Opioids

A Shuttered West Virginia Pharmacy Shows the DEA's Role in Escalating America's Overdose Crisis

A drug that treats opioid addiction may also be abused. That’s not a good reason to restrict access.

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Overdose deaths in the United States have escalated during the pandemic, deaths fueled frequently by the continued spread of synthetic opioids like fentanyl mixed into the drug supply in cocaine and meth.

Provisional numbers show a record high of more than 93,000 drug overdose deaths in 2020, a remarkable escalation in a death rate that has slowly been climbing for the past two decades.

If we consider this a public health crisis (and certainly the politicians of both parties do), one would think the easy availability of drugs that would help treat people with opioid addictions would be a high priority among public health officials. But as Kaiser Health News, an independent affiliate of the Kaiser Family Foundation, reports this week, instead the Drug Enforcement Administration (DEA) has been taking aim at pharmacies offering them, in part because they think drug addicts are turning to them.

It's a sadly predictable outcome of the drug war. Kaiser reports that the DEA targeted a West Virginia pharmacy operated by Martin Njoku in Fayette County. Njoku began dispensing the drug buprenorphine, often sold under the name Suboxone or Subutex, to customers starting in 2016.

As a drug, buprenorphine helps treat opioid addiction and chronic pain. But buprenorphine is also addictive and can be misused. Njoku's prescriptions drew the attention of the DEA, which accused him of facilitating opioid addiction and revoked the pharmacy's registration to dispense it and other controlled substances.

Njoku fought the revocation in federal court and in 2019 a U.S. District Judge Joseph R. Goodwin ruled that the DEA had not actually proven or shown that any patient who bought drugs at Njoku's pharmacy had abused the drug or diverted it elsewhere. The DEA had not provided a single instance that the buprenorphine was misused and instead used a lot of circumstantial evidence to justify shutting down his operation.

Even though Njoku had a federal ruling on his side, the years he spent fighting took their toll and he shut his pharmacy down in April. The fact that there are now fewer ways to get buprenorphine is not a winning strategy for reducing drug overdoses.

Reason's Jacob Sullum has reported regularly on how federal efforts to reduce overdose have instead exacerbated the problem by targeting prescription painkillers and the companies that make them as the sources of the crisis. But the evidence shows that, in fact, prescription drug use is not the primary cause of the overdose problem, and depriving people of access to drugs like Suboxone ends up sending addicts out to the street for alternatives. Those black market drugs are often laced with fentanyl, which then leads to overdose deaths.

People are much less likely to overdose on Suboxone, and as Sullum has noted, people rarely overdose while on prescribed painkillers, even if they're abusing them. Kaiser notes that new research shows that increasing the number of prescriptions of buprenorphine has not resulted in increased misuse. When these drugs are diverted to other users, it's most often to reduce and avoid the withdrawal symptoms of people who can't get prescriptions.

The DEA's targeting of Njoku's clinic had much broader implications than just depriving West Virginians of buprenorphine, Kaiser notes. Even though medical experts and the federal government both see the drug as a very important tool to fight addiction and drug overdoses, 20 percent of U.S. pharmacies don't stock the drug. A former West Virginia pharmacy compliance officer told Kaiser that these pharmacies are terrified they'll be targeted and put out of business by the DEA.

For the pharmacies that do prescribe buprenorphine, they essentially take their orders from the DEA, and wholesalers limit the amounts of pain meds individual pharmacies can have to keep the DEA happy. DEA attorneys actually argued as evidence that people were traveling long distances to get their drugs from Njoku. Goodwin noted in his ruling how the DEA's own behavior causes this to happen: "It is also well known and often commented upon that medical care providers in West Virginia, including physicians and pharmacies, are reluctant to fill prescriptions for buprenorphine-based treatment medications, meaning that even if patients live near a pharmacy, they may have to travel long distances to access their medication."

This DEA-enforced reduction of access to buprenorphine is actually helping fuel the drug overdoses as people unable to get prescriptions from doctors or to even get the prescriptions filled are turning to the black market for substitutes. The final horrible irony of the DEA's behavior here is that the DEA has also put out all sorts of fact sheets and alerts about counterfeit pills, warning that they might have fentanyl in them in potentially lethal doses. This is absolutely true. Then they say "the only safe medications are ones prescribed by a trusted medical professional and dispensed by a licensed pharmacist," ignoring the role the agency plays in making it harder to actually get these safer medications.