[Congressional Record Volume 165, Number 120 (Wednesday, July 17, 2019)]
[Senate]
[Pages S4883-S4885]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Opioid Epidemic
Mr. President, years ago, there was a Senator from Wisconsin named
William Proxmire. He used to come to the floor every month and give
what he called his ``Golden Fleece Award'' for the worst example of
Federal Government waste. Earlier this year, I launched a new series
dedicated to that tradition with floor speeches that built off the
Proxmire work, with a focus on the most extreme cases of the
pharmaceutical industry's greed. It is known as the Pharma Fleece
Award.
I have highlighted price-gouging for lifesaving insulin, the patent
abuses that extend monopoly control over pricing of drugs, and the
billions of dollars' worth of medications that are thrown away each
year deliberately due to the production of oversized, unnecessary drug
vials.
This month, I want to focus on the pharmaceutical industry's role in
another national disgrace--the opioid epidemic. We are in the midst of
the Nation's worst drug overdose epidemic in our history. There is no
town too small, no suburb too wealthy to be spared the suffering and
the deaths that have been wrought by this problem.
Last year, 2,062 people in my home State of Illinois died from opioid
overdose. There is culpability with nearly all the stakeholders,
including the U.S. Government. There is no denying how this epidemic
was ignited. For years, the pharmaceutical industry wildly
mischaracterized the risk of opioids, falsely claiming they were less
addictive and less harmful; that these painkillers should be prescribed
for common aches and pains, even when the industry itself had
information proving the dangers of such long-term use.
In 2007, the manufacturer of OxyContin, Purdue Pharma, pleaded guilty
to a felony charge of misbranding the drug by misrepresenting
OxyContin's risks. This resulted in a modest fine as the company
continued to flood the Nation with their deadly painkillers.
New reporting this morning from the Washington Post found that Big
Pharma saturated the country with 76 billion oxycodone and hydrocodone
pills between 2006 and 2012. During a 6-year period, 76 billion pills
were produced by pharma. One subsidiary company, Mallinckrodt, put 28
billion opioid pills on the market during this time.
Downstate in Illinois is a small rural county, Hardin County. It has
fewer than 10 doctors who can prescribe controlled substances. The
total population of the county is 4,300 people. It is one of the
smallest, least populated counties in my State. In the year 2010,
approximately 6 million hydrocodone pills and 1 million oxycodone pills
were shipped to Hardin County and its surrounding communities. For
4,300 people, they shipped 7 million pills. All of this data was
actually captured and reported to a Federal agency, the Drug
Enforcement Administration. They will come up again in my presentation.
That means drug manufacturers knew about this obscene volume of pills
being produced and sold; that drug distributors knew exactly where and
how this was being transported, and law enforcement had its eyes on it
all along.
Mr. President, I ask unanimous consent to have printed in the Record
the list of the top opioid distributors and manufacturers from 2006 to
2012.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[[Page S4884]]
TOP PILL MANUFACTURERS, 2006 THROUGH 2012
------------------------------------------------------------------------
Percent of
Manufacturer Number of Pills Market
------------------------------------------------------------------------
SpecGx (Mallinckrodt).............. 29 billion............ 37.70
Actavis Pharma..................... 26 billion............ 34.50
Par Pharmaceutical (Endo).......... 12 billion............ 15.70
Purdue Pharma...................... 2.5 billion........... 3.30
Amneal Pharmaceuticals............. 2.3 billion........... 2.90
Teva Pharmaceuticals USA........... 690 million........... 0.90
KVK Tech........................... 580 million........... 0.80
West-Ward Pharmaceuticals (Hikma).. 380 million........... 0.50
Kaiser Foundation Hospitals........ 370 million........... 0.50
Endo Pharmaceuticals............... 300 million........... 0.40
Ethex Corporation.................. 290 million........... 0.40
AbbVie Inc......................... 250 million........... 0.30
Sun Pharmaceutical Industries, Inc. 240 million........... 0.30
UCB, Inc........................... 180 million........... 0.20
Mylan Pharmaceuticals, Inc......... 140 million........... 0.20
Cardinal Health.................... 120 million........... 0.20
Dispensing Solutions Inc........... 95 million............ 0.10
Golden State Medical Supply, Inc... 85 million............ 0.10
Aphena Pharma Solutions--Tennessee, 74 million............ 0.10
LLC.
