It may have been legal, but it was wrong

One of the problems with any system of governance is that it contains flaws that cast shadows on the other elements, no matter how good they may be.  I happen to believe that capitalism is the best of the systems so far developed for economic governance;  but it, too, has its flaws, one of which is the tendency of businesses to argue that if something is legal, they’re entitled to do it.  Moral and ethical considerations aren’t taken into account.

That’s come home to roost in West Virginia in a big way.

In six years, drug wholesalers showered the state with 780 million hydrocodone and oxycodone pills, while 1,728 West Virginians fatally overdosed on those two painkillers, a Sunday Gazette-Mail investigation found.

The unfettered shipments amount to 433 pain pills for every man, woman and child in West Virginia.

“These numbers will shake even the most cynical observer,” said former Delegate Don Perdue, D-Wayne, a retired pharmacist who finished his term earlier this month. “Distributors have fed their greed on human frailties and to criminal effect. There is no excuse and should be no forgiveness.”

The Gazette-Mail obtained previously confidential drug shipping sales records sent by the U.S. Drug Enforcement Administration to West Virginia Attorney General Patrick Morrisey’s office. The records disclose the number of pills sold to every pharmacy in the state and the drug companies’ shipments to all 55 counties in West Virginia between 2007 and 2012.

The wholesalers and their lawyers fought to keep the sales numbers secret in previous court actions brought by the newspaper.

. . .

The nation’s three largest prescription drug wholesalers — McKesson Corp., Cardinal Health and AmerisourceBergen Drug Co. — supplied more than half of all pain pills statewide.

For more than a decade, the same distributors disregarded rules to report suspicious orders for controlled substances in West Virginia to the state Board of Pharmacy, the Gazette-Mail found. And the board failed to enforce the same regulations that were on the books since 2001, while giving spotless inspection reviews to small-town pharmacies in the southern counties that ordered more pills than could possibly be taken by people who really needed medicine for pain.

As the fatalities mounted — hydrocodone and oxycodone overdose deaths increased 67 percent in West Virginia between 2007 and 2012 — the drug shippers’ CEOs collected salaries and bonuses in the tens of millions of dollars. Their companies made billions. McKesson has grown into the fifth-largest corporation in America. The drug distributor’s CEO was the nation’s highest-paid executive in 2012, according to Forbes.

In court cases, the companies have repeatedly denied they played any role in the nation’s pain-pill epidemic.

Their rebuttal goes like this: The wholesalers ship painkillers from drug manufacturers to licensed pharmacies. The pharmacies fill prescriptions from licensed doctors. The pills would never get in the hands of addicts and dealers if not for unscrupulous doctors who write illegal prescriptions.

In other words, don’t blame the middleman.

. . .

“It starts with the doctor writing, the pharmacist filling and the wholesaler distributing. They’re all three in bed together,” said Sam Suppa, a retired Charleston pharmacist who spent 60 years working at retail pharmacies in West Virginia. “The distributors knew what was going on. They just didn’t care.”

. . .

The Big Three wholesalers together are nearly as large as Wal-Mart, with total revenues of more than $400 billion. Their revenues account for about 85 percent of the drug distribution market in the U.S.

There’s more at the link.

Whether we like it or not, there is a moral and ethical dimension to many of the decisions we make.  No matter what our system of belief (if any), we remain responsible for that.  Examples:

  • There is no legal requirement in most US states to store one’s firearms in a safe manner, where children and casual thieves can’t easily get at them.  Nevertheless, I believe that if one fails to do so, and a child is injured or killed with one, or a thief steals one that he later uses to commit further crimes and threaten innocent lives, one bears some moral responsibility for failing in one’s ethical duty of care.
  • If one turns a blind eye to the misconduct of one’s children, so that they grow up without any moral code or understanding of what is, and is not, acceptable behavior, one shares some responsibility for the damage and hurt they will inevitably inflict on others.
  • If one sees conduct that is morally and/or ethically questionable, whether or not it’s actually legal, I believe one has the responsibility to – at the very least – dissociate oneself from it.  That may extend to resigning from one’s job, rather than be linked to it by our presence.  Silence is presumed consent.  Areas such as shoddy workmanship hidden from the customer, trash-talking competitors . . . they’re all ethically and morally wrong.  If we associate ourselves with them by our presence and our silence, we share complicity in them.

