The manufacturer, the distributor, the physician, the pharmacist, the drug dealer and the customer are all the chains on a link that creates the Opioid Epidemic. Nearly 500,000 people died from an overdose involving any opioid in 1999–2019. Whether through a flimsy prescription from a doctor or a packet of pills from a local drug dealer, people are dying.

It only takes five days to develop opioid dependence. So who do we hold legally responsible for letting these pills fall into the hands of an addict? Is it the dealer's hustle for money? A pharmacist neglecting to refuse drugs to an obvious abuser? Or is it the manufacturers whose deep pockets don't seem to care that they're putting an unnecessary excess of pain pills in big or small populated communities? Director Brendan Fitzgerald answers these questions in his documentary The Oxy Kingpins, which premiered this spring at the SXSW Film Festival.

The documentary follows a middle-aged drug dealer named Alex, who goes from selling weed to selling oxycontin. Moving his business to Miami, a well-known hotspot for the drug trade market, Alex and other drug dealers across the world were able to effortlessly get their hands on Oxy.

The Oxy Kingpins also pays attention to Alex’s drug supplier, Doug, who testifies to  Miami’s loose restrictions on Oxy distribution. He recounts buying himself an Oxy prescription with $200, driving 15 people to obtain Oxy prescriptions by complaining of pain to their doctor and traveling to different Walgreens throughout the day, and obtaining 10-20 bottles of Oxy directly from a pharmacist.

Pain Clinics

The term “pill mill” is used to describe a doctor, clinic or pharmacy that is inappropriate in prescribing and distributing prescription drugs.

In south Florida, so-called "pain clinics" (actually pill mills) were popping up everywhere. Pain clinics hire doctors to write thousands of Oxy prescriptions to patients a day.

Within just June to December 2008, 9 million Oxycodone pills were dispensed by only 45 South Florida doctors, many operating from these pain clinics. The pain clinics helped in the proportionate increase of pill distribution and opioid overdose deaths.

Calling Out the Fortune 500

Fortune annually releases its list of the 500 most profitable American companies, which in 2018 made over $12.8 trillion. On this list that year were the three major pharmaceutical companies McKesson, Cardinal Health and AmerisourceBergen.

In The Oxy Kingpins  Mike Papantonio is an American lawyer committed to helping victims of corporate wrongdoing. He has initiated lawsuits affected by the Oxy crisis. He hopes that by winning these lawsuits, cities will reinvest the money into extra police, EMTs and rehabs to help address the problem. Papantonio has called out these three corporate companies on the horrifying business plan that has fueled the opioid crisis.

He claims that pharmaceutical distribution companies distribute too many prescription pills, creating an excess glut. There was an oversaturation of pills in the market and not enough rules to avoid misuse. The extra pills not used by chronic pain patients have to go somewhere. So where do they go? The Oxy Express.

How Did We Get Here?

There had to have been a fault in the system to allow the volume of pills in the U.S. to increase from 8.4 billion in 2006 to 12.6 billion in 2012.

Carol Moore is a legal investigator for the Levin Papantonio Firm. After doing some digging, she found negligence with the care of pharmacies' threshold request. Every pharmacy has a monthly opioid limit that the distributor sets. A threshold request is when the pharmacy wants to raise that limit. Moore found that 200 threshold requests were being approved in one day. There are 30,000 units per pharmacy, so the threshold request must be written out individually 200 times. It is impossible for a human being to get this done all in one day, yet all 200 requests were approved.

The Controlled Substances Act calls for due diligence in the distribution of drugs. This example shows that requirement is not being met, and furthermore that pharmacies don't care about people getting addicted, but about the money in their pockets.

When distributors are given the right to distribute, there are rules that they must follow.

  1. They must report any suspicious activity, a large number of orders, or a pattern. Not only must they report it, but they must also correct it as well.
  2. They have the responsibility to design a system that calculates and follows suspicious orders. These orders must be timely reported and then fixed.

Washington State Attorney General Bob Ferguson released a press release that claims "McKesson, Cardinal Health and AmerisourceBergen have faced multiple actions by the DEA and others for failing to monitor and stop suspicious orders. McKesson has faced more than $160 million in fines, with the DEA determining that the company filled 'hundreds of suspicious orders placed by pharmacies participating in illicit internet schemes, but failed to report the orders to DEA.' Cardinal has been fined five times for a total of nearly $100 million since 2008, while DEA suspended AmerisourceBergen's distributor licenses in 2007 for failing to monitor and report suspicious orders adequately. The DEA noted that, between June 2008 and May 2013, one McKesson distribution facility "processed more than 1.6 million orders for controlled substances . . . , but reported just 16 orders as suspicious."

Sue for a Solution

These corporations know precisely the role they play in the opioid epidemic.

Despite the numerous lawsuits, these companies continue to rationalize the ugly truth of their crimes publicly. They want the public to place blame on the addicts and not the people over providing the drugs.

With laws in place that allow U.S. courts to destroy documents deemed "temporary," it is difficult to bring these company's crimes to the public eye. In some states, they can even seal or make confidential records that concern a public health hazard. But people like Papantonio will continue to fight a good fight against the corruption in the Opioid Epidemic.


Photo (C) THE OXY KINGPINS / The Young Turks, courtesy of IMDB