Merchants of Death: The pharmaceuticals, Congress and the US opioid epidemic

A glimpse into the pervasive corruption and political machinations that have gone into creating the deadly drug epidemic in the United States was provided last week in a joint investigative report by the Washington Post and CBS News’ “60 Minutes” television program.

The investigation exposed a bipartisan scheme spearheaded by Republican Congressman Tom Marino to block the Drug Enforcement Administration (DEA) from reining in the illicit sale of opioids. The flooding of economically devastated working class communities with opioid pain-killers has profited the drug distribution corporations to the tune of billions of dollars while addicting millions and killing hundreds of thousands of people across the US.

The effort to eviscerate the already inadequate oversight powers of the DEA started in 2014 and culminated in the Ensuring Patient Access and Effective Drug Enforcement Act of 2016, which passed by overwhelming votes in Congress and signed into law by then-President Barack Obama.

The main purpose of the legislation was to stop the DEA’s Office of Diversion Control from halting drug shipments for unusually large and unexplained sales. Previously, for example, when several Walgreens pharmacies in Florida sold more than one million opioid pills in a year, compared to a nationwide average of 74,000, the Office of Diversion Control could impose fines and suspend distribution, preventing the drugs from reaching the streets pending the results of an investigation. The 2016 law effectively ended the ability of the DEA to suspend such orders.

The campaign pursued by Marino and his colleagues was aimed at purging the oversight agency of any officials or employees who actually sought to carry out their stated mandate: to combat drug epidemics. By the end of the two-year behind-the-scenes campaign, Joe Rannazzisi, after previously being removed as head of the Office of Diversion Control, had been pushed into retirement, the DEA had undergone a change in its top leadership, and the bill in its final form had sailed through Congress.

Rannazzisi, the principal whistle-blower in the Post-“60 Minutes” exposé, was asked by his interviewer, “You know the implications of what you’re saying, that these big companies knew that they were pumping drugs into American communities that were killing people.” He replied, “That’s not an implication, that’s a fact. That’s exactly what they did.”

The relations between gigantic corporate monopolies and the institutions of state power that are revealed in the particular case of opioid drug distributors are the relations that prevail across-the-board in American bourgeois “democracy.” The fusion of the capitalist state with massive corporations and banks is the characteristic feature of what Lenin in 1916 called “state-monopoly capitalism,” the form of decadent capitalism in its final stage—the stage of imperialism.

The complete domination of big business over society and the entire political system; the rampant bribing and corruption of the “elected representatives” as well as the supposed “regulators” of the corporations and banks; the general plundering of society for the enrichment of a tiny oligarchic elite—these features have matured and metastasized since Lenin’s time. What is perhaps new is the degree of outright criminality in the ruling elite, which knowingly condemns millions to drug addiction and hundreds of thousands to death in order to pile up ever greater profits.

Three major companies, all in the top 20 of the Fortune 500, dominate the distribution of opioids: McKesson, Cardinal Health and AmerisourceBergen. They have combined annual revenues of over $450 billion. McKesson Chairman and CEO John Hammergren has the biggest pension fund, at $160 million, of any US corporate boss.

Par for the course in the current administration, President Trump picked Rep. Marino, a shill for the drug industry, to head his drug-control efforts. But the Washington Post“60 Minutes” exposé forced him to withdraw the appointment. This decision was driven by the crassest political considerations. Trump has presented himself as the champion of working class communities ravaged by deindustrialization, mass unemployment and endemic poverty, such as the former coal mining centers of Appalachia, where the opioid epidemic has taken its greatest toll. He has demagogically denounced the spread of illegal pain-killers and linked it to his America-First denunciations of foreign rivals for supposedly “stealing” American jobs and American wealth.

The Post-“60 Minutes” exposé focused on devastated mining regions such as Mingo County, West Virginia, presenting damning figures on the flooding of impoverished communities with opioids by the drug companies, assisted by the legislation pushed by Marino and his Republican and Democratic co-conspirators. In Mingo County, population 25,000, the mid-sized Ohio-based drug distributor Miami-Luken shipped 11 million doses of oxycodone and hydrocodone in a five-year period—enough to give two pills a week to every man, woman and child in the county.

These policies have resulted in a historic reversal in the long-term rise of life expectancy in the United States. For middle-aged whites, particularly those living in rural areas, life expectancy is declining and death rates soaring, in large part because of the impact of opioid abuse and addiction.

Over 52,000 people in the US died of drug overdose in 2015, with 20,101 of those deaths directly linked to prescription pain relievers.

Flush with profits, the drug corporations routinely buy off politicians to secure ideal business conditions. Political action committees representing the pharmaceutical industry contributed at least $1.5 million to the 23 lawmakers who sponsored or co-sponsored four versions of Marino’s bill. Overall, the drug industry spent $102 million lobbying Congress on the bill and related legislation between 2014 and 2016.

The DEA exemplifies the fact that the federal agencies supposedly tasked with policing big business—the Securities and Exchange Commission, the Food and Drug Administration, the Environmental Protection Agency, the Occupational Health and Safety Administration—are under the thumb of the corporations and run political interference for them. The corrupt relations are brazen.

At least 46 investigators and attorneys from the DEA, including 32 directly from the Office of Diversion Control, were hired by the pharmaceutical companies since scrutiny of the drug distributors began in 2014. Mike Gil, former chief of staff for an acting DEA administrator, was hired by one of the country’s largest health care firms. Jason Hadges, senior DEA attorney overseeing enforcement, now has a leading position in the pharmaceutical division of a high-powered Washington, D.C. law firm.

As Lenin wrote in 1916: “The difference between the democratic-republican and the reactionary-monarchist imperialist bourgeoisie is obliterated precisely because they are both rotting alive. … Political reaction all along the line is a characteristic feature of imperialism.” Political reaction and criminality—such is the essence of what passes for “democracy” under capitalism.