A decade ago, the Drug Enforcement Administration launched an aggressive campaign to curb a rising opioid epidemic that was claiming thousands of American lives each year. The DEA began to target wholesale companies that distributed hundreds of millions of highly addictive pills to the corrupt pharmacies and pill mills that illegally sold the drugs for street use.
Leading the campaign was the agency's Office of Diversion Control, whose investigators around the country began filing civil cases against the distributors, issuing orders to immediately suspend the flow of drugs and generating large fines.
But the industry fought back. Former DEA and Justice Department officials hired by drug companies began pressing for a softer approach. In early 2012, the deputy attorney general summoned the DEA's diversion chief to an unusual meeting over a case against two major drug companies.
"That meeting was to chastise me for going after industry, and that's all that meeting was about," recalled Joseph Rannazzisi, who ran the diversion office for a decade before he was removed from his position and retired in 2015.
Rannazzisi vowed after that meeting to continue the campaign. But soon officials at DEA headquarters began delaying and blocking enforcement actions, and the number of cases plummeted, according to on-the-record interviews with five former agency supervisors and internal records obtained by The Washington Post.
The judge who reviews the DEA diversion office's civil caseload noted the plunge.
"There can be little doubt that the level of administrative Diversion enforcement remains stunningly low for a national program," Chief Administrative Law Judge John J. Mulrooney II wrote in a June 2014 quarterly report obtained under the Freedom of Information Act.
In fiscal 2011, civil case filings against distributors, manufacturers, pharmacies and doctors reached 131 before dropping to 40 in fiscal 2014, according to the Justice Department. The number of immediate suspension orders, the DEA's strongest weapon of enforcement, dropped from 65 to nine during the same period.
"Things came to a grinding halt," said Frank Younker, a DEA supervisor in the Cincinnati field office who retired in 2014 after 30 years with the agency. "I talked to my fellow supervisors, and we were all frustrated. It was ridiculous. I don't know how many lives could have been saved if the process was done quicker."
The slowdown began in 2013 after DEA lawyers started requiring a higher standard of proof before cases could move forward.
Top officials at the DEA and Justice declined to discuss the reasons behind the slowdown in the approval of enforcement cases. The DEA turned down requests by The Post to interview Mulrooney, acting DEA administrator Chuck Rosenberg, chief counsel Wendy Goggin and Rannazzisi's replacement, Louis J. Milione.
The agency provided a statement from Rosenberg:
"We combat the opioid crisis in many ways: criminally, civilly, administratively, and through robust demand reduction efforts.
"We implemented new case intake and training procedures for our administrative cases, increased the number of enforcement teams focused on criminal and civil investigations, restarted a successful drug take back program, and improved outreach to - and education efforts with - our registrant community.
"We have legacy stuff we need to fix, but we now have good folks in place and are moving in the right direction."
The Justice Department, which oversees the DEA, declined requests to interview Attorney General Loretta Lynch and Deputy Attorney General Sally Q. Yates.
The department issued a statement saying that the drop in diversion cases reflects a shift from crackdowns on "ubiquitous pill mills" toward a "small group" of doctors, pharmacists and companies that continues to violate the law.
Justice Department spokesman Peter Carr said diversion investigators are also increasingly using criminal procedures to force targets to surrender their licenses without administrative hearings.
"Although these reasons largely account for the decline in administrative case filings, the department remains committed to eliminating the problem of opioid abuse," Carr said, pointing out that the diversion control chief had recently been elevated to a "top leadership post."
But Justice statistics show that surrenders of licenses have remained relatively constant since 2011 before dropping by more than a third in the last fiscal year. Carr could not say how many were tied to DEA enforcement actions. The former agency supervisors said the majority of surrenders do not involve DEA enforcement actions.
The epidemic began in the late 1990s after the introduction of the powerful, long-acting opioid OxyContin and an aggressive marketing campaign by the drug's manufacturer, Purdue Pharma, to persuade doctors to prescribe it for all kinds of pain. A new philosophy of pain management resulted in a surge in demand and the U.S. addiction rate.
From 2000 to 2014, 165,000 people died of overdoses of prescription painkillers nationwide. The crisis has also fostered follow-on epidemics of heroin, which caused nearly 55,000 overdose deaths in the same period, and fentanyl, which has killed thousands more. The number of U.S. opioid prescriptions has risen from 112 million in 1992 to 249 million in 2015.
Several DEA officials on the front lines of the opioid war said they could not persuade headquarters to approve their cases at the peak of the epidemic. They said they confronted Clifford Lee Reeves II, a lawyer in charge of approving their cases, to no avail. Through a DEA spokesman, Reeves declined to comment for this report.
Jim Geldhof had been with the DEA for nearly four decades and was serving as the diversion program manager in the Detroit field office when Reeves took over at DEA headquarters in 2012.
"It was like he was on their side, not ours," said Geldhof, who retired in January. "I don't know what his motive was, but we had people dying. You'd think he'd be more aggressive. We were in the throes of a major pill epidemic."
In the field, Younker and other DEA supervisors said they grew to distrust Reeves and became suspicious about what was taking place at headquarters.
