Obama administration bungled opioid crisis response: IG report

The Obama administration bungled its response to the nation’s opioid epidemic, according to a stunning inspector general’s report released Tuesday that says the Drug Enforcement Administration allowed painkiller production to soar even as deaths mounted.

DEA officials failed across the board, said the Justice Department’s inspector general, pointing to a “toxic” environment, lack of data to spot the mounting crisis, and a failure to use tools that could have shut down some of the worst offenders among manufacturers, doctors and pharmacies dealing the drugs.

“We found that DEA was slow to respond to this growing public health crisis,” said Michael E. Horowitz, the inspector general.

The problems stretch back to the Bush years, investigators found. Although the report doesn’t fault President Barack Obama, the worst of the epidemic happened on his watch, with deaths rising 71% a year from 2013 to 2017, when it claimed 130 lives each day.

The DEA has improved since then, Mr. Horowitz said, by building its capacity to enforce the law and fostering better cooperation with state and local authorities who are on the front lines. President Trump has declared a public health emergency, and Congress has poured billions of dollars into the effort.

Still, he said, the agency needs better regulations and needs to track trends to quickly spot emerging epidemics.

State officials saw the report as vindication of their warnings over the years that the federal government was ineffective.

“Every aspect of the pharmaceutical supply chain bears responsibility for the havoc and senseless death unleashed upon West Virginia — and the DEA is no exception,” said Patrick Morrisey, West Virginia’s attorney general.

“For years, the DEA was grossly negligent in its mismanagement of the national drug quota system. Unfortunately, this mismanagement contributed to the senseless death of many Americans. Fortunately, we are now working with the Trump administration to reverse the awful trends we saw for many, many years,” he said.

Now, with the death toll plateauing, states are searching for places to blame. Wealthy pharmaceutical companies are the chief targets for hundreds of lawsuits.

The inspector general’s report, though, says the government also deserves a significant amount of blame.

The DEA approved a 400% increase in total oxycodone production from 2002 to 2013. It wasn’t until 2017 that the agency, now under the Trump administration, cut the production quota. A 25% trim in 2017 was followed by a 6% cut last year, the inspector general said.

The DEA cut its use of immediate suspension orders beginning in 2013, the investigation found. Those orders allow the agency to halt production or distribution of a drug by a company registered with the DEA.

DEA officials said there were several reasons for the slowdown, including a few targeted operations that led to a surge of suspension orders in 2010, 2011 and 2012, but then petered out afterward. The agency also got dinged by a court, which said the DEA was cutting corners in issuing the orders.

A “toxic” atmosphere among DEA divisions may also have hindered investigations, the report said, including delayed action on one oxycodone “pill mill” for more than a year.

Those findings undercut a media feeding frenzy from two years ago, when CBS’s “60 Minutes” and The Washington Post, citing a DEA whistleblower, blamed a 2016 law for making it tougher to issue suspension orders.

CBS and The Post said the law raised the threshold for issuing suspension orders at the behest of pharmaceutical interests. The reports earned the two outlets a Peabody Award.

But the inspector general’s report says the number of suspension orders fell well before the 2016 law was enacted. Indeed, in 2015, just five suspension orders were issued.

The Washington Times on Tuesday contacted the whistleblower, former DEA Agent Joe Rannazzisi, but he said he hadn’t had time to read the report.

The DEA, in its official response to the report, said suspension orders also dropped because of a lack of training and a change in strategy to target “upstream” producers. The agency also said talk of a “toxic” environment was overstated.

More broadly, the DEA said it is making progress in ousting bad actors from its approved lists.

“Working with United States attorneys’ offices across the country, an increasing number of individuals and corporations are facing civil and criminal charges for actions that have fueled the opioid crisis,” the agency said.

The inspector general acknowledged improvements but made nine recommendations. The DEA and its overseers at the Justice Department generally agreed with the recommendations.

Still, the report didn’t sit well with everyone.

Leo Beletsky, a public health and legal analyst at Northeastern University, said the report “glosses over” big questions about the DEA’s role.

He said the DEA’s strategy of suppressing the legal supply of painkillers has pushed people to seek them on the streets, leading to more overdoses.

Ronald T. Libby, emeritus professor of political science at the University of North Florida, agreed. He said the casualties of the DEA’s approach are patients who are in pain but can no longer get access to drugs because doctors are afraid to write prescriptions for opioids.

He also questioned the statistics on opioid-related deaths, which uses a correlation of drugs and deaths to draw a causation.

“There’s no evidence that the proper medical use of opioids is dangerous. Now the misuse of the drugs, that’s a problem. But it has nothing to do with medical treatment or chronic pain,” he said.