美国鸦片类药危机系列报道之四（2）--FDA与鸦片类药品批发商一直在斗争，近五年执法力度下降，死亡率大幅上升。
健康早知道157期
（以下中文由“美国针灸政治行动委员会”提供；英文原自美国“华盛顿邮报“）
2000年至2014年，全国处方止痛药过量死亡人数达165,000人。危机还促成了海洛因的后续流行，造成同期接近5.5万次的过量死亡事件，芬太尼已经杀死了数千人。美国阿片类药物的处方从1992年的1.12亿增加到2015年的2.49亿。
阿拉伯鸦片战争前线的几名DEA官员说，他们不能说服总部在疫情高峰期批准他们的案件。他们说，他们面对着负责批准他们的案件的律师Clifford Lee Reeves II，没有任何效果。 Reeves通过DEA发言人拒绝对此报告发表评论。
吉姆·格尔霍夫（Jim Geldhof）近四十年来一直在DEA工作，并且在里维斯（Dev）于2012年在DEA总部接手时，担任底特律总部外办事处的转移项目经理。
1月份退休的格尔霍夫（Geldhof）说：“就像他在一边，而不是我们的。” “我不知道他的动机是什么，但我们有人死亡。你会认为他会更具侵略性。我们正在流行一场大药片。“
在现场，Younker和其他DEA主管表示，他们越来越不信任Reeves，并对总部发生的事情怀疑。
“我们都有一种感觉，有人把他放在那里故意扼杀这些情况，”尤内克说。
担任俄亥俄州哥伦布市DEA集团主管的凯西·陈尼（Kathy Chaney）看到了这个问题。她负责俄亥俄州的35个县，并监督该机构在阿片类危机的零点，遏制诸如Chillicothe和朴次茅斯等城市的处方止痛药滥用的努力。
她说，她的一个案件反对一个经销商，多年没有采取行动。 Chaney表示，经验是特别困难的，因为她曾经和那些死于过氧化氢可乐酮和其他止痛药的儿童的父母见面。
“我们很失望，我终于告诉我的团队，”我们不会把任何案件送到总部，“Chaney说，他在2013年退休。”25年来，我从来没有见过这样的事情。这是我离开的原因之一。士气太可怕了我没办法做任何事情这几乎就像是看不见的。“
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约瑟夫·兰纳齐西（Joseph Rannazzisi）在2009年的参议院司法小组委员会听证会上表示，在DEA办公室进行了十年的工作，之后他被撤职，并于去年退休。 （Haraz N. Ghanbari / Associated Press）
2004年，由于日益增多的处方止痛药供应过量死亡人数的增加，DEA的转移办公室的领导人感到震惊。在线药店蓬勃发展，使购买强力止痛药如羟考酮和氢可酮容易。死亡人数达到一千五百七十七人，一年上升百分之十五。
痛苦管理诊所在全国各地开始爆发。 DEA导师调查人员很快就意识到，他们正在玩一个真正的Whac-a-Mole游戏。一旦他们关闭一个设施，就会出现另一个设施。
“人们正在死亡，”威廉J.沃克说，他是一名31年的DEA退伍军人，他在2004年和2005年领导转移办公室。
沃克在全国各地设立战术单位，调查医生，药剂师，经销商和制造商。
他说：“我们有一个多层面的威胁，这是一种非常紧迫的感觉。” “我把工作人员的热量提高了，我们开始追赶了。”
在2005年年底，国民警卫队准将沃克被迫上任，离开了办公室。取而代之的是他的顶级副手，约翰·兰纳齐西（Joseph Rannazzisi），一位街头聪明的纽约客，他在药学和法律学士学位。他已经开始他的职业生涯，作为DEA街头代理人，然后在底特律的主管，然后前往位于弗吉尼亚州阿灵顿的该机构总部的转移办公室的顶端。
Rannazzisi决定专注于药物的来源：药品批发商。
药物由普锐派药业等高调公司制造。他们依靠不太知名的分销商网络，其中一些也是跨国公司。经销商担任中间商，向药剂师，医院，疗养院和疼痛诊所发送数十亿剂阿片类止痛药。美国的阿片类药物市场年销售额达100亿美元。
在拥有DEA药品许可证的160万人和公司中，有数千家分销商，其中有三家是McKesson，AmerisourceBergen和Cardinal Health，占美国药品出货量的85％。这些公司共收集了约4000亿美元的年收入，为角色药剂师以及巨型医疗中心提供服务。
原文链接："period."
https://www.washingtonpost.com/investigations/the-dea-slowed-enforcement-while-the-opioid-epidemic-grew-out-of-control/2016/10/22/aea2bf8e-7f71-11e6-8d13-d7c704ef9fd9_story.html
From 2000 to 2014, 165,000 people died of overdoses of prescription painkillers nationwide. The crisis has also fostered follow-on epidemics of heroin, which caused nearly 55,000 overdose deaths in the same period, and fentanyl, which has killed thousands more. The number of U.S. opioid prescriptions has risen from 112 million in 1992 to 249 million in 2015.