"We all had a feeling that someone put him there to purposely stonewall these cases," Younker said.
Kathy Chaney, who served as the DEA's group supervisor in Columbus, Ohio, saw the problem play out firsthand. She was responsible for 35 counties in Ohio and had overseen the agency's efforts to curb prescription painkiller abuse in cities such as Chillicothe and Portsmouth, both at ground zero of the opioid crisis.
She said one of her cases against a distributor languished for years without action. The experience was particularly difficult, Chaney said, because she had been meeting with parents of children who had died of overdoses of oxycodone and other painkillers.
"We got so frustrated, I finally told my group, 'We're not going to send any cases up to headquarters,' " said Chaney, who retired in 2013. "In 25 years, I had never seen anything like it. It was one of the reasons I left. Morale was terrible. I couldn't get anything done. It was almost like being invisible."
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In 2004, the leaders of the DEA's diversion office became alarmed by the rising number of overdose deaths amid a growing supply of prescription painkillers. Online pharmacies were flourishing, making it easy to buy powerful painkillers such as oxycodone and hydrocodone. The death toll had hit 8,577, a 15 percent jump in one year.
Pain-management clinics began popping up around the country. DEA diversion investigators soon realized that they were playing a real-life game of Whac-a-Mole. As soon as they shut down one facility, another would appear.
"People were dying," said William Walker, a 31-year DEA veteran who headed the diversion office in 2004 and 2005.
Walker set up tactical units around the country to investigate doctors, pharmacists, distributors and manufacturers.
"We had a multilayered threat, and there was a tremendous sense of urgency," he said. "I turned up the heat on the workforce, and we started getting after it."
Toward the end of 2005, Walker, a brigadier general in the National Guard, was called up for active duty and left the office. Taking his place was his top deputy, Joseph Rannazzisi, a street-smart New Yorker who held degrees in pharmacy and law. He had begun his career as a DEA street agent and then a supervisor in Detroit before working his way to the top of the diversion office at the agency's headquarters in Arlington, Va.
Rannazzisi decided to focus on the source of the pills: the wholesale distributors of pharmaceuticals.
Drugs are manufactured by high-profile corporations such as Purdue Pharma. They rely on a lesser-known network of distributors, some of which are also multinational corporations. The distributors serve as middlemen, sending billions of doses of opioid pain pills to pharmacists, hospitals, nursing homes and pain clinics. The U.S. prescription opioid market generates $10 billion in annual sales.
There are thousands of distributors among the 1.6 million people and companies that hold DEA licenses to dispense drugs, but three of them - McKesson, AmerisourceBergen and Cardinal Health - account for 85 percent of the drug shipments in the United States. These companies, which together collect about $400 billion in annual revenue, supply the corner pharmacist as well as giant medical centers.
For years, the DEA had taken a hands-off approach to the prescription drugs flowing out of the distributors. The companies had been reporting their drug sales inconsistently or not at all. They had been largely left alone as the DEA focused on doctors and pharmacies.
"The distributors had been ignored for years and years and years," John Coleman, the third-ranking administrator at the DEA in the mid-1990s, said in a recent interview.
In 2005, the Office of Diversion Control, under Rannazzisi, launched its "Distributor Initiative" and briefed 76 companies about it. The new campaign pitted the DEA against an industry with close ties to lobbyists, lawyers and politicians in Washington.
On Sept. 27, 2006, the diversion office sent a letter to distributors across the country, reminding them that they were required by law to ensure that their drugs were not being diverted to the black market.
"Given the extent of prescription drug abuse in the United States, along with the dangerous and potentially lethal consequences of such abuse, even just one distributor that uses its DEA registration to facilitate diversion can cause enormous harm," Rannazzisi wrote in the letter.
Five months later, D. Linden Barber, then-associate chief counsel for the DEA diversion office, wrote to DEA supervisors across the country, telling them to be vigilant. Abuse of prescription drugs, he said, had become "greater than the abuse of cocaine, heroin and methamphetamine."
Under Rannazzisi's initiative, distributors would have to monitor their sales in real time, withhold drug shipments if they detected suspicious activity and report those red flags to the DEA.
The diversion office deployed two weapons to ensure compliance. The first was an "order to show cause," which permits investigators to begin a process to stop drug shipments from warehouses. The second was an "immediate suspension order," which allows the DEA to instantly freeze shipments of narcotics from facilities where an "imminent threat" to public health exists. The immediate suspension order was especially dreaded by the distributors.
Younker, the former DEA supervisor in Cincinnati, said the agency had no other choice.
"The distributors could have stopped what was going on, but they didn't," he said. "They were doing the bare minimum. Why would you want to cut off a customer that's paying you $2 million a year? They have sales reps and sales quotas and bonus structures and employees of the month. Everyone was making a lot of money."
The DEA diversion office started small. Investigators targeted Southwood Pharmaceuticals, a mom-and-pop distributor in Lake Forest, Calif., where shipments of hydrocodone had skyrocketed over nine months in 2005, from 7,000 doses per month to 3 million. Southwood eventually lost its license to dispense controlled substances.