McKesson Corp...................... 65 million............ 0.10
Xanodyne Pharmaceuticals, Inc...... 55 million............ 0.1O
Forest Laboratories, Inc........... 47 million............ 0.10
Bryant Ranch Prepack............... 37 million............ 0.1O
Pfizer Laboratories Div Pfizer Inc. 31 million............ 0.00
A-S Medication Solutions........... 28 million............ 0.00
------------------------------------------------------------------------
TOP PILL DISTRIBUTORS, 2006 THROUGH 2012
------------------------------------------------------------------------
Percent of
Distributor Number of Pills Market
------------------------------------------------------------------------
McKesson Corp...................... 14 billion............ 18.40
Walgreens.......................... 13 billion............ 16.50
Cardinal Health.................... 11 billion............ 14.00
AmerisourceBergen.................. 9.0 billion........... 11.70
CVS................................ 5.9 billion........... 7.70
Walmart............................ 5.3 billion........... 6.90
Smith Drug Co...................... 1.3 billion........... 1.80
Rite Aid........................... 1.3 billion........... 1.70
Kroger............................. 1.2 billion........... 1.60
H. D. Smith........................ 1.1 billion........... 1.50
Anda, Inc.......................... 1.1 billion........... 1.50
Kaiser Permanente.................. 880 million........... 1.10
Morris & Dickson Co................ 880 million........... 1.10
Thrifty Payless Inc................ 870 million........... 1.10
Eckerd Corporation................. 780 million........... 1.00
Omnicare Distribution Center LLC... 700 million........... 0.90
Kinray Inc......................... 630 million........... 0.80
N C Mutual Wholesale Drug Co....... 550 million........... 0.70
Smith's Food & Drug Ctr's Inc...... 500 million........... 0.70
The Harvard Drug Group............. 410 million........... 0.50
Advantage Logistics................ 380 million........... 0.50
Value Drug Co...................... 310 million........... 0.40
Publix Super Markets, Inc.......... 280 million........... 0.40
River City Pharma.................. 270 million........... 0.40
SAJ Distributors................... 270 million........... 0.40
HEB Grocery Company, LP............ 240 million........... 0.30
Harco.............................. 210 million........... 0.30
Valley Wholesale Drug Co........... 210 million........... 0.30
Associated Pharmacies Inc.......... 190 million........... 0.30
Louisiana Wholesale Drug Co........ 190 million........... 0.30
Qualitest Pharmaceuticals.......... 180 million........... 0.20
Frank W Kerr Inc................... 170 million........... 0.20
KeySource Medical.................. 160 million........... 0.20
Top Rx, Inc........................ 160 million........... 0.20
American Drug Stores............... 150 million........... 0.20
American Sales Company............. 140 million........... 0.20
Longs Drug Store................... 130 million........... 0.20
Quest Pharmaceuticals Inc.......... 120 million........... 0.20
Miami-Luken........................ 120 million........... 0.10
Hy-Vee............................. 11O million........... 0.10
Pharmacy Buying Association........ 110 million........... 0.10
Mc Queary Brothers................. 100 million........... 0.10
Meijer Distribution Inc #90........ 100 million........... 0.10
Rochester Drug Co-Operative Inc.... 100 million........... 0.10
HBC Service Company................ 93 million............ 0.10
Par Pharmaceutical, Inc............ 85 million............ 0.10
Dakota Drug........................ 79 million............ 0.10
Dik Drug Co........................ 78 million............ 0.10
KPH Healthcare Services, Inc....... 76 million............ 0.10
Albertsons LLC..................... 74 million............ 0.10
Aphena Pharma Solutions............ 71 million............ 0.10
Sunrise Wholesale, Inc............. 66 million............ 0.10
P J C Distributor Co Inc........... 65 million............ 0.10
Wakefern Food Corporation.......... 65 million............ 0.10
Auburn Pharmaceutical.............. 62 million............ 0.10
Winn Dixie Logistics............... 58 million............ 0.10
Southwood Pharmaceuticals Inc...... 57 million............ 0.10
Discount Drug Mart................. 54 million............ 0.10
Dispensing Solutions............... 52 million............ 0.10
Prescription Supply Inc............ 51 million............ 0.10
Murfreesboro Pharmaceutical........ 47 million............ 0.10
Burlington Drug Company............ 46 million............ 0.10
