Drug Law Blog

Pharmacist Refuses to Sell OxyContin, Citing Risk of Robbery

For about the last six months, any time I've done a Google News search for OxyContin, the headlines are nothing but stories about robberies of pharmacies by people looking for that drug. There are new stories on this theme literally every day.

Today I see that a pharmacist in Deland, Florida has decided to simply stop selling OxyContin altogether because he has been robbed at gunpoint for the drug and has had enough.

Even though the suspect [in that robbery] was shot and killed by a security guard, pharmacist Ken Ritter feels that a big change is needed.

"So many pharmacies have been targeted by armed robbers lately. Most of them looking for OxyContin and related drugs," Ritter said.

Last year, Ritter's pharmacy encountered another man looking for OxyContin.

"I noticed him shaking. He had the black bag in his hand and he was shaking real bad," witness Susie Timko said.

The assailant then passed them a note that said, "I want OxyContin and I have a gun."

These stories are worth keeping in mind when we talk about the problems associated with markets around other drugs, such as medical marijuana. Robberies do occur in connection with medical marijuana dispensaries, but the incidence of such crime pales in comparison to the violence around the legal drug OxyContin.

On the Public Health *Upside* to Recreational Use of Prescription Opioids

Earlier this month the Miller-McCune blog published an intriguingly counterintuitive item noting the possibility that public health may actually improve because of the shift from "street" drugs to diverted pharmaceutical opioids.

The reason that upside exists, according to the blog (which is based on an academic piece written by Benedikt Fischer of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University in Vancouver):

Those who use prescription opioids to get high are less likely than heroin users to take the drug in the form of an injection. “Injecting is identified as a primary risk factor for both infectious disease transmission and overdose risks,” they note.

Furthermore, users tend to obtain prescription opioids by forging prescriptions or seeing several doctors at the same time and getting prescriptions from each. In contrast, heroin users usually buy their supply from street dealers, often obtaining the money they need by committing crimes.

Two interesting wrinkles to this: a commenter on the article contends that it is misinformed because "Oxy[contin] is crushed, cooked, THEN injected." As far as I know, that is accurate in some cases but not all cases, as folks have many different methods for abusing the drug, including snorting it.

The other point that needs to be emphasized, I think, is simply that there may be a public health benefit in simply keeping these users out of jail or prison by virtue of the fact that they are less likely to be arrested, prosecuted and convicted. This is particularly true if those users are able to maintain relatively trouble-free lives and simply use their drug of choice without causing a problem for other people, though obviously it gets more complicated if they engage in the same type of income-producing criminal behavior associated with street drug consumers.  

FDA and Pain Doctors Looking Toward Clearer, Tighter Rules on Pain Meds

Sorry for the dearth of posting lately. I've just been slammed with work/kid responsibilities.

At any rate, the Wall Street Journal's Health Blog notes that both the FDA and two associations of pain doctors are trying to establish clearer standards around pain medication.  The FDA intends to "subject the makers of certain extended-release pain drugs to a new risk-management program designed to cut down on misuse and abuse of the products," according to the WSJ. Meanwhile, "the American Pain Society and the American Academy of Pain Medicine, published guidelines for doctors about how best to manage patients chronically taking strong, potentially addictive opioids."

Crappy Hackington Discovers OxyContin

I keep posting articles about the recreational and abusive use of pharmaceutical drugs because I believe that it's an issue that is neither well explored in the media nor adequately acknowledged in the way our legal system around drugs is structured. At the same time, though, I'm wary about the tendency for the media to create a "drug scare" hype around such drug use in much the same way we've seen in the past around methamphetamine and crack cocaine.

Today, a TV station from my childhood home of San Diego has a story that takes the pharmaceutical use issue and treats it with a fact-free style that would make Crappy Hackington proud, slinging undocumented assertions around as if they were flapjacks at Denny's:

Oxycontin The Drug Of Choice For Young, White Males

Last Updated:
07-14-08 at 6:38PM

More and more teenagers are turning to their parents' medicine cabinet to get high. Their prescription drug of choice: a pain reliever called oxycontin. It's a disturbing trend of teenage boys getting hooked on a drug as powerful as morphine.

...

[An OxyContin user named] Joe fits the demographic of an increasing number of oxycontin addicts: young white males. Alvarado Parkway Institute psychologist Sean O'Hara says he sees six to seven teenagers a week who abuse oxycontin

"Kids are getting it by forging their own prescriptions. Kids are getting it by buying it on the internet. Kids are getting it by going down to Mexico," he said.