In 2007, the DEA raised its sights, bringing an enforcement case against McKesson - now the nation's largest drug distributor and the fifth-largest corporation in the country. The DEA accused the company of failing to report hundreds of suspicious orders from online pharmacies.
"As a result, millions of dosage units of controlled substances were diverted from legitimate channels of distribution," a Justice Department news release said in 2008. Without admitting liability, McKesson eventually settled the case, agreeing to pay a $13 million fine.
That same year, the diversion office filed a case against Cardinal Health, another member of the Big Three wholesalers. DEA investigators alleged that the company was sending millions of doses of painkillers to online and retail pharmacies without alerting investigators to an obvious sign of illegal diversion.
Cardinal settled the allegations in 2008, paying a $34 million fine without acknowledging wrongdoing and promising to improve its monitoring of suspicious orders. Cardinal's chief executive at the time said the company had spent $20 million to control diversion and took its responsibility "very seriously."
Still, the painkiller crisis raged. In 2008, 13,149 people died of opioid overdoses.
The next year, a federal law made it illegal to distribute controlled substances online and required doctors to see their patients face-to-face before writing prescriptions.
By now, the DEA's campaign was broad and deep. Mulrooney, the agency's chief law judge, noted in an internal report that the agency had filed 115 charging documents in 2010, including 52 immediate suspension orders.
"Progress," the chief judge wrote, noting that all pending cases were scheduled for hearings. "This has not been true for as long as anyone here can remember."
In late 2011, Rannazzisi's office filed warrants to yet again inspect the records of a Cardinal warehouse. Investigators alleged that the company was overlooking escalating oxycodone orders from pharmacies in Florida. The DEA was also targeting four drugstores supplied by Cardinal in the state, including two CVS pharmacies.
Rannazzisi's office obtained an internal Cardinal email from 2010 showing that the company's own investigator had warned against selling narcotics to Gulf Coast Medical Pharmacy, an independent drugstore in Fort Myers, Fla., citing suspicions that the pills were winding up on the street.
Despite the warning, Cardinal hadn't notified the DEA or cut off the supply of drugs.
Instead, the company shipped increasing quantities of pain pills to Gulf Coast. In 2011 alone, Cardinal sent more than 2 million doses of oxycodone to Gulf Coast. The wholesaler typically shipped 65,000 doses annually to comparable pharmacies.
"I had the case of my dreams," Rannazzisi said.
About Thanksgiving in 2011, Rannazzisi said that he received an unexpected phone call.
It was from James Dinan, then-chief of the Organized Crime Drug Enforcement Task Forces program at the Justice Department. Dinan worked with then-Deputy Attorney General James Cole, the second-most powerful Justice Department official after Attorney General Eric Holder Jr.
Rannazzisi said Dinan told him: "We're getting calls from attorneys, former Justice people, that are saying you guys are doing some enforcement action."
Rannazzisi said he told Dinan that warrants for Cardinal records had already been served.
Among the attorneys representing Cardinal at the time were two former deputy attorneys general, Jamie Gorelick, who served in the Clinton administration, and Craig Morford, who served in the George W. Bush administration. Both contacted the DEA, records show.
Gorelick did not respond to requests for an interview. Morford declined to comment. Instead, Cardinal referred questions to Barber, the former DEA associate chief counsel in charge of diversion litigation, who joined the law firm Quarles & Brady and is now representing distributors.
Barber told The Post that there was nothing unusual about Morford contacting the agency.
"It was not anything other than 'we'd like to sit down and have a discussion at an early stage of the investigation,' " Barber said.
On Feb. 1, 2012, as Rannazzisi was preparing to sign off on immediate suspension orders against Cardinal and CVS, he said he received another call from Dinan.
Rannazzisi said Dinan told him that Cole, the deputy attorney general, known in the department as the "DAG," was demanding a briefing before the suspension orders were executed.
The next morning, at 1:36 a.m., Dinan followed up with an email.
"Please call me in the morning," he wrote, according to Rannazzisi. "I want to make double sure nothing unreversible happens before the DAG is briefed as we talked about at Thanksgiving."
That morning, Rannazzisi went to the Justice Department in Washington to meet with a number of officials, including Cole; Dinan; Goggin, the DEA's top lawyer; and Stuart Goldberg, Cole's chief of staff.
Rannazzisi said Goldberg did most of the talking.
"He asked me a question about what my goals were in this case, and why I was going after these corporations," Rannazzisi said. "I said, 'Before I answer that, I've got to ask you: I've done hundreds of these cases, and I've never been called over to the Justice Department to explain myself. I'm just curious why this case is so important.' "
Rannazzisi said Cole interrupted.
"Because I'm the deputy attorney general of the United States, and I want to know about it," he recalled Cole saying.
"Then I say, 'Well, that doesn't really answer the question,' " Rannazzisi said.
The meeting went downhill from there,
"It spiraled out of control," Rannazzisi said. "It got very adversarial."
Cole, who is now a partner at the Washington law firm Sidley Austin, disputed Rannazzisi's characterization of the meeting.