The same applies to the epidemic of opioid abuse in West Virginia and elsewhere.  If we become part of the conspiracy of silence, it doesn’t help to argue that we don’t abuse them ourselves, or provide them to abusers.  We’re still part of the conspiracy . . . and people are still suffering and dying because of it.

No man is an island,
Entire of itself,
Every man is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thy friend’s
Or of thine own were:
Any man’s death diminishes me,
Because I am involved in mankind,
And therefore never send to know for whom the bell tolls;
It tolls for thee.
           – John Donne



  1. Amen, and amen! I have come to the position that morality and ethics obey the Second Law of Thermodynamics: without the continuous input of energy, the system ceases to operate.

  2. I have to disagree with you on this one. If a person overdoses on pills, there are only two causes: Either the person was prescribed the wrong dosage by their doctor, or the person was abusing the drugs. Blaming the drug manufacturer is like blaming McDonald's because people are fat.
    The same is true for blaming a person whose guns are stolen in a burglary because he or she didn't put them in a safe. They are in a locked house, and blaming the victim of the burglary for what the burglar did with your guns after he broke into your locked home and stole them is ridiculous. If a locked house isn't enough, then you could easily say that a safe that can be opened with an acetylene torch isn't either.

  3. I would also add that a person can only do so much to teach their children to be responsible. I have 2 children: one was a high school honor student who finished high school in only three years, then became a paramedic and licensed firefighter at the age of 18. By the age of 25, he was a licensed flight nurse with a BS in medicine, owned his own home, two cars, and was making 6 figures.
    My 27 year old daughter was arrested several times for drug possession while still in high school, and she and her husband are living with her mother with their two children while collecting welfare and food stamps.
    Both kids were raised in the same house under the same rules. We show our children the path, but it is their choice whether or not to follow that path.

  4. Certainly more regulation isn't the answer. (shrug) My wife has chronic pancreatitis and related liver problems that are equally debilitating. Getting medication for her is a constant battle.

    I'm more than a bit skeptical that the state of West Virgina was ignorant about this. There is a registry for usage of all schedule 2 drugs to be monitored, with pharmacies required to account for every single pill. This simply could not have happened without the state and federal authoritaties deliberately turning a blind eye.

  5. What is the reason why so many people are taking pain pills? Is it because so many people have undiagnosed medical problems? Or are these pain pills being used for the same reason that people would use cocaine or pot? I'm not sure about the latter. I've never had either hydrocodone and oxycodone. Can people actually get "high" from either of these two compounds?

    I'm asking these questions because I honestly do not understand why this problem even exists and I'm trying to understand why it exists.

  6. @kurt9: Yes, they provide a sort of 'high' that is said to be not dissimilar to illegal narcotics. I've never used the latter, so I can't compare them, but I have had morphine, the maximum strength of Percoset, and other high-end painkillers prescribed from time to time (although fortunately I've never become addicted to them, and discontinued their use as soon as possible). I absolutely hated the 'high' feeling they gave me. Percoset 10mg. in particular made me 'see visions and dream dreams' in a very unpleasant way. Hallucination is not your friend!

  7. Freedom is very dangerous. The Founding Fathers of this country knew that only a moral society could keep the Republic alive. It seems at every step government is destroying personal/societal morality (and self responsibility) with the concept of the Nanny State.

  8. Yet when I go to the doctor with back spasms, he deals out painkillers with an eye-dropper. I have to save the 'good stuff' for bedtime and wince and squirm my way through the day on OTC stuff because he's too scared to prescribe more than fifteen stinkin' pills.

    Once more, our betters are protecting the stupid from themselves and the rest of us suffer. In my case, it's literal.


