Combatting The Opioid Crisis At Its Source

Companies have paid tens of millions of dollars in fines, but have failed to meaningfully address their roles in the crisis.

In the Cherokee Nation, where I serve as Attorney General, I have seen the opioid crisis worsen every year, breaking up more families and taking more lives, as the prescription opioid industry increased its profits by flooding our community with more and more lethal painkillers.

Every day, companies that manufacture and distribute prescription opioid drugs and retail pharmacy chains that sell them to the public reap astronomical profits. And every day, 91 Americans die from an opioid-related overdose, 1,000 people are treated in U.S. emergency departments for prescription opioid misuse, and 55 babies enter this world suffering from opioid withdrawal symptoms, according to the CDC and NIH.

In April, we decided that we could not abide this situation any longer, so we sued McKesson, AmerisourceBergen, Cardinal Health, Walgreens, CVS and Walmart for their shameful role in perpetuating the opioid crisis. Morality has not stopped them and neither have fines, so the Cherokee Nation will hold them responsible using the most effective means at our disposal – a civil proceeding in a court of law.

Over the past two years, these companies have flooded the Cherokee Nation with enough prescription opioid painkillers to provide every man, woman and child 153 doses each.

For far too long, manufacturers, distributors, and retail pharmacy chains have ignored their solemn legal duties to prevent the diversion of massive quantities of prescription opioid drugs from the legitimate supply chain to illegitimate channels of distribution and use, fueling the opioid addiction and health crisis that is sweeping the country and destroying communities, families, and lives. While law enforcement authorities have made efforts to hold these companies accountable for diversion, sadly this has not stemmed the tide of opioid drugs flowing to those who should not have them. The companies apparently view the fines they have paid as a cost of doing business and have not reformed their corporate culture or meaningfully changed their practices.

Last month, CVS agreed to pay $5 million to resolve allegations that it violated the federal Controlled Substances Act because its pharmacies in the Eastern District of California lacked effective controls and procedures to prevent the diversion of prescription opioids. This is a pervasive pattern of behavior. CVS pharmacies have repeatedly filled false prescriptions and ordered more opioids than communities could possibly need, even falsifying DEA registration numbers to fill invalid prescriptions. Over the last decade, CVS has paid over $45 million in fines for conduct that facilitates diversion of prescription opioids.

And CVS is not alone in failing to live up to its legal obligations. The country’s largest distributors and pharmacy retailers have all been subject to numerous DEA investigations and collectively have paid hundreds of millions in fines. Earlier this year, McKesson alone paid a record civil penalty of $150 million for failing to follow its own compliance program from an earlier settlement, filling suspicious orders, and supplying pharmacies with an alarming quantity of prescription opioids. In Florida, Walgreens ignored its own pharmacists’ warnings of diversion printing “FAKE CII DO NOT FILL CANDY DR***FAKE” on  prescription labels beneath the doctors’ name, yet continuing to dispense prescriptions to customers its own pharmacists had reported to authorities.

A decade of DEA fines and investigations has not meaningfully altered the opioid industry’s behavior. Manufacturers, distributors, and pharmacy chains continue to dump enormous quantities of prescription opioids on communities across the country. Retail pharmacy chains fill massive numbers of illegitimate prescriptions, despite red flags that they are obligated by law to recognize and act upon to prevent diversion. Prescription opioids now represent a nearly $10 billion industry, but the prescription opioid crisis costs states more than 11 times as much – at least $78.5 billion a year. In the Cherokee Nation, where the government pays for our citizens’ health care throughout their lives, the costs of the opioid epidemic are staggering.

Over the past two years, these companies have flooded the Cherokee Nation with enough prescription opioid painkillers to provide every man, woman and child 153 doses each, according to figures from the Oklahoma Bureau of Narcotics and Dangerous Drugs. There is no legitimate explanation for a number this large. Our community cannot sustain the human and economic toll of this crisis. It is an existential threat to our community.

If we are serious about stopping the onslaught of prescription opioid drugs, we must recognize that the practices of the past, while important, are not sufficient. The Cherokee Nation is taking matters into our own hands and moving forward decisively to hold companies in the opioid supply chain accountable for the tidal wave of drugs that, if we do not act, will soon drown every town and shatter every family. I urge my fellow attorneys general to follow the Cherokee Nation’s example and join in this crucial effort.

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