"My conversation with Mr. Rannazzisi was simply to confirm whether or not he had refused to meet with Cardinal regarding a potential DEA action and, if so, share my view that it made good sense to listen to what Cardinal had to say," Cole said in a statement.
"Hearing what Cardinal had to say could inform DEA of facts they may not have known. I did not tell Mr. Rannazzisi how to come out on the Cardinal matter and certainly did not discourage him from going after any company in violation of any statutes or regulations," he said.
Dinan, now the principal assistant U.S. attorney for the District of Columbia, declined to comment through a spokesman. Goldberg and Holder did not respond to requests for an interview.
Rannazzisi said he left the meeting undeterred. The same day, his office filed the suspension order against Cardinal, and two days later, DEA investigators shut down the two CVS pharmacies. A week later, DEA officials said in court documents that Cardinal's activities constituted "an imminent danger to the public health or safety."
As the cases were pending, Goggin wrote to Rannazzisi to inform him that CVS was attempting to go around the agency by appealing to the office of the deputy attorney general, known as ODAG.
"CVS lawyers (who used to work at DOJ) are trying to do an end run with ODAG," Goggin wrote, according to Rannazzisi. "They want (1) to get the administrator to hold off issuing a final order until we are able (presumably) to try and work out a settlement."
In his statement, Cole said, "I do not recall having any involvement with CVS matters while at DOJ."
Final orders make cases public because the decisions are published in the Federal Register. A final order was issued against CVS, which ultimately paid a $22 million fine.
In 2012, Cardinal also reached a settlement. A company spokesman recently told The Post that Cardinal uses state-of-the-art techniques, including advanced analytics, to combat diversion.
To date, the company has not been fined. A federal prosecutor and company officials said negotiations are continuing.
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In December 2012, a new lawyer filled the position in charge of approving cases brought by the DEA's diversion office. A career employee of the Justice Department, Clifford Reeves had worked on the case against CVS. At first, diversion investigators were encouraged by the arrival of an experienced lawyer.
But soon, complaints arose in some of the DEA's field offices around the country. Under Reeves, DEA attorneys began demanding additional evidence before investigators could take action.
"After Reeves arrived, everything became confrontational," Geldhof, the retired DEA diversion manager in Detroit, recalled in a recent interview. "There were a lot of roadblocks all the time. Everything was an issue."
Before Reeves's arrival, Geldhof said, investigators had to demonstrate that they had amassed "a preponderance of evidence" before moving forward with enforcement cases, which are administrative, not criminal. Under Reeves, Geldhof said, investigators had to establish that their evidence was "beyond a reasonable doubt," a much higher standard used in criminal cases.
Geldhof said he repeatedly confronted Reeves about the languishing cases.
"I said, 'Lee, what's going on?' " Geldhof said.
He said Reeves simply told him about the new higher standard.
Barbara Heath, a DEA program manager in Atlanta, said she and her investigators were frustrated by the new policy in Washington.
"It was the most significant change in my 20 years at the DEA," said Heath, who oversaw the agency's diversion efforts in Georgia, the Carolinas and Tennessee from 2006 until her retirement in December. "It got to the point where they wanted the same evidence as criminal prosecutions. It was very difficult to prove intent."
In Washington, Mulrooney, the chief DEA judge, was documenting the falling caseload. In a June 24, 2013, quarterly report, Mulrooney wrote that there was "a significant drop" in the number of "orders to show cause." Four months later, he noted "a free fall in the numbers of charging documents." For the first time since records had been kept, he noted, no charging documents had been filed for an entire month.
Younker, the retired DEA supervisor in Cincinnati, said he, too, called Reeves to complain.
"Look, these cases are lingering here, they're down in your shop for six to 12 months," Younker recalled telling Reeves. "They're sending drugs out and people are dying, and this is like the emperor has no clothes on."
Younker said Reeves replied: "Who's the emperor?"
"I said, 'You're the emperor. You can't sit on these things like this.' "
Seeing what was happening in the field, Rannazzisi said he became furious with Reeves.
"At one point, I said: 'I've lost all faith in the counsel, and you've become a hindrance and not a help, and all these people are dying,' " Rannazzisi said.
Chaney, the former DEA supervisor in Columbus, said her office in 2011 began investigating an Ohio distributor that sent tens of millions of pain pills to doctors and pharmacies in Florida over three to four years.
Chaney said there was no reason to ship that many pills to Florida from Ohio, because the company already had a distribution facility in Florida. The DEA also had previously taken action against some of the doctors who were writing prescriptions for opioids filled by the Florida pharmacies.
"It was a righteous case," she said.
But the lawyers at DEA headquarters disagreed. The original DEA attorney assigned to the case was removed and replaced by a lawyer who stalled the case at every turn, Chaney said.
"It was never enough," she said. "We could never satisfy them."
Chaney declined to identify the company because no legal action was taken.
At the end of 2013, she retired from the DEA.
"We were all very dedicated, and we were all deeply disappointed that the program was being manipulated this way," she said.
Chaney said she had joined the DEA because of a personal loss: Her mother became addicted to Percocet after a car accident and died of an accidental overdose.