This reporter dips into the classic Crappy Hackington lexicon to document a trend, relying on meaningless terms like "more and more," and "an increasing number," in spite of the fact that there are actually several studies out there, with good data, directly on point. One could look at the annual Monitoring the Future study of youth drug use, for example, which stated in its 2007 report (on p. 28 of the "Key Findings" document) that

OxyContin use increased for all grades over the interval 2002 (when it was first measured) through 2007, though the trend lines have been irregular. Annual prevalence in 2007 was 1.8%, 3.9%, and 5.2% in grades 8, 10, and 12, respectively. Use of Vicodin, on the other hand, has remained fairly constant since 2002, though at considerably higher levels than OxyContin. In 2007 annual prevalence rates were 2.7%, 7.2%, and 9.6% in grades 8, 10, and 12.

One could also look at the National Survey on Drug Use and Health, which reported last year that "nonmedical use of prescription drugs among young adults increased from 5.4 percent in 2002 to 6.4 percent in 2006, due largely to an increase in the nonmedical use of pain relievers."

So there is a story here, but the reporter just didn't make any effort to figure out what it is. She doesn't really even attempt to back up the assertion that OxyContin use is somehow unusually high among white teenage boys compared to other groups, deciding instead to rely on the claim by one psychologist that he sees a couple kids a week. Needless to say, that psychologist's claim, presented with no comparison to anything else and no attempt to determine whether these numbers have gone up or down, shows absolutely nothing.  And yet, the  "young, white male" idea is actually the hook of this story on a "disturbing trend."

Related Posts:

Getting the Facts Straight on Drug Use, Policing, Sentencing and Incarceration 7/1/08

Rational Actors, or Why "Generation Rx" Uses Cough Syrup for Fun 3/19/08

I'm Your Pusher: Purdue Pharma Cops to Oxycontin Charges 5/10/07

The Crappy Hackington Awards For Meritorious Service of the Status Quo 7/31/07

Nevada Sees More Than 400% Increase in Prescription Drug Overdoses

From the Associated Press:

LAS VEGAS — A newspaper investigation found skyrocketing abuse of prescription narcotics in southern Nevada, accompanied by a startling increase in the number of fatal overdoses.

Deaths involving prescription painkillers have more than quadrupled in a decade, to exceed those involving illicit drugs, according to Clark County coroner's data.

...

[D]eaths involving prescription narcotics [were] on par with deaths involving firearms (321) and motor vehicle accidents (234) in Clark County in 2007.

In contrast, the number of deaths caused by illicit drugs plateaued. Data showed street drugs such as cocaine, methamphetamine and heroin were involved in a combined 197 fatal overdoses in 2007, up from 64 in 1997.

Related posts:

Prescription Drug Use Seen Causing 147% Increase in Indiana Overdose Deaths 6/30/08

LA Times:Prescription Meds the New Drug of Choice 5/19/08

Slate on Pharmaceutical Substitutes for Recreational Drugs 10/17/07

DEA To Propose Easier Electronic Prescription of Pharmaceutical Meds, Including OxyContin, Ritalin

This is a truly bizarre story: the Wall Street Journal reports that the DEA will introduce a proposed rule as early as next week to "eas[e] a barrier" to online prescription of pharamaceutical meds, apparently including Schedule II drugs like OxyContin, Ritalin and Adderall, which are prone to recreational and abusive use.

Why is this a strange move? Because the recreational use and abuse of pharmaceutical drugs is already a very serious health issue in the United States, one that is actually eclipsing the health problems involved with traditional street drugs like heroin and cocaine.  More 12 and 13 year olds now abuse pharmaceutical drugs than use marijuana, a fact that is noted in the White House's National Drug Control Strategy for 2008 (pdf).

Why, then, is the DEA pushing for easier online access to these drugs? And who is lobbying the DEA to do this, when it clearly will only make the DEA's job harder?

(Update: Pharmalot has coverage here.)

Further OxyContin Fallout for Purdue

Pharmalot points today to a website called OxyDeaths, set up by the mother of a woman who died of respiratory failure after taking OxyContin for a back problem.

Marianne Skolek, the creator of the website, sought jail time for the Purdue executives who pled guilty this summer to lying about the addictive potential of OxyContin for six years and encouraging company sales reps to literally make up their own "scientific" charts to help sell the drug. Pharmalot also reports:

[Skolek] wants Howard Udell, Purdue’s top lawyer, disbarred, and Paul Goldenheim, formerly Purdue’s medical director, to have his medical license revoked. So she’s filed a grievance against Udell in Connecticut, where Purdue is based, and it’s been referred to the state panel...

As even a casual reader of this blog will know, I'm firmly in the defense camp, a strong supporter of legitimate pain medicine, and not an advocate of jail time for any drug offense.

