document-5.pdf - CASE 32 Profiting from Pain: Business and...

Profiting from Pain: Business
and the U.S. Opioid Epidemic
Anne T. Lawrence
San Jose State University
I
n 2017, McKesson Corporation, a leading whole-
sale drug distributor, agreed to pay $150 million
in fines to the U.S. Department of Justice. The
charges were that the company had failed to imple-
ment effective controls to prevent the diversion
of prescription opioids for nonlegitimate uses, in
violation of the Controlled Substances Act.
1
For
example, McKesson had supplied pharmacies in
Mingo County, West Virginia—a poor, rural county
with the fourth-highest death rate from opioid over-
doses in the nation—with 3.3 million more hydroco-
done pills in one year than it had in five consecutive
earlier years.
2
At the time, Mingo County had just
25,000 residents. Yet, the company had not flagged
these orders to federal drug enforcement officials as
out-of-the-ordinary.
McKesson, which at the time was the fifth larg-
est company in the United States—with almost $200
billion in annual revenue—played a largely unnoticed
middleman role in the pharmaceutical industry. The
firm’s main business was shipping legal, government-
approved medicines to pharmacies, hospitals, and
health systems. McKesson’s unmarked trucks rolled
out at midnight from its 28 enormous, highly auto-
mated distribution centers, on route to their morning
deliveries of one-third of all pharmaceuticals sold in
North America. Although distributors like McKesson
did not either manufacture or dispense opioids,
they were responsible for notifying the federal Drug
Enforcement Administration (DEA) and correspond-
ing state regulators if orders suggested that controlled
substances were being improperly diverted.
3
McKesson and other drug distributors were
not the only businesses implicated in the nation’s
burgeoning epidemic of addictive opioids. Drug
companies—such as Purdue Pharma, the maker of
OxyContin—had developed new prescription opi-
oids and aggressively marketed them to doctors
and patients, making vast profits for their own-
ers. Entrepreneurs had opened pain clinics where
unscrupulous doctors could write big scripts for the
addictive pills, and pharmacies had looked the other
way while dispensing drugs to suspicious patients.
And illegal businesses, from producers of street
drugs like heroin to networks of dealers, had also
played their parts. What responsibility did these
businesses bear for the tragedy of opioid addiction,
disability, and death?
THE OPIOID EPIDEMIC
At the time of the McKesson’s settlement with the
Justice Department, the United States was deep in
the throes of what the Centers for Disease Control
and Prevention (CDC) had called “the worst drug
overdose epidemic in [U.S.] history.”
4
Fueling the epidemic was addiction to prescrip-
tion opioids. Opioids were a class of painkillers
derived from the opium poppy. Also referred to as
narcotics, opioids included legal prescription medi-
cations such as morphine, codeine, hydrocodone,
oxycodone, and fentanyl, as well as illegal drugs such
as heroin. Opioids worked by dulling the sensation of