NuCare Pharmaceuticals............. 45 million............ 0.10
DRx Pharmaceutical Consultants, Inc 40 million............ 0.10
Bellco Drug Corp................... 39 million............ 0.10
Bryant Ranch Prepack............... 37 million............ 0.10
Schnucks Pharmacy Distribution Ctr. 37 million............ 0.10
Drogueria Betances................. 36 million............ 0.10
Bloodworth Wholesale Drugs......... 36 million............ 0.10
Expert-Med......................... 35 million............ 0.10
------------------------------------------------------------------------
Mr. DURBIN. This opioid epidemic wasn't started by some runaway
virus. They were decisions made by real people to flood America's towns
and streets with ``a blizzard of prescriptions,'' as Richard Sackler of
Purdue Pharma put it in his own words. In fact, the pharmaceutical
industry in the United States produced 14 billion opioid pills in 2016
alone--enough opioid pills for every adult in America to have a 3-week
supply of opioids. Who would approve the production of 14 billion
opioid pills in 1 year, 2016? It turned out it was your government. The
Drug Enforcement Administration of the United States of America is
responsible for determining and basically giving a license for the
production of a specific amount of opioid pills allowed to be
distributed to the market each year.
It is the Drug Enforcement Administration--of all agencies--that
establishes annual production quotas for opioids that are, effectively,
the gatekeepers for pharma. Pharma, of course, wants to produce as much
as possible in order to sell as much as possible. The Drug Enforcement
Administration is supposed to draw the line. Yet, for all of these
years, while we have faced this epidemic, our government--the Drug
Enforcement Administration--has been increasing the production quotas
each year for opioid pills.
Between 1993 and 2015, the Drug Enforcement Administration allowed
the production of oxycodone to increase in America 39 times--from 3\1/
2\ tons of opioids in 1993 to 151 tons of opioids in 2015. It is the
same story for hydrocodone, which increased twelvefold, and for
fentanyl, which increased twenty-fivefold.
I pressed those in the Drug Enforcement Administration on this issue.
I asked them how they could possibly approve of these ever-increasing
quotas while America faced this epidemic. How did they reconcile their
decision to flood America with these drugs at a time in which they were
being abused and when addiction was leading to death all across our
country?
Last year, I passed bipartisan legislation. I and Senator John
Kennedy, a Republican from Louisiana, gave those at the Drug
Enforcement Administration more authority to set commonsense production
levels. It is hard to believe we had to do that--to actually bring to
their attention that they were authorizing the production of opioid
pills for an America that was facing the worst opioid epidemic in its
history.
Previously, those at the Drug Enforcement Administration could only
look at what pharma asked for when it determined quotas. In other
words, they believed, officially, that they had statutory blinders by
which they couldn't even consider the impact of pharma's annual request
for production. So Senator Kennedy and I, on a bipartisan basis,
changed the law to require the Drug Enforcement Administration to
consider abuse, overdose deaths, and the impact on public health.
Finally, between 2016 and 2019, the Drug Enforcement Administration
has lowered opioid quotas by an average of 46 percent. No longer can
Big Pharma get away with producing this sheer volume of painkillers.
The Drug Enforcement Administration will soon be proposing its 2020
quotas, and I will soon be sending it a letter and will urge it to use
its new authority, which we put in this new law that I passed with
Senator Kennedy, to continue reining in Big Pharma's insatiable demand.
Think about that. While we are going through this opioid epidemic,
pharma--made up of the people who make the pills--is coming to
Washington, to the Drug Enforcement Administration, and is getting
permission each year to produce billions of opioid pills to be sold in
the United States--enough for every adult American to have a 3-week
opioid prescription.
Incidentally, 2 years ago, the Centers for Disease Control and
Prevention sent out a notice to doctors. It read that only in the most
extraordinary cases should one prescribe a drug to last for more than 3
days--only in the most extraordinary cases. Then watch them carefully
because, in a short period of time, addiction begins. Three days?