But I've been astounded by the double standard that was applied to the Purdue prosecution and the appearance of Justice Department intervention on behalf of this corporation. The Purdue case is simply appalling, and it amazes me that the U.S. can continue to apply such harsh laws to the sale of certain recreational drugs and to doctors' prescription of pain medication after having treated the years-long corporate fraud that occurred around OxyContin sales as if it were comparable with some sort of civil negligence.

I'm not a person who believes that some drugs are "good" and others are "bad." But any drug, even one that has useful purposes, can become awfully dangerous when the manufacturer lies to consumers about its potential risks.

More on Purdue, the Department of Justice, and the War on Pain Doctors

The story of Michael Elston's late-night call on behalf of Purdue Pharma in October (background here) would raise the eyebrows of any reader who expects the Justice Department to behave in a professional manner and is concerned about corporate influence on the operation of our government.

But this phone call is even more stunning when one considers the context in which the call occurred: in the midst of a virtual pain doctor pogrom, during which the Justice Department was (and continues to be) raiding doctors' offices and pharmacies and pushing for extremely harsh prison sentences for physicians who are simply negligent in the way they prescribe drugs like OxyContin. As Siobhan Reynolds of the Pain Relief Network testified (pdf) yesterday before the very Senate committee that is considering the OxyContin settlement:

Over the last five or so years, US DOJ has engaged in a brutal and systematic campaign to intimidate medical practitioners out of prescribing supposedly legal opioid pain medications. They have imprisoned many skilled and compassionate physicians on trumped up charges, for sentences amounting to three decades or more, (See the New York Times Magazine Cover article, When Is A Pain Doctor a Drug Pusher, June 17, 2007) and have caused thousands more physicians to stop treating their patients’ serious pain.

And with that campaign going on, Purdue had been lying about the addictive potential of OxyContin for six years and encouraging drug reps literally "to draw their own fake scientific charts that they then distributed to doctors." During this period, Purdue brought in nearly $3 billion dollars in revenue from OxyContin while patients around the country plunged into addictive risks that had been ignored, concealed and grossly distorted.

And yet Purdue, the very company that was manufacturing the drugs and then lying to the doctors about the risks of the drugs, had enough clout to get Michael Elston on the phone badgering John Brownlee, the U.S. attorney handling the case. Even in the midst of this pogrom, Purdue was able to get the message to Brownlee that he should "slow down" on the plea deal or face the consequences.

The Justice Department treated this corporation as if it were its closest ally at the very moment it was sending doctors away for decades in prison for prescribing that corporation's products. Ms. Reynolds argued yesterday that the Purdue plea somehow sent a "deadly message . . . to the pharmaceutical industry," but in fact it was Purdue sending a message. Not only did Brownlee get the late night call, he nearly lost his job for standing up to Elston. All so that Purdue could craft the most minimal sanctions possible for itself after years of shameful deceit and billions of dollars of profit.

 

(Above: Law enforcement agents haul evidence out of the office of Dr. Milton Brindley of Augusta, Kentucky during a June 2007 raid. Photo by Terry Prather of the Ledger Independent)   

(Hat tip: War on Doctors/ Pain Crisis.)

Purdue Pharma and the Justice Department

The Washington Post has a story today tying together Purdue's recent plea deal in the OxyContin case (background here) to the scandal over the politically motivated firing of U.S. attorneys and suggesting what a cozy relationship the drug maker has with the Justice Department.

Reporters Amy Goldstein and Carrie Johnson write that John L. Brownlee, the U.S. attorney who was handling the prosecution of Purdue, received a call at home on the night before the plea deal was to go through. The person making the call, according to Brownlee's testimony yesterday before the Senate Judiciary Committee, was Michael J. Elston, the chief of staff to Deputy Attorney General Paul J. McNulty.

The point of the call, Brownlee testified, was to "urg[e] him to slow down" on the Purdue case.

Brownlee testified he told Elston "to leave it alone, to go away."  Eight days later Brownlee's name showed up on the list of U.S. attorneys who should be fired, although he ultimately kept his job.

Goldstein and Johnson report that the call was made "at the direction of McNulty, who that evening had received an appeal for more time by Mary Jo White, a defense lawyer representing an executive for OxyContin's manufacturer, Purdue Pharma."

Brownlee and other former prosecutors said nighttime calls such as Elston's, coming just hours before the end of a long, complex case, are unorthodox, particularly when the department's criminal division already has signed off on a case.

Both McNulty and Elston have since resigned from the Justice Department, according to the Post.

(Hat tip: Pharmalot.)

(Update: More discussion of this case in the context of the war on pain doctors here.)

I'm Your Pusher: Purdue Pharma Cops to Oxycontin Charges

Today is clearly not a good day at Purdue Pharma, which is being pilloried in the press and in the blogosphere after pleading to charges of "misl[eading] regulators, doctors and patients about [oxycontin's] risk of addiction and its potential to be abused."

