美國(guó)鴉片類藥危機(jī)系列報(bào)道之四（2）--FDA與鴉片類藥品批發(fā)商一直在斗爭(zhēng)赘方，近五年執(zhí)法力度下降，死亡率大幅上升弱左。

健康早知道157期

（以下中文由“美國(guó)針灸政治行動(dòng)委員會(huì)”提供窄陡；英文原自美國(guó)“華盛頓郵報(bào)“）

2000年至2014年，全國(guó)處方止痛藥過(guò)量死亡人數(shù)達(dá)165,000人拆火。危機(jī)還促成了海洛因的后續(xù)流行跳夭，造成同期接近5.5萬(wàn)次的過(guò)量死亡事件涂圆，芬太尼已經(jīng)殺死了數(shù)千人。美國(guó)阿片類藥物的處方從1992年的1.12億增加到2015年的2.49億币叹。

阿拉伯鴉片戰(zhàn)爭(zhēng)前線的幾名DEA官員說(shuō)润歉，他們不能說(shuō)服總部在疫情高峰期批準(zhǔn)他們的案件。他們說(shuō)颈抚，他們面對(duì)著負(fù)責(zé)批準(zhǔn)他們的案件的律師Clifford Lee Reeves II踩衩，沒有任何效果。 Reeves通過(guò)DEA發(fā)言人拒絕對(duì)此報(bào)告發(fā)表評(píng)論贩汉。

吉姆·格爾霍夫（Jim Geldhof）近四十年來(lái)一直在DEA工作驱富，并且在里維斯（Dev）于2012年在DEA總部接手時(shí)，擔(dān)任底特律總部外辦事處的轉(zhuǎn)移項(xiàng)目經(jīng)理匹舞。

1月份退休的格爾霍夫（Geldhof）說(shuō)：“就像他在一邊褐鸥，而不是我們的〈突” “我不知道他的動(dòng)機(jī)是什么叫榕，但我們有人死亡。你會(huì)認(rèn)為他會(huì)更具侵略性姊舵。我們正在流行一場(chǎng)大藥片晰绎。“

在現(xiàn)場(chǎng)蠢莺，Younker和其他DEA主管表示寒匙，他們?cè)絹?lái)越不信任Reeves，并對(duì)總部發(fā)生的事情懷疑躏将。

“我們都有一種感覺，有人把他放在那里故意扼殺這些情況考蕾，”尤內(nèi)克說(shuō)祸憋。

擔(dān)任俄亥俄州哥倫布市DEA集團(tuán)主管的凱西·陳尼（Kathy Chaney）看到了這個(gè)問題。她負(fù)責(zé)俄亥俄州的35個(gè)縣肖卧，并監(jiān)督該機(jī)構(gòu)在阿片類危機(jī)的零點(diǎn)蚯窥，遏制諸如Chillicothe和樸次茅斯等城市的處方止痛藥濫用的努力。

她說(shuō)塞帐，她的一個(gè)案件反對(duì)一個(gè)經(jīng)銷商拦赠，多年沒有采取行動(dòng)。 Chaney表示葵姥，經(jīng)驗(yàn)是特別困難的荷鼠，因?yàn)樗?jīng)和那些死于過(guò)氧化氫可樂酮和其他止痛藥的兒童的父母見面。

“我們很失望榔幸，我終于告訴我的團(tuán)隊(duì)允乐，”我們不會(huì)把任何案件送到總部矮嫉，“Chaney說(shuō)，他在2013年退休牍疏〈浪瘢”25年來(lái)，我從來(lái)沒有見過(guò)這樣的事情鳞陨。這是我離開的原因之一昨寞。士氣太可怕了我沒辦法做任何事情這幾乎就像是看不見的∠寐耍“

***

約瑟夫·蘭納齊西（Joseph Rannazzisi）在2009年的參議院司法小組委員會(huì)聽證會(huì)上表示编矾，在DEA辦公室進(jìn)行了十年的工作，之后他被撤職馁害，并于去年退休窄俏。 （Haraz N. Ghanbari / Associated Press）