"That's the reason I got into this work," she said. "To see this happening, it makes me want to cry."
In Washington, Mulrooney was becoming increasingly frustrated, his quarterly reports show. In a June 24, 2014, report, the judge wrote that the DEA's legal office had filed only seven show-cause orders and one immediate suspension order in the previous three months.
"These numbers continue to reflect an alarmingly low rate of Agency Diversion enforcement activity on a national level relative to historical data," Mulrooney wrote.
He noted that the drop in cases coincided with "a leadership transition" in the legal office. He wrote that he couldn't determine who was to blame - the field offices or the lawyers at headquarters. Mulrooney divided the operating budget of the legal office by the number of cases it was approving. He found that each case was costing taxpayers nearly $11 million.
"Assuming also that opioid-related deaths remain at over 20,000 per year (2010-2011 levels), this would mean that the Agency is on course to institute one administrative enforcement action for every 625 fatalities," he wrote.
Three months later, Mulrooney reported that the diversion caseload was so low, his judges had little to do. He began permitting them to hear cases from other federal agencies, including the Bureau of Prisons and the Treasury Department.
In the summer of 2014, Rannazzisi said that he received an unusual request. To foster better relations with industry, the Justice Department wanted to meet with senior representatives of drug distributors and pharmacy chains.
Rannazzisi said he was appalled. Some of the companies were either under investigation or in the midst of settlement negotiations with the DEA diversion office, he said.
But Rannazzisi said that he objected and that the meeting did not take place.
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That summer, lobbying by the pharmaceutical industry intensified on Capitol Hill. Several members of Congress, led by Reps. Tom Marino, R-Pennsylvania, and Marsha Blackburn, R-Tennessee, were proposing a measure that critics said would undercut the DEA's ability to hold drug distributors accountable.
Four major players lobbied heavily in favor of the legislation, called the Ensuring Patient Access and Effective Drug Enforcement Act. Together, McKesson, AmerisourceBergen, Cardinal and the distributors' association, the Healthcare Distribution Alliance, spent $13 million lobbying House and Senate members and their staffs on the legislation and other issues between 2014 and 2016, according a Post analysis of lobbying records.
In July 2014, Rannazzisi was asked to explain his opposition to the bill in a conference call with congressional staffers.
"I said, 'This bill passes the way it's written we won't be able to get immediate suspension orders, we won't be able to stop the hemorrhaging of these drugs out of these bad pharmacies and these bad corporations,' " Rannazzisi recalled telling them. " 'What you're doing is filing a bill that will protect defendants in our cases.' "
His remarks enraged Marino, the chairman of the House Judiciary subcommittee on regulatory reform.
In a Sept. 18, 2014, congressional hearing, Marino tore into then-DEA Administrator Michele Leonhart, Rannazzisi's boss. By then, the legislation had passed the House; the bill was about to be introduced in the Senate.
"It is my understanding that Joe Rannazzisi, a senior DEA official, has publicly accused we sponsors of the bill of, quote, 'supporting criminals,' unquote," Marino said. "This offends me immensely."
Marino told Leonhart that Congress was sending the DEA a message: "You should take a serious look at your regulatory culture and seek collaboration with legitimate companies that want to do the right thing."
Marino mentioned Holder's desire to meet with representatives of the pharmaceutical industry. At a hearing, Marino said he was "disappointed that DOJ staff has not made this a priority."
Seven days later, Marino and Blackburn, who represent districts in states that have been hit hard by the opioid epidemic, demanded that the Justice Department's inspector general investigate Rannazzisi's remarks. They said he had tried to "intimidate" members of Congress. An investigation was launched. Rannazzisi was replaced in August 2015 and retired last October.
"That led to his undoing," said Matthew Murphy, a DEA official who worked with Rannazzisi in the diversion office. Rannazzisi had "very, very strong views" on what was happening on the street, Murphy said. "He wasn't going to change his opinion because of some heat."
Marino said the conflict boils down to one person - Rannazzisi.
"We had a situation where it was just out of control because of [Rannazzisi]," Marino said. ". . . His only mission was to get big fines. He didn't want to [do] anything but put another notch in his belt."
The legislation passed in 2016. It raises the standard for the diversion office to obtain an immediate suspension order. Now the DEA must show an "immediate" rather than an "imminent" threat to the public, a nearly impossible burden to meet against distributors, according to former DEA supervisors and other critics. They said the new law gives the industry something it has desperately sought: protection from having its drugs locked up with little notice.
DEA officials, who declined to speak on the record, said the agency retains its power to issue immediate suspension orders under the new law.
Four months after Rannazzisi left, representatives from drug distributors and pharmacy chains got the meeting they had long wanted with key government officials, including Rosenberg, the acting DEA administrator, and Milione, Rannazzisi's replacement.
Afterward, the DEA issued a news release declaring that it had established a new relationship with the companies.
"The pharmaceutical industry has a vital role on the front lines of preventing drug misuse and abuse across America, as do we," Rosenberg said in the release, "and we plan to work closely with them."
The new relationship had been in the making for years.
