AMERICAN PAIN by John Temple Page B

production of seventy thousand kilograms of oxycodone.
    Almost twenty times the amount manufactured just fourteen years earlier.
    Twenty times.
    Less than four tons compared to seventy-seven tons.
    And it wasn’t just oxycodone. Between 1996 and 2007, the DEA had nearly quadrupled the production of hydrocodone, allowed manufacturers to produce almost ten times the amount of fentanyl, and hiked the quota of hydromorphone by four and a half times.
    Despite its impact on public health, the quota-setting process was conducted in secret. Each pharmaceutical company applied to make a certain amount of a given controlled substance each year, but the DEA wouldn’t reveal how many pills each wanted to produce. That was considered to be a trade secret. Then, the companies and the DEA had negotiation meetings, the content of which was restricted from the public record. The DEA then set quotas based on “expected need.” Essentially, the only information the DEA revealed each year was the total amounts of each drug requested by the entire industry and the total amounts the DEA allowed them to produce. The DEA said it would be unfair to the pharmaceutical companies to reveal how many pills the individual companies wanted to manufacture.
    Amid the uproar over painkillers and all the strategies invoked to curb abuse and overprescription, few officials or politicians seemed to consider simply reducing the supply. The idea had been brought up seriously only one time, in 2001, when the country was first becoming aware of Oxy-Contin abuse. The DEA had asked Purdue to restrict OxyContin prescribing to physicians trained in pain management, and Purdue balked. In response, during a congressional subcommittee hearing, DEA administrator Donnie R. Marshall said he was considering “rolling back those quotas to 1996 levels.” The pain industry said this would be a disaster, that prices would skyrocket and pain patients would suffer. Purdue didn’t budge, and the quota-cut idea vanished when new administrators came in.
    Cutting back the quotas wasn’t a radical idea. In fact, the DEA had combated drug waves by reducing quotas before. In the 1970s, when speed pills were popular, the DEA cut the quota of amphetamines by 90 percent, and the illicit market dried up. A decade later, sedative-hypnotics like Quaa- ludes swept across the country, and the DEA cut the quota of the ingredient methaqualone by 74 percent, which effectively erased the problem.
    Now, prescription narcotics were killing far more people than speed or sedatives, but the government was signing off on large increases in the supply each year. It baffled previous DEA administrators like Gene Haislip, former head of the DEA’s Office of Diversion Control. Haislip had been in charge during the methaqualone quota reduction. It hadn’t been easy to buck the pharmaceutical industry, but, as he told a reporter shortly before his death: “You’ve got to have some kind of principles.”

    Golbom had come to the conclusion that a $7 billion industry had been built on marketing and bad science.
    By 2008, the United States was awash in prescription narcotics, enough for every American adult to pop a 5-milligram Vicodin every four hours for nearly a month. According to the International Narcotics Control Board, the US had consumed 83 percent of the global supply of oxyco-done in 2007. And 99 percent of the world’s hydrocodone. No one believed that the US was in that much more pain than the rest of the world.
    Golbom could see how it had happened. It wasn’t the 1970s or the 1980s any more. Pharmaceuticals were the most profitable industry in the country, and the pharmaceutical lobby was by far the biggest in Washington. *
    He’d never considered himself prone to conspiracy theories. But now he had his own pet belief that he couldn’t stop thinking about. He’d been an unwitting tool of the conspiracy for years, until it had infiltrated his home. When he came across an advertisement for