  9. The problem isn't the drug companies or even the pharmacists. How are they supposed to know who really needs extensive medication and who doesn't? Should they just arbitrarily limit the state to a rationed amount of pain medication and assume it will get to the right people? I don't see how they could act on the assumption that they were seeing too much consumption even if they wanted to.

    The blame for drug abuse falls on the drug abuser. Period. Even the doctor who writes the prescriptions for pain meds doesn't force the patient to take them, and has to rely on feedback from the patient to determine actual pain levels. I generally don't take pain meds of any form, but I know when I have dental work done it takes 2x-3x the normal amount of local anesthesia to numb me, and it wears off much faster than the dentists expect it to. People have different body chemistries and what works for one person won't necessarily work the same way for someone else.

    People need to take responsibility for their own problems, and we as a society need to make sure we place the blame where it belongs as well.

  10. There are several realities here:

    1. Pain management in this country is terrible.
    2. Withdrawing from opioid addiction can be painful in general and may exacerbate a chronic pain syndrome in particular even if the physical cause for the original pain is gone.
    3. Chronic pain is, in a perverse way, a learned response (not consciously or deliberately learned, but our brains tend to get good at what they do a lot of.) That means that getting out of chronic pain syndromes can be difficult and labor intensive, and may require motivation. Opioids don't do great things for motivation.
    4. If you pay for something, you get more of it. Such as opioid prescriptions and the related provider visits and pharmacy sales.
    5. If you suddenly restrict the legal supply of an addictive and legal pain modulating drug and fail to provide an alternative, some people will break their addictions, some will seek illegal supplies and in both cases there will be real suffering both in terms of the pain syndromes and the addictions.

    This is in large part the result of multiple bad legislative and regulatory responses to #1. I once (about 30 years ago! I'm old!) did some literature research on drug addiction; with heroin it seemed as though a bit over 25% of people who got addicted managed to kick on their own but many people struggled the rest of their lives. Yes, people need to take responsibility for their own problems, but in reality some won't and as Peter reminded us, no man is an island. Appropriate blame placing is only part of the required response.

    And Mike: Acute dental pain is one thing. Chronic pain from injuries or chronic disease is something altogether different. If you don't know that from personal experience you are fortunate.

  11. Quite apart from the liberty aspects of drug laws, suppose that evil wholesaler decided to stop being "evil"? Should they ration each pharmacy to the number of pills that they think that that pharmacy should be dispensing? If so I would bet that there would be articles about the evil wholesaler who would not supply relief to people in chronic pain (the fact that the pharmacy had used up its quota of pills on prescriptions that never should have been written notwithstanding). Perhaps even calls for criminal action if some of the sufferers committed suicide?
    The system in place depends on the doctors to write prescriptions responsibly, the pharmacists to dispense these drugs only for valid prescriptions and the State of West Virginia to monitor the doctors and pharmacists to ensure that they do so. Note who fell down on the job here vs. who is taking the blame.
    To sum up with a question, what would you have the wholesalers do? Keep in mind that if it is expensive, the prices of the medication will have to go up and if all the wholesalers do not do this, the ones that do will lose market share to the ones that do not. Also keep in mind that if they co-ordinate, they may be subject to anti-trust proceedings.

  12. In the final analysis, there is only one person responsible for being an addict: The addict.

    I've been on pain medications multiple times during my life. Every single time I started to feel as though I were becoming dependent on them, I weaned myself off of them, and dealt with the residual pain.

    Allowing yourself to become an addict is a choice you make. The question is, who is master of your soul? The chemicals, or you?

    I've got lifelong debilitating injuries that could probably get me a lifetime of government-provided prescription painkillers. I don't use them because I don't like the effect of them, and I refuse to be subservient to a drug, whether it's alcohol, a narcotic, or something else.

    Every single person I've ever met who has become an addict to their drug of choice has done so on their own. I've watched a couple of friends of mine go down that path, and even though I warned them of what they were doing, they still allowed themselves to become dependent.

