Chuck Rosenberg, acting administrator of the Drug Enforcement Administration (DEA), had a fairly easy time at Wednesday’s Senate Judiciary Committee hearing, where his efforts to change the opaque culture of the agency won praise.
“Who is responsible when it comes to decisions made that have created this and made it worse?” he asked.
The DEA, according to Durbin.
He quoted Rosenberg’s testimony about DEA’s enforcement activities against “the violent cartels and drug trafficking gangs responsible for feeding the heroin and prescription drug epidemic in our communities.” But that strategy has “one key element missing and it is an element that you have responsibility for,” he told Rosenberg. “That is the overproduction of opioids by the pharmaceutical industry.”
The numbers are staggering.
In 2014 alone, the industry put 14 billion opioid pills on the market with DEA approval, “enough for every adult in America to have a one-month prescription,” Durbin said. More than 28,000 people overdosed and died from prescription opioid and heroin, an illegal opioid, that year. Many heroin addicts started with prescription opioids.
DEA sets annual production quotas for opioids, which is a class of pain relievers. Between 1993 and 2015, oxycodone production jumped from 3.5 tons to 150 tons, according to Durbin. During that same period, he said the production of hydrocodone increased 12-fold, hydromorphone 23-fold and fentanyl, the drug that killed Prince, 25-fold.
“You’ve said all the right things, after the fact,” Durbin told Rosenberg. “What your agency has failed to concede is that they have been the gatekeepers who have opened the gate wide. . . . Do you accept responsibility as an agency for being part of the problem?”
“I think we’re part of the problem,” Rosenberg said, with the directness that characterized much of his testimony.
But he pushed back when Durbin said the DEA “has decided to flood America with opioid pills, far beyond any medical purpose. Why?”
Rosenberg said the agency is trying to meet legitimate industry needs that are fueled by physician requests.
Durbin wouldn’t back down, saying the 14 billion pills went beyond pain management: “We are feeding the beast we are trying to kill.”
There’s lots of blame to go around, but DEA decides “to red light or green light production. Look at what’s happened…it starts with your decision.”
Does some of the fault rest with DEA, “yes it does,” Rosenberg acknowledged. “Can we do better? We will.”
Durbin has introduced legislation to fight opioid abuse. One section of the bill would require DEA to consider opioid addiction when setting production quotas. If annual quotas increase, DEA would be required to justify that in writing, explaining why the bump outweighs the risk of having more addictive drugs available.
Opioid death stats demonstrate the ravages of the epidemic.
About 47,000 people died from overdoses in 2014, Rosenberg said. That’s 129 every day. About 61 percent were due to prescription opioid and heroin.
At the same time the DEA authorizes the production of the drugs, it also tries to take them back. It sponsors a National Drug Take Back Initiative that Rosenberg said collected 1.6 million pounds of unwanted medication during take-back events in September and April.
“The illicit drug market is constantly evolving,” he said. “We are increasingly encountering counterfeit prescription drugs laced with fentanyl and fentanyl derivatives, as well as heroin laced with fentanyl.” The number of fentanyl evidence items jumped 1,392 percent in two years, according to Rosenberg, from 934 in 2013 to 13,002 in 2015.
“The trafficking of this drug, which is significantly more potent than street-level heroin, presents a significant risk of overdose to users,” Rosenberg said, “and to the law enforcement personnel who may come into contact with the substance during the course of their work.”
Durbin said he recognizes the appropriate role opioids play in relief and the need for medicine makers to turn a profit.
But, “we need drug companies,” he added, “who, for years, pedaled these dangerous drugs, misrepresenting their benefits and under-representing their risks, to step up. We need doctors – who have been prescribing these addictive pain medications in ever-greater quantities year after year – to step up.
“And we need the DEA – which is responsible for determining how many of these opioid pills are allowed to flood the U.S. market every year – to step up.”