So the safe consumption discussion got me thinking: what has the DOJ, and especially the DEA, done to address the crisis they claimed will be "worsened" by the introduction of a proven public health measure? Stand by for some news
So in thinking about what has the DEA done to address the overdose crisis, the tally is...not very positive. It does appear that the agency has done far more harm than good. Here's my take, in tomorrow's @nytopinion nytimes.com/2018/09/17/opi… … w @JeremiahGoulka. Thread to follow
To be fair, the DEA never got a fighting chance. A brainchild of Nixon’s War on Drugs, it was mostly a bigger, badder version of its fed predecessors whose mission was to dismantle drug trafficking at home and abroad. See @mattpembleton's excellent history umass.edu/umpress/title/…
Also, DEA is a product of its authorizing leg. The Controlled Substances Act, subsequent War on Drugs legislation, and the UN Single Convention on Narcotic Drