When Agencies Fail
Lives can be lost when agencies fall down on the job.
What happens when agencies fail in their jobs? People can die. The most dramatic example is the opioid crisis, in which a whole series of state and federal agencies fell short. The result has been hundreds of thousands of deaths.
The FDA was one of the prime culprits. It bought into a myth, carefully cultivated by the drug industry, that opioids were needed to treat an “epidemic” of chronic pain, with little likelihood of addiction when prescribed by doctors. It turns out that the evidence is equivocal on whether opioids are even effective when used over long periods. There was equally little evidence for the idea that prescription drugs aren’t an addiction problem. Long after the dire consequences had become clear, FDA refused to budge.
FDA wasn’t the only agency to fall down on the job. DEA and state law enforcement agencies were very reluctant to move against doctors running pill mills, not wanting to tangle with the medical profession. DOJ pulled its punches in prosecuting drug company executives. DOJ also drew back from enforcement actions against the big drug distributors, who were making too much money to want to report pill mills that were handing out opioid prescriptions like candy. State medical boards were essentially useless in dealing with doctors who had engaged in gross misconduct. The Substance Abuse and Mental Health Service Administration was only interesting in treating addiction, not preventing it. The National Institute on Drug Abuse avoided involvement in policy issues.
There were exceptions in all these agencies, officials who tried to take action. Largely, their actions were repressed, or they were unable to get a hearing. A CDC official first compiled the relevant statistics to document the opioid and tried to get attention to the problem from superiors and other agencies. It took until 2010 to get a CDC leader who was willing to deal with the issue. Even then, there was resistance or apathy from other agencies and from White House health advisors who were focused on other issues.
There were a number of reasons for these failures. The drug industry has enormous political clout and were adept in selling their ideas through all kinds of channels, using the playbook of deception first pioneered by Big Tobacco. The victims of the epidemic were drug addicts, who were often blamed for their addiction problems. The medical profession was considered exempt from external controls. Agencies had narrow images of their roles. The FDA didn’t think it was its business to worry about powerful drugs being dispensed to addicts. DEA was focused on drug dealers and cartels, not irresponsible doctors or heedless drug distributors. And on the industry side, everyone was making too much money to entertain serious scruples.
Ronald Reagan famously said, “Government is not the solution to our problem, government is the problem.” An avid advocate of deregulation, he pledged to ”to get the government off people’s backs.” The opioid crisis shows that this approach can go disastrously wrong.