"One longstanding Congressional criticism of DEA's diversion control division has been a lack of communication with its registrants," Carr, the Justice Department spokesman, said in the recent statement. "Upon his arrival at DEA in May 2015, in response to these concerns, Acting Administrator Rosenberg made it a priority to improve communication with registrants and strengthen partnerships with the regulated industry."
John Gray, president and chief executive of the Healthcare Distribution Alliance, the wholesalers' trade association, praised the new approach.
"HDA is pleased with the willingness of the new leadership at the DEA to meet with and engage registrants, and is encouraged by the Administration's desire to 'reset the relationship' with our industry,' " Gray said in a recent statement to The Post.
Rannazzisi said he views the new relationship as a surrender to industry.
"This idea that they're going to say, 'I'm sorry I violated the law, give me another chance and I'll make it right,' without having some type of punishment, to me is outrageous," he said. "Every time I talked to a parent who lost a kid, I'm pretty sure they didn't want me to say, 'Oh, give them another chance because corporate America needs another chance.' "
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Steven Rich, David S. Fallis, Alice Crites and Josephine Peterson contributed to this report. Peterson is attached to The Post's investigative unit through a program at American University.
Even if he loses, Donald Trump isn't going away. But the man and the political phenomenon he has unleashed over the past 16 months are already posing a difficult chicken-or-egg question: Has Trump transformed America, or simply revealed it?
Trump's slash-and-burn march to the Republican nomination and on into this fall is perhaps the ultimate blending of entertainment and politics, a coarse yet mesmerizing new show that appears to have changed political language and deepened divisions in an already polarized nation. But is this a singular moment, tied exclusively to Trump's larger-than-life personality and searing rhetoric, or has he loosed into the culture a new virus of confrontation and anger?
"Win or lose, the Trump effect will be felt long after the election," said David Nevins, president of Showtime, who has spent decades reflecting the nation's mood on TV shows such as "24," "Friday Night Lights" and "Homeland." "Trump and his followers are in many ways a rebuke to the elites who are perceived as controlling popular culture. The people who feel left out, passed over, now have a champion, even though he's actually one of the New York media power establishment."
Admire him or loathe him, many Americans are fascinated by Trump, and that fascination is feeding a wave of new work that will aim to entertain and challenge the public in the coming years. Trump's ability to embrace - or manipulate - average Americans' anxieties is inspiring more raw and rough rhetoric in politics, darker and more somber popular music, and in TV, movies and other arts, an edgier, more nervous set of characters and themes.
Social media exposes rifts
Has Trump granted Americans license to express overt racism or new levels of acrimony? "It seems like a plausible narrative, but I seem to recall all kinds of sketchy things said about races and genders and groups aired publicly on a weekly basis before, say, the summer of 2015," said John McWhorter, a Columbia University professor who studies public rhetoric. "He is distinct only in being someone of such prominence saying such things. I think the real change was Facebook and Twitter in 2009. Trump is just a symptom."
Even as offensive language and ethnic insults became routine at Trump rallies, McWhorter saw the real culprit as social media. Twitter and Facebook became the foundations of daily communication for many Americans between 2007 and 2009, "revolutionizing conversation about, well, everything," and pushing political chatter in a far meaner direction, McWhorter said.
In this view, the Trump effect is not unique to the man, but is a natural, almost inevitable result of economic and social forces unleashed by swift, powerful technological change that had, even before Trump's candidacy, made the country meaner, more confrontational and more divided.
The populism Trump represents and the social strains that made millions of Americans eager for someone like him appear regularly throughout American history. Previous bursts of populism have usually burned through in less than a generation, fading away as economic expansion, war or political reform eased people's sense of insecurity.
The frustration and resentments evident among Trump's supporters have roots, some historians say, as far back as Pat Buchanan and Ross Perot's third-party insurgencies in the 1990s. Others say Trump's success is the result of disorienting, displacing changes in the world beyond politics, in the technological revolution that has altered the way Americans relate to one another and in the arc of millions of work lives.
On college campuses, battles over clashing world views, identity politics and the definition of free speech have raged for years. Online, many Americans had already spent years swimming in a virtual ocean of pornography, foul language and sexual misbehavior - long before Trump's coarse language about women and the allegations about his inappropriate advances became campaign issues.
Although much of the country had moved toward acceptance of same-sex marriage, the issue continued to divide many people by faith, family tradition and cultural expectations. The tea party, the Occupy movement, and Barack Obama's 2008 campaign all demonstrated a popular hunger for thoroughgoing change and a realignment of the political parties.
"Trump didn't appear out of nowhere," said Chris Buskirk, a Trump supporter and talk radio host in Arizona who runs a conservative website called American Greatness. "He's amplified things that were already happening anyway. In two years, politicians are going to look at Trump and say, maybe I can be more revealing, more authentic."