Pharma was asking for a production of opioid pills so that each adult
American could buy 3 weeks' worth of pills, and the Drug Enforcement
Administration was complicit.
To hold all stakeholders accountable, major legal challenges have
been brought against the pharmaceutical industry for its role in
deceptive promotion and all of the suffering and deaths that have
resulted. Over 1,600 lawsuits from States, counties, cities, and
victims have been consolidated into one Federal case in Cleveland, OH.
This reminds me of another public health scourge we confronted when
Americans suffered the consequences of misleading marketing and false
information about the health risks of tobacco. It took the 1998 Tobacco
Master Settlement Agreement to finally hold major manufacturers of
tobacco responsible for their actions--that of cigarettes that hook
adults and youth to lifetimes of addiction and death.
That settlement was estimated to provide States with $246 billion
over 25 years ago. Sadly, only a tiny fraction of that amount--only 8
percent of the settlement--was actually dedicated to tobacco's
prevention and cessation. Instead, $145 billion from the tobacco
settlement has gone to fill State budgets and pet projects--roads,
bridges, stadiums, even a tobacco museum.
Should today's opioid litigation result in large monetary settlements
from the pharmaceutical companies and their distributors, it will be
essential that this funding be dedicated to legitimate public health
efforts so as to respond to the current epidemic and prevent the next
one.
In the city of Chicago, near an area known as Greektown, there is a
drug rehab facility that I have visited many
[[Page S4885]]
times. It is called Haymarket. It was started many years ago by a
Catholic priest who took on a ministry that nobody else wanted. He was
the one who prowled every night along skid row and helped those who
were addicted to drugs and alcohol turn their lives around. He started
this Haymarket House as a refuge for them in an attempt to get them
some help in escaping their addictions and being rehabbed.
Can you imagine what it is like today?
Today, sadly, he is gone, but they continue the Haymarket House.
Imagine what they face in trying to deal with a combination of
addiction to drugs and alcohol and mental illness on top of it. They
are dramatically understaffed. They don't have the necessary bed space
for people who need a helping hand--for folks who realize they need a
helping hand.
Should there be a successful outcome of this Cleveland lawsuit,
wouldn't it be best if some of the resources would be dedicated to
places just like that all over the United States?
I can tell you, in the city of Chicago, there are many more options
than there are in the more sparsely populated downstate areas from
which I hail. There are some counties in which people wait 6 months--
once they have realized their need for help--for any kind of treatment
whatsoever, and then they have to travel great distances for that to
happen.
Senator Sherrod Brown and I recently wrote an opinion piece that was
published in the Cleveland Plain Dealer. I confess publicly that I hope
those who are party to this lawsuit in Cleveland will read it, which is
where the consolidated court case is taking place. In it, we outlined
what we thought should happen if we were to have any input in a
settlement agreement.
We need to make sure that the money is spent for addiction;
treatment; medication; residential and community treatment services;
mental health counseling, which is a necessary adjunct to this effort;
building on a behavioral health workforce and naloxone distribution;
and addressing childhood trauma, which is often the root of addiction.
Wouldn't it be great if there were to be a settlement here that would
be dedicated to ending this drug epidemic, turning lives around, and
saving people from addiction and death?
The diversion of tobacco's settlement money should be a cautionary
tale that guides our efforts to heal from the opioid epidemic. If Big
Pharma is held to account for fueling this crisis, its restitution
should be devoted to helping our Nation heal.
This chart shows the dramatic increase in the production of two of
the most popular opioid products. I will never be able to explain how
the agency of the U.S. Federal Government, which is dedicated to
protecting us from drug crime and drug addiction, ended up authorizing
these enormous quotas of the production of opioid pills. Yet we know
what happened. In tiny Hardin County in southern Illinois, as well as
on the streets of Chicago, they were flooded with opioid pills. When
the opioid pills became too expensive, they turned to a cheaper
alternative--heroin. Heroin was then being laced with fentanyl, and we
have today this deadly epidemic that is almost out of control.
I can't understand what pharma was thinking except for its just
looking at the profits and the bottom line that would justify the
production of that level of opioid pills into the United States of
America. All I can promise is that a number of us--myself included--
will be holding the Drug Enforcement Administration accountable in
order to make certain that this is not duplicated again in the years to
come.
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. ALEXANDER. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.