As a PR issue, it's a mess. On the other hand, the $600 million fine that Purdue will suck up (plus another $34.5 million that a couple execs will pay) doesn't seem especially large given what was actually going on and given the comparable sanctions that would be imposed on a "pusher" of a non-FDA approved drug. Think about it:

* Purdue Pharma fraudulently marketed oxycontin for six years, according to the New York Times.
* During that time, again according to the Times, "OxyContin brought in $2.8 billion in revenue for Purdue Pharma, a closely held company based in Stamford, Conn. At one point, the drug accounted for 90 percent of the company’s sales." 
* The fraudulent conduct was egregious, including among other things allowing sales reps "to draw their own fake scientific charts that they then distributed to doctors," according to Pharmalot.
* And this was going on against the backdrop of a criminal regime in which individuals like Virginia Pain Doctor William Hurwitz were being aggressively prosecuted and sentenced to lengthy prison terms for, you guessed it, prescribing too much oxycontin and being willfully blind to the addictive consequences.
* Moreover, this was going on while "pushers" of street drugs were getting slapped with truly massive sentences. Like, say, 55 years in prison for being a dealer of marijuana rather than oxycontin.

All of which is not to suggest that the sanction against Purdue Pharma was inappropriate or should have been harsher. Perhaps, in fact, it's entirely appropriate because really, as Jacob Sullum points out, "Purdue Pharma is essentially being held responsible for the behavior of patients and black-market OxyContin buyers." In other words, Purdue Pharma didn't twist anybody's arm to make them snort oxycontin. It didn't force anybody to do anything. It just marketed a product in a way that was not entirely candid, and facilitated a predictable binge of addictive behavior.

That's what all pushers do. They push.

The interesting thing is that some pushers get to write a check when they're caught. $600 million later, they're out on the golf course, sipping a martini.

Meanwhile, other pushers are torn out of society altogether, their homes, vehicles and businesses are ransacked by SWAT teams, they're thrown in prison for decades, their children are taken away from them by the court, all of their assets are forfeited through civil proceedings, they are barred from receiving financial aid, barred from government housing, barred from serving on juries, barred from voting.

When you think of it that way, $600 million is a hell of a bargain.

Seventh Circuit Upholds Sentence for Oxycontin Dealer That Departed Upward from Plea Deal

A federal trial judge did not err in sentencing a Wisconsin oxycontin dealer to a prison term based on a higher quantity of drugs than the defendant and the prosecutor had agreed on in the plea deal, the Seventh Circuit held Monday in U.S. v. Marty, No. 05-3297. The determination of the drug quantity was a factual one that the appeal court reviewed on a "clear error" standard. And it didn't find clear error.

This is the second appeals court opinion this blog has covered recently (the other one being the DC Circuit's decision in In Re Sealed Case, here) where a drug defendant has struck a bargain with a prosecutor, the judge has completely ignored the spirit of the bargain, and the circuit court has upheld the decision. Which seems fine, as a purely legal matter, but still doesn't exactly feel right.

One other interesting thing about this opinion is footnote 4, on page 6, which says the following:

The danger that arises from the sale, misuse, and abuse of OxyContin is not excused by its status as a prescription painkiller. While Marty may have obtained her pills from a pharmacy, rather than a drug dealer, her crime still poses a grave danger to the community. See NATIONAL DRUG INTELLIGENCE CENTER, U.S. DEPARTMENT OF JUSTICE, INTELLIGENCE BULLETIN: OXYCONTIN DIVERSION, AVAILABILITY AND ABUSE (Aug. 2004), http://www.usdoj.gov/ndic/pubs10/10550/10550p.pdf; GENERAL ACCOUNTING OFFICE, REPORT TO CONGRESSIONAL REQUESTERS, PRESCRIPTION DRUGS: OXYCONTIN ABUSE AND DIVERSION AND EFFORTS TO ADDRESS THE PROBLEM, GAO-04-110 (Dec. 2003), http://www.gao.gov/new.items/d04110.pdf; Michael Janofsky, Drug-Fighters Turn to Rising Tide of Prescription Abuse, N.Y. TIMES, Mar. 18, 2004, at A24. “Law enforcement officials around the country have been wrestling with an epidemic of prescription drug abuse, especially of powerful painkillers such as OxyContin, popularly known as ‘hillbilly heroin.’” Prescription Drug Abuse Rises To ‘Epidemic’ Level, L.A. TIMES, Jul. 11, 2005, available at 2005 WLNR 23350246.

What's interesting about that? Just that the court is obviously working to incorporate up-to-date social science (or the journalism equivalent thereof) into its reasoning. Which is a good thing, maybe. Or maybe not, depending on how accurate the reporting is.