[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.