By Taylor Knopf
U.S. Attorney General Jeff Sessions stopped in Raleigh on Tuesday to discuss the rising number of opioid overdoses and deaths, and what his office is doing to curb the crisis.
He said law enforcement is making a number of large fentanyl and heroin seizures, as well as drug dealer arrests across the country. He announced several changes and new tools to combat the drug addiction problem.
For example, he’s placed experienced prosecutors in “opioid hot spot” areas, including North Carolina, to investigate and prosecute opioid-related health care fraud cases.
Sessions noted that treatment, prevention and law enforcement efforts will all see funding increases.
“The budget agreement called for major increase in opioid funding,” he said, referring to the bill passed by Congress and signed into law by President Donald Trump in March. “I suppose most of that we will see will go to treatment, but also will go to the prevention campaign.”
In terms of prevention, Sessions defended the “classic” approach, used by President Ronald and Nancy Reagan, known as “Just say no.”
“People thought that was something silly and that it wouldn’t work,” Sessions said. “They still try to say it didn’t work. But it did work.
“In 1981, when I became United States attorney, half the high school seniors admitted using an illegal drug. Twelve or 13 years later that had dropped by half. Murder rate dropped by half also during that period of time. So what we do makes a difference.”
However, addiction recovery advocates in North Carolina say the “Just say no” campaign was not that effective, as do many others.
Real risk factors
Experts say the simple campaign doesn’t address the real risk factors that lead to substance abuse, such as genetics, family history, childhood trauma and social inequities.
“If ‘Just say no’ had worked out, prisons would not be filled with people with substance use disorder and our morgues would not be full of people who died from overdoses,” said Donald McDonald, executive director of Addiction Professionals of NC.
He said the age of first use is crucial.
The National Center on Addiction and Substance Abuse at Columbia University found that about 28 percent of kids who drink alcohol or use substances before the age of 15 end up with a substance abuse disorder. That drops to about 4 percent for those who waited until they were 21 or older to start.
“If we are going to make a huge impact on prevention, we need to be mindful of creating a culture that doesn’t celebrate alcohol or other drugs and give adolescents the opportunity to engage in more after-school activities, pursue other interests, find healthier peers,” McDonald said.
Chris Budnick, executive director of the treatment center, Healing Transitions in Raleigh, said he grew up in the 1980s right in the middle of the “Just say no” campaign and it didn’t work for him.
He said pediatricians and physicians should be screening for substance use disorders in patients with a family history of addiction the same way they screen for risk of diabetes or any other chronic illness.
“‘Just say no’ doesn’t work for underdeveloped adolescent brains,” he said. “They have trouble with impulse control.”
McDonald emphasized the need to invest in adequate and robust treatment, on demand, for every community.
“The other part of prevention is promoting policies that restrict access [to substances] and also supporting policies that change culture,” he said. “The culture we have celebrates alcohol and drugs. And the policies make access very easy for any 14-year-old.”
Law enforcement collaboration
Sessions announced that Tuesday morning, law enforcement across West Virginia, Ohio and Michigan seized enough fentanyl to kill a quarter of a million people.
He said the Department of Justice charged 90 defendants and dismantled a multi-state drug trafficking ring that had allegedly been operating for 20 years. It took 200 local, state and federal officers to pull it off.
Sessions stressed the importance of this type of collaboration between law enforcement agencies to combat the opioid epidemic.
The Drug Enforcement Agency is now collaborating with 48 attorneys general, including North Carolina’s Josh Stein, to share prescription drug information with one another, Sessions said.
The DEA collects about 80 million transaction reports from drug manufacturers every year containing information such as distribution and inventory numbers, Sessions explained.
The DEA will share that with the attorneys general offices, and in turn, the states will provide their own data from their various prescription drug monitoring programs.
Opioid fraud indictments
This kind of data is crucial for catching rogue physicians and pharmacies, Sessions said. He noted a doctor from Robeson County who was found guilty of accepting cash in exchange for writing prescriptions for names supplied by a drug dealer who was selling the pills on the street.
Before introducing Sessions, Robert Higdon, U.S. Attorney for Eastern District of NC, announced that Donovan Dixon, a doctor working in Lumberton, was convicted by a jury on Monday after a four-day trial.
Higdon noted that four of the top oxycodone prescribing pharmacies in the state were in Lumberton, which eventually led prosecutors to discover Dixon was driving those high prescription numbers.[Note: Dixon surrendered his medical license in 2016; complaints about his practice were made to the NC Medical Board in 2015.]
“This case is indicative of the problem we face and the serious approach we are taking here in this district,” Higdon said.
Session said the DOJ is using a new data analytics tool called the opioid fraud and detection unit to detect opioid-related health care fraud.
Additionally, he’s placed a dozen veteran prosecutors in what he called “opioid hot spot” districts to conduct these types of investigations. One is assigned to the middle district of North Carolina, another in the eastern district of Tennessee.
The opioid fraud prosecutor in Tennessee has already indicted seven people running a pain clinic. The indictment says that about 700 of the clinic patients are dead, in no small part due to the drugs they were prescribed by the clinic.
“The president has been very explicit to me about it… He wants to see this end,” Sessions said. “And we do believe and know that a lot of addiction in America come from opioid prescription drugs.”
He said the president’s goal is to cut opioid prescriptions by 30 percent over the next three years.
One way to do this is to limit opioid manufacturers. Sessions announced that the DEA will begin reducing the number of opioids a company can produce if there is evidence pills are being diverted or misused.
“We are going to be more aggressive in that effort,” Sessions said. “The DEA will also be able to use other information when determining what those quotas should be.”