Several DEA officials on the front lines of the opioid war said they could not persuade headquarters to approve their cases at the peak of the epidemic. They said they confronted Clifford Lee Reeves II, a lawyer in charge of approving their cases, to no avail. Through a DEA spokesman, Reeves declined to comment for this report.
Jim Geldhof had been with the DEA for nearly four decades and was serving as the diversion program manager in the Detroit field office when Reeves took over at DEA headquarters in 2012.
“It was like he was on their side, not ours,” said Geldhof, who retired in January. “I don’t know what his motive was, but we had people dying. You’d think he’d be more aggressive. We were in the throes of a major pill epidemic.”
In the field, Younker and other DEA supervisors said they grew to distrust Reeves and became suspicious about what was taking place at headquarters.
“We all had a feeling that someone put him there to purposely stonewall these cases,” Younker said.
Kathy Chaney, who served as the DEA’s group supervisor in Columbus, Ohio, saw the problem play out firsthand. She was responsible for 35 counties in Ohio and had overseen the agency’s efforts to curb prescription painkiller abuse in cities such as Chillicothe and Portsmouth, both at ground zero of the opioid crisis.
She said one of her cases against a distributor languished for years without action. The experience was particularly difficult, Chaney said, because she had been meeting with parents of children who had died of overdoses of oxycodone and other painkillers.
“We got so frustrated, I finally told my group, ‘We’re not going to send any cases up to headquarters,’ ” said Chaney, who retired in 2013. “In 25 years, I had never seen anything like it. It was one of the reasons I left. Morale was terrible. I couldn’t get anything done. It was almost like being invisible.”
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Joseph Rannazzisi, shown at a Senate Judiciary subcommittee hearing in 2009, ran the DEA Office of Diversion Control for a decade before he was removed from his position and retired last year. (Haraz N. Ghanbari/Associated Press)
In 2004, the leaders of the DEA’s diversion office became alarmed by the rising number of overdose deaths amid a growing supply of prescription painkillers. Online pharmacies were flourishing, making it easy to buy powerful painkillers such as oxycodone and hydrocodone. The death toll had hit 8,577, a 15 percent jump in one year.
Pain-management clinics began popping up around the country. DEA diversion investigators soon realized that they were playing a real-life game of Whac-a-Mole. As soon as they shut down one facility, another would appear.
“People were dying,” said William J. Walker, a 31-year DEA veteran who headed the diversion office in 2004 and 2005.
Walker set up tactical units around the country to investigate doctors, pharmacists, distributors and manufacturers.
“We had a multilayered threat, and there was a tremendous sense of urgency,” he said. “I turned up the heat on the workforce, and we started getting after it.”
Toward the end of 2005, Walker, a brigadier general in the National Guard, was called up for active duty and left the office. Taking his place was his top deputy, Joseph Rannazzisi, a street-smart New Yorker who held degrees in pharmacy and law. He had begun his career as a DEA street agent and then a supervisor in Detroit before working his way to the top of the diversion office at the agency’s headquarters in Arlington, Va.
Rannazzisi decided to focus on the source of the pills: the wholesale distributors of pharmaceuticals.
Drugs are manufactured by high-profile corporations such as Purdue Pharma. They rely on a lesser-known network of distributors, some of which are also multinational corporations. The distributors serve as middlemen, sending billions of doses of opioid pain pills to pharmacists, hospitals, nursing homes and pain clinics. The U.S. prescription opioid market generates $10 billion in annual sales.
There are thousands of distributors among the 1.6 million people and companies that hold DEA licenses to dispense drugs, but three of them — McKesson, AmerisourceBergen and Cardinal Health — account for 85 percent of the drug shipments in the United States. These companies, which together collect about $400 billion in annual revenue, supply the corner pharmacist as well as giant medical centers.
