point healthcare providers get caught up by two processes causing abuse; some simply get tired of telling people, no. Patients with chronic back pain, fibromyalgia, and other chronic pain syndromes look just like people who don’t have those problems. Often, after a long and expensive work-up doctors are left with patients with no demonstrable physical problem who plead that they are in pain. Some doctors actually believe that they are helping the patients who become addicted to opioids.
Other doctors are just greedy. Many of the pain pill mills are staffed with foreign medical graduates who may have a hard time getting a position in a respectable clinic, and take what is available. Some are homegrown versions of Dr. Feelgood.
Whatever the route that gets healthcare providers established as an easy source of opioids, the reputation spreads quickly, and the clinic soon does a brisk business as reported by the DEA ex-employees, know where the big orders come from, but maintain that they should not be responsible for being whistle blowers to the DOJ. Of course, they are making huge profits from selling the drugs.
The chief architect of the law, the investigation found, was Rep. Tom Marino of Pennsylvania, a Republican whom President Donald Trump nominated to lead the White House's Office of National Drug Control Policy, a position commonly referred to as the nation's "drug czar." Marino on Tuesday withdrew his name from consideration, we found by Trump tweet, and the president atdded that Marino was "a fine man and a great Congressman."
Nothing here looks like anything that could be fixed by a Quality Assurance program because at almost every turn someone stands to lose money by fixing the problem. Drug companies lose, unethical physicians lose, members of congress whose compaigns are funded by drug distributor dollars lose.
Who knows about our president? As he talks about addressing the opioid crisis we find that he is appointing a member of congress dedicated to contributing to the problem by disarming the DEA. The DOJ, under Attorney General Jeff Sessions, appears to be returning to a program that prosecutes the actual drug mills instead of the distributors of the drug.
That process is analogous to prosecuting users instead of dealers.
I can’t, personally, imagine an attraction to opioids. I’ve taken them after hernia surgery and after oral surgery and thrown medicine away when it was no longer needed for pain. On the other hand, I discovered in college after taking “uppers” to study, that I liked the way amphetamines made me feel. I was the smartest guy in the room and able to leap tall buildings in a single bound.
I crashed in the midst of an organic chemistry final and escaped with a “B”. It was then that I decided never to use those, or any, drugs again. If you discount alcohol I have stuck to that plan.
My point? Users may or may not be addicts. An astounding number of people overdose and die every year in the U.S. taking only prescription drugs. The victims are not street people; they are often someone in the neighborhood, or celebrities. They are hard to discount and dismiss, but members of congress and the pharmaceutical industry and distributors dismiss these people daily as statistics.
“Oscar-winning actor Philip Seymour Hoffman died in February 2014 from a mixture of the opioid heroin and cocaine, benzodiazepines and amphetamines. He was 46.”
* "Brown defuncit": a seriously depressed mental state. I have heard this all of my life, but can find it nowhere under slang words and phrases. I suspect that it derives from "funk". When I substituted "brown funk" I got references to James Brown.
^ "...the Southeast or Florida." Florida is definitely not part of the Southeast, and, like Puerto Rico, arguably not part of the U.S.