2004年，由于日益增多的處方止痛藥供應(yīng)過(guò)量死亡人數(shù)的增加碘菜，DEA的轉(zhuǎn)移辦公室的領(lǐng)導(dǎo)人感到震驚凹蜈。在線藥店蓬勃發(fā)展，使購(gòu)買強(qiáng)力止痛藥如羥考酮和氫可酮容易忍啸。死亡人數(shù)達(dá)到一千五百七十七人仰坦，一年上升百分之十五。

痛苦管理診所在全國(guó)各地開始爆發(fā)计雌。 DEA導(dǎo)師調(diào)查人員很快就意識(shí)到悄晃，他們正在玩一個(gè)真正的Whac-a-Mole游戲。一旦他們關(guān)閉一個(gè)設(shè)施凿滤，就會(huì)出現(xiàn)另一個(gè)設(shè)施妈橄。

“人們正在死亡，”威廉J.沃克說(shuō)翁脆，他是一名31年的DEA退伍軍人眷蚓，他在2004年和2005年領(lǐng)導(dǎo)轉(zhuǎn)移辦公室。

沃克在全國(guó)各地設(shè)立戰(zhàn)術(shù)單位反番，調(diào)查醫(yī)生沙热，藥劑師，經(jīng)銷商和制造商罢缸。

他說(shuō)：“我們有一個(gè)多層面的威脅篙贸，這是一種非常緊迫的感覺》憬” “我把工作人員的熱量提高了爵川，我們開始追趕了⊙”

在2005年年底雁芙，國(guó)民警衛(wèi)隊(duì)準(zhǔn)將沃克被迫上任轧膘，離開了辦公室。取而代之的是他的頂級(jí)副手兔甘，約翰·蘭納齊西（Joseph Rannazzisi）谎碍，一位街頭聰明的紐約客，他在藥學(xué)和法律學(xué)士學(xué)位洞焙。他已經(jīng)開始他的職業(yè)生涯蟆淀，作為DEA街頭代理人，然后在底特律的主管澡匪，然后前往位于弗吉尼亞州阿靈頓的該機(jī)構(gòu)總部的轉(zhuǎn)移辦公室的頂端熔任。

Rannazzisi決定專注于藥物的來(lái)源：藥品批發(fā)商。

藥物由普銳派藥業(yè)等高調(diào)公司制造唁情。他們依靠不太知名的分銷商網(wǎng)絡(luò)疑苔，其中一些也是跨國(guó)公司。經(jīng)銷商擔(dān)任中間商甸鸟，向藥劑師惦费，醫(yī)院，療養(yǎng)院和疼痛診所發(fā)送數(shù)十億劑阿片類止痛藥抢韭。美國(guó)的阿片類藥物市場(chǎng)年銷售額達(dá)100億美元薪贫。

在擁有DEA藥品許可證的160萬(wàn)人和公司中，有數(shù)千家分銷商刻恭，其中有三家是McKesson瞧省，AmerisourceBergen和Cardinal Health，占美國(guó)藥品出貨量的85％鳍贾。這些公司共收集了約4000億美元的年收入鞍匾，為角色藥劑師以及巨型醫(yī)療中心提供服務(wù)。

原文鏈接："period."

https://www.washingtonpost.com/investigations/the-dea-slowed-enforcement-while-the-opioid-epidemic-grew-out-of-control/2016/10/22/aea2bf8e-7f71-11e6-8d13-d7c704ef9fd9_story.html

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.”

***

Joseph Rannazzisi, shown at a Senate Judiciary subcommittee hearing in 2009, ran the DEA Office of Diversion Control for a decade before he was removed from his position and retired last year. (Haraz N. Ghanbari/Associated Press)

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 J. 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, Amerisource-Bergen 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.