Follow The Money (Gwen Moritz Editor’s Note)

I thought “Follow the money” was advice Mark Felt, the associate director of the FBI long known as “Deep Throat,” gave the Washington Post’s Bob Woodward when his investigation of the Watergate break-in was stalled. It turns out that those words were written by novelist and screenwriter William Goldman, who won an Oscar for his adaptation of Woodward and co-author Carl Bernstein’s “All the President’s Men.”

Regardless of the origin, it is brilliant advice for any investigator. Who hired the Watergate burglars? Follow the money. Why did Bill Clinton pardon financier Marc Rich? Follow the money. Why did President Trump want to award next year’s G7 summit to his Trump National Doral resort that is typically less than half full in June? Well, you know.

Following the money also explains the opioid crisis and explains why it has been allowed to continue. Just this month, two more physicians have been charged by federal prosecutors in the Western District of Arkansas with running “pill mills,” and last week the Eastern District announced the arrests of 49 people involved in fentanyl trafficking.

I’ve haven’t lost any friends or family members to addiction, but that’s just luck; this particular epidemic is no respecter of persons. Anyone suffering from pain — from injury or surgery or a degenerative disease — is likely to be prescribed a miracle painkiller. Research conducted by the University of Arkansas for Medical Sciences found that the number of pills in the initial prescription predicted the likelihood of long-term use, even just a few days’ worth. Doctors may stop refilling prescriptions, but that doesn’t cure an addiction, so patients turn to illegal sources.

More than 700,000 Americans died of drug overdoses between 1999 and 2017, according to the Centers for Disease Control & Prevention, and every time I write about this topic I hear from more readers who have lost loved ones. During those 19 years, the number of annual deaths quadrupled, from fewer than 17,000 in 1999 to more than 70,000 in 2017.

Some 7 million Americans are believed to have become addicted to opioids, and about two-thirds of overdose deaths are associated with opioids.

OxyContin, the granddaddy of modern opioid painkillers, was introduced in 1996, just before the overdose death rate started to explode. Correlation does not equal causation, except in this case it does. As the Los Angeles Times revealed in 2016, OxyContin’s maker, Purdue Pharma, knew almost immediately that its claim of smooth, 12-hour pain relief — the only thing that made OxyContin superior to existing painkillers — was exaggerated. But unlike typical marketing puffery, this one had deadly consequences.

When patients complained that the relief wore off hours sooner than advertised, Purdue told doctors to prescribe stronger doses. Those stronger doses led to more addiction and more overdoses and more deaths.

This was known too, but not to the general public. Early lawsuits were quietly settled or dismissed on the grounds that OxyContin was a legal drug prescribed by licensed physicians. Evidence filed in those cases remained sealed year after year, until someone, alarmed by the mounting death toll, leaked them to the Times.

While the truth was under seal, similar products hit the market because, as it turns out, addictive drugs have a lot of repeat customers. Drugmakers were reaping billions — the Sackler family that owns Purdue Pharma offered to give up the entire company and its future profits as long as they could keep billions (reportedly between $4 billion and $10 billion) they have already socked away.

Money flows throughout the supply chain, which is why, federal prosecutors say, Dr. Robin Ann Cox of Rogers prescribed almost 215,000 oxycodone tablets between May 2018 and last month. And why Dr. Lonnie Parker of Texarkana prescribed some 1.2 million opioids to 1,500 patients in a two-year period — an average of more than 800 doses per patient.

A Virginia doctor was sentenced this month to 40 years in federal prison after a jury heard evidence that he prescribed opioids to every patient who visited his practice in the 19 months it was open. (I have to wonder why he took his chances with a jury. Richard Johns, the former Little Rock doctor who wrote fraudulent prescriptions for drug rings in Lonoke and White counties, took a plea and got just 10 years.)

Purdue Pharma and Teva Pharmaceutical Industries, an Israeli maker of generic opioids, agreed to pay the state of Oklahoma $355 million, and Johnson & Johnson is on the hook for more than $400 million in the same case. Johnson & Johnson agreed to pay two Ohio counties $20 million, while Teva and the three biggest pharmaceutical distributors this month settled a lawsuit with the Ohio counties for $260 million.

The Ohio case was considered a bellwether in holding opioid suppliers accountable. If so, there is about to be a lot more money to follow.

Email Gwen Moritz, editor of Arkansas Business, at GMoritz@ABPG.com and follow her on Twitter at @gwenmoritz.