Buskirk, 47, said Trump's blunt rhetoric and coarse language would have been startling decades ago but today only mirrors a society in which many people feel stifled by new limits on what can be said at work or school. "We'd all like a high level of public discourse," he said, "but a 3 a.m. tweetstorm isn't among my worries about the next generation." Buskirk views Trump as a breakthrough candidate who has spread optimism that "change is still possible when the American people act on their own behalf. Trump supporters see not his coarseness or vulgarity, but a sense that an ordinary person can rise up and make a difference."
Donald Trump, ordinary person? "Yeah, it doesn't compute in a certain way," Buskirk quickly conceded, "but even though he's a billionaire, he's a guy from Queens, not the Upper East Side, and he talks like average Americans talk."
Effect on pop culture
In TV, movies and the theater, programming decisions are starting to reflect Trump's impact. Showtime's "Billions," a drama pitting a crusading prosecutor against a morally shady hedge fund operator, "would never have caught on without Trump," Nevins said. "Two years earlier, I wouldn't have put it on. But with Trump the billionaire running against the billionaire class, we're confronting all these questions of when our aspiration and our worship of wealth and business comes in conflict with our anger at what the big guys are getting away with."
As the writers putting together the next season of the political thriller "Homeland" thought about "how to reflect the Trump era," Nevins said, they searched, as ever, for "the edge of what you can get away with on television. That's a line that's constantly moving, not so much sexually as what qualifies as subversive or dangerous." And Trump's campaign has pushed that line in a coarser, angrier direction.
R.J. Cutler, a documentary filmmaker who has focused on political culture in movies such as "The War Room" and "The World According to Dick Cheney," is developing a TV series set in small-town America, in post-election 2017, "when any bad thing seems possible, when we no longer know the ground rules about the weather, about democracy, about very basic things."
Trump didn't emerge from the blue, Cutler said. A figure like him - charismatic, media-savvy, offering "believe me" solutions and bountiful blame - was inevitable. "Trump arose out of the perfect storm - the power of television at its most pervasive, the maturation of social media, and the world's greatest huckster," Cutler said. "Trumpism isn't going away. Even if he only wins 37 percent of the vote, that's tens of millions of people, and in a way, it's even better for Trump if he loses because then his policies never have to be tested."
If Trump loses, he can say, as he has been for weeks now, that the system is rigged - the voting apparatus, the media, the parties' domination. That opens the door to Trump or a would-be successor to lead a movement of disaffected Americans against both major parties and the elites that support them.
But couldn't a post-Trump exhaustion set in, making it harder for a lasting movement to develop? No one interviewed for this article argued that Trump or his followers would simply vanish following a loss, but some wondered if many Americans might crave escapism over another round of battle.
The widespread unhappiness with this year's choices - Trump and Hillary Clinton are the least liked presidential candidates in modern times, polls consistently show - is part of a national spirit that's been growing grumpier for years. Pop music, which often reflects the mood of the country, has been trending slower and darker, following a period of much more energetic hits around the start of the economic recovery in 2009, said Sean Ross, who analyzes pop music and radio play for Edison Research.
"This was the summer of unhappy popular music," Ross said. "There's an almost complete dearth of up-tempo, major-chord happiness. There's no tempo right now in country, pop, R&B, anywhere."
In the summer hit, "Stressed Out," the indie group Twenty One Pilots sang, "I was told when I get older, all my fears would shrink, but now I'm insecure and I care what people think. Wish we could turn back time, to the good ol' days . . . but now we're stressed out . . ."
The Chainsmokers' hit, "Don't Let Me Down," tells a story of being "stranded, reaching out. . . . I think I'm losing my mind now."
The exception to the trend proved the rule, Ross said: Justin Timberlake's "Can't Stop the Feeling" was "the only up-tempo tune of the summer and it was immediately scooped up by an anxious audience." Ross said the current popularity of slow, low-energy songs is the most striking run of such music since the early 1980s - also a time of severe economic stress.
Since Trump became a mainstay of TV viewing, that soundtrack has accompanied notably harsher debate in politics and beyond. For generations, candidates could assume that voters wanted leaders who could achieve consensus. Trump capitalized on the ideological polarization of the past two decades and the more recent cultural shift toward the kind of hot takes that go viral on social media.
The result is a new pressure on politicians to be at once entertaining, provocative, and even outrageous. The shift is evident in the media, advertising, even sports. "There's no place in 2016 for considering the other guy's point of view, unless you want to be called a wishy-washy, namby-pamby flip-flopper," Sports Illustrated columnist Steve Rushin wrote last month. "There will never be a sports talk show called 'You May Be Right,' no TV roundtables called 'Point Well Taken.' "
The muzzles are off
Trump supporters say he has liberated them to speak out against political correctness, whether in opposition to same-sex marriage or in defense of police officers accused of racial animus. "Trump has given some people permission to say things they were afraid to say," said John Lott Jr., president of the Crime Prevention Research Center and an opponent of gun control who joined dozens of researchers and academics on a pro-Trump petition. "People are just tired of having their motives questioned, of being demonized. Trump's letting people give voice to that feeling."
Over the past year, Trump's blunt, provocative rhetoric has morphed from outrageous to virtually ordinary for many Americans, said Frank Luntz, the longtime Republican consultant who uses focus groups of voters to analyze not only what they believe but also how they express it.