    In the end, the choice is the addicts, not the pusher, not the distributor, not the doctor. You either master the pain yourself, or you allow the narcotic to become your master.

  13. Others have said a lot of what I want to say. I want every person in legitimate pain to get the appropriate amount of pain killers to deal with their pain. I want doctors to make prescription decisions based entirely on the medical needs of their patients, without worrying about being accused of over-prescribing. Compared to that protecting abusers from their own decisions doesn't matter at all.

    But even if I were to worry about the abusers, I believe they would be safer if they could get a steady supply of low-cost drugs of known potency and quality, and availability of legal opioids will not increase the overall amount of opioid abuse. I'd rather corporations profit from abuse instead of cartels. If someone has a severe habit, I'd rather it be cheap enough that they don't have resort to crime (or less crime) to support it.

    And "you should have known that too many of product X was sold for legitimate users" is right out of the gun control handbook. It's not a good enough excuse to deprive legitimate users.

  14. Our daughter is a pharmacist at an all-night pharmacy associated with a major hospital. As such, she normally only deals with prescriptions for people being discharged from the hospital or patients at the affiliated medical center. In other words – not a normal retail pharmacy, and the vast majority of the patients are covered by insurance.

    And she *still* has new you've-got-to-laugh-or-else-you'd-cry stories about people trying to scam the system for "fun" drugs. "That wasn't my husband that picked up my prescription!" "I lost my painkillers – please issue me some to hold me until Monday!" (Usually on a Friday night) Or the ever-popular "let's try to change the 3 pills on the form for 30, or 300".

    Then there are the fund-raisers. Until recently, they handed out diabetes test kits to folks covered by their health plan at will – after all, why request a test kit when you didn't need it, and it's not like it was a recreational drug. Now, they keep track of how many any one patient takes, and although they'll allow for some "lost or damaged", if you exceed ~150% of expected usage per month they look at it very carefully. Because one enterprising soul was going to all the local pharmacies covered by their plan and picking up a 3 month supply at each. Every month. And selling the excess online at half-price – apparently, they were making several hundred dollars a month.

  15. I'm like Mike, in that pain meds work in odd or frustrating ways. My dentist has a drug that is seldom used, except for people like me.

    In my twenties, I shattered my wrist, and discovered that real pain meds were not very effective. The maximum Demerol shot for a human would only last 2hrs, and they had to wait 4 hrs between shots in the hospital.

    I ended up using an odd pairing of drugs to control the pain, but required a large quantity. The pharmacist accused me of selling them on the street. Idiot. They cut me off a couple days after the pins were removed from the wrist. Found out years later that they could have killed me by doing that. This was in the early days of the Drug War ('73).
    The stupidity has gotten worse, not better. Now I have trouble getting allergy meds in enough quantity to be useful, when I need them.

    I want the .gov out of the drug control business. Alcohol is still the most damaging drug in use. They couldn't stop that, what the hell do they think they are doing with other drugs?

  16. Having intimate experience with debilitating, relentless and many times agonizing pain and having seen so-called pain management and the effects of the drug war on physicians and most importantly patients up close, I have some rather clear views on the subject. Provide the medication or treatment to relieve pain. Period. If some junkie ODs or dope head scams a scrip so be it. I've seen too many people through no fault of their own, live in horrific relentless pain because doctors were afraid to prescribe the proper pain meds. I've also seen what happens when a person denied the pain meds they were on by doctors and medical lawyers scared of the DEA. One person took the pain as long as they could, then carefully arranged their affairs, walked outside to a prepared area so as not to make a mess for their family, put a 12 gauge under their chin and blew their brains out the top of their head and onto some thoughtfully placed plastic shower curtains. Pain patients need to have their pain treated in whatever manner they and their physicians deem appropriate. The problem in West Virginia and in poor and middle class White America aren't pain killers, they're merely a symptom of other issues. Making people in pain suffer and jump through more hoops aren't going to fix those issues. Hopefully there's special place in hell for those who deny relief to those in pain because someone,somewhere might get high or OD.

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