Ridiculous 60 Minutes Piece on the Opioid Epidemic

Here is the original piece. See McKesson's response. HT Jeff for the story.

The 60 Minutes piece basically rehashes the standard narrative of the opioid epidemic. The CBS correspondent breathlessly and unskeptically interviews DEA agent David Schiller. I am struck by how self-serving and self-congratulatory Schiller comes off. 60 Minutes obviously made no attempt to get a contrary point of view. It leaves the viewer with the mistaken impression that McKesson was unwilling to talk about the story. ("We wanted to speak to a McKesson representative on camera but they declined. But in a statement, McKesson said, "In the interest of moving beyond disagreements… The company agreed to settle with the DEA and DOJ." Ellipses in original; see the link to the 60 Minutes story.) McKesson's very public response seems to contradict that impression. Here is an excerpt:

MYTH: McKesson fueled the opioid abuse problem in this country.

This is an unfounded accusation. We are committed to doing our part to help solve this epidemic, but we are only one part of the pharmaceutical supply chain. McKesson’s role is to distribute medications provided by pharmaceutical manufacturers – including opioid medications – that are ordered by DEA-registered pharmacies and prescribed by DEA-registered and state licensed health care providers.

Each participant in the supply chain can play an important role in combatting this crisis, including:

-The Drug Enforcement Administration (DEA), which sets yearly quotas for the volume of opioids that can be manufactured

-Drug manufacturers that design, develop and promote the medication

-Doctors who identify and diagnose the need for the medication, in addition to prescribing the medication

-Pharmacists who dispense the medication

-Private and public health insurance groups that determine what they will pay for

-Distributors like McKesson that deliver medications ordered by pharmacists to fill prescriptions written by doctors

 MYTH: McKesson knowingly supplies controlled substances, like opioids, to rogue pharmacies who in turn divert the drugs to bad actors.

-This is false. McKesson only distributes controlled substances, including opioids, to DEA-registered and state licensed pharmacies. McKesson maintains – and continuously enhances – our programs that detect and prevent opioid diversion at these DEA-registered pharmacies. Further, every controlled substance ordered by a pharmacy in the U.S. – including both orders that are shipped and those that are deemed suspicious and blocked – is reported to the DEA for their internal database.
-It’s important to note that distributors like McKesson have no line of sight into whether a pharmacy is ordering from multiple distributors. The DEA is the only entity that knows the total amount of controlled substances being dispensed, pharmacy-by-pharmacy across the country.

Self-serving? Sure, maybe, but their description of the supply chain is pretty accurate. It seems absurd to go after the distributor when there are so many other people in the supply chain closer to any wrongdoing. It seems like doctors, pharmacists, and the DEA (who are being fed a steady data-stream on opioid shipments!) are better positioned to monitor whether or not there is misuse of prescription opioids. Given that McKesson reports its shipments to the DEA, it's pretty despicable for the DEA to turn around and say, "Do our job for us. Police America's drug problem." I think this is what's really going on here: It's just easier to blame a large company at the center of production than to monitor all the various distributors, doctors, pharmacies, and patients who might actually be breaking the law or doing something wrong. This is government attempting to be "efficient", meaning lazy.

I see two separate strands of puritanism coming together here in an unholy alliance. Right-wing puritanism, which prohibits anything fun (well...anything that isn't on the "approved" list of vices). From this viewpoint, drug use is "just wrong". The inherent wrong-ness of drug use (err...certain drug use) justifies any amount of violence to suppress it and shields any anti-drug policy from cost-benefit analysis. And there is also left-wing puritanism, which stigmatizes making money. From this viewpoint, large companies can do no right. Large companies are responsible for the foolish behavior of individuals who misuse their products. These separate strands of puritanism come together into a truly revolting blend of populism.

Slick operators like David Schiller fan the flames of populist outrage. They call for the heads of unsympathetic targets, e.g. a faceless corporation like McKesson. Don't fall for it. These guys talk a good talk. They are good at manipulating the media. They want you to believe they are acting in the public interest. But they are careerist shills. Schiller is hunting big game, and he wants to mount a big head on his wall because it will raise his status. The pliant interviewer utterly failed to challenge his assertions.

It's pretty good policy to believe almost nothing you read about the so-called "opioid epidemic." You need to do your own digging to have an informed opinion. Assume that whoever wrote what you are reading got lazy with details, got basic facts wrong, and omitted some relevant information. Yes, you should apply that lesson to this blog, too. Check references. The media just aren't doing their job here. They know that the public eats up a sexy drug panic story, and they are exploiting this weakness to the hilt. This is irresponsible journalism. We're going to end up stuck with bad drug policy because of it. People with intractable chronic pain won't be able to get the only medicine that works for them, and it's all because of sleazy drug cops and an all-too-credulous media.