"Early on, people were horrified by his offensive statements," Luntz said. "But as time went on, they came to enjoy it and absorb it. There's no filter anymore. I hear Trump's words over and over: 'We have to keep them out.' Trump has liberated their inner voice, and I'm shocked at what I hear now."
Luntz sees no indication that the rougher rhetoric is a passing fad. "The more coarse language gets, the more coarse it stays," he said. "We don't go back. We don't suddenly become civil and good to each other."
In Luntz's focus groups recently, the tone of disagreements has deteriorated into the kind of attacks that once would have silenced the room. " 'You're an idiot' has become relatively common," he said. "It's gotten to the point where I cannot stop people from yelling at each other."
Luntz has seen a sharp increase in parents telling him that their children are using Trump-inspired smears at school. "It's 'Lyin' Thomas' and 'Little David' in fifth or sixth grade," he said. "That's when you know you have a problem."
Teachers around the country report not only a disturbing rise in the number of kids who mimic Trump's insults, but also a burst of fear among immigrant children about the threat of deportation, even when their families are legal U.S. residents.
In the Roxbury section of Boston, Karene Hines, an eight-grade English teacher, was startled recently to see a boy shaking with fear. She asked what was wrong, and the boy, whose family immigrated legally from Colombia, said that a Trump campaign sign that the owner of the neighborhood laundromat had posted had freaked him out: "He thought it meant that the INS was going to sweep through and he'd be rounded up even though he is legal," Hines said.
"These kids are always asking, 'Why does he hate us? We haven't done anything,' " the teacher said. "These are kids who before Trump were interested in the latest sneakers, the Red Sox, the Patriots. Now they're hyperfocused on Trump. One boy brought me his cellphone to show me Trump's tweets. They know his insults by heart. They're scared."
Both of the nation's major teachers unions - which have endorsed Clinton - and the Southern Poverty Law Center have been collecting such reports as evidence of a Trump effect in which the candidate's comments about minorities and women show up in classrooms and schoolyards.
Fear has not been limited to children. Psychiatrists and counselors say people on both sides of the nation's ideological divide are losing sleep and expressing concerns likely to extend beyond Election Day.
When a patient recently complained that he's being kept awake by his fear that a President Trump might start a nuclear war, Washington psychiatrist Bernard Vittone added the man to a growing list of people "whose main anxiety is Trump anxiety." The doctor, who runs the National Center for the Treatment of Phobias, Anxiety and Depression, said that in three decades of practice, "I've never had people come in like this, about four a week, coming in scared, actually frightened, about a candidate winning an election. They may hate Clinton, but they're not scared of her. They may have hated Bush, they may have hated Obama, but they were never scared."
Vittone said he normally treats such patients with cognitive behavioral therapy, in which "you try to get people to look at things more realistically. But in this case, I can't really dispel their anxiety because they have facts and quotes from Trump that they spout back at me that totally nullify my attempts to ease their fear." The psychiatrist tends to treat Trump-fearing patients with anti-anxiety medication.
A darker future?
Such frayed nerves reflect a loss of trust and community that predates Trump's political emergence. In a culture in which characters on reality-TV shows lash out at one another for sport, in a society in which bonds of trust have frayed as relationships become distanced from physical proximity, "along comes Donald Trump to give us permission to say out loud the things we've been saying anonymously online," said playwright Joshua Harmon, whose short play, "Ivanka: A Medea for Right Now," will be read at Washington's Studio Theatre next month as part of a flash festival of Trump-related plays at five D.C. theaters. "He's closer to how a lot of people are living than Hillary Clinton. A lot of men talk exactly like Trump online; he's just the first person to do that while running for president."
In most of popular culture, there's a long lag between social change and the art that bubbles up from the streets. Playwrights, novelists and songwriters say that when Trump-inspired works begin to appear, they will probably focus on the sense that, as Harmon said, "People are immersed in their own worlds now. We were already being horrible to each other on social media, so we were kind of ripe for someone to come along and further dehumanize us."
Many new works may be dark or tragic. "This doesn't feel like something that people will look back and chuckle about," Harmon said.
Very little in the culture points toward any 'what was that all about?' reckoning if Trump loses. More likely, Trumpism will continue to be the agitator that propels the nation's political machinery.
For many, Trump's lasting impact is directly tied to his domination of the news media this year. "The depressing and dangerous change that Trump brought is this: The media have surrendered their airtime to him," said Doug McGrath, a satirist and playwright whose show, "Beautiful," is running on Broadway. "There seems to be no calculation other than 'can we get him on and can we keep him on?' " Even before Trump came along, cable news had morphed from traditional reporting to "mainly people yelling at each other," as McGrath put it.
Now, Trump has taken that coarsening of the culture and exacerbated it. "In Trump, we have the candidate himself making jokes about his own penis size, or calling women terrible names," McGrath said. "He has obliterated the idea that tone matters, . . . that there is such a thing as going too far. For the next person who tries it, it will seem less shocking because this has been accepted by the media who report it in detail (mostly without shock or complaint) and by the rest of us who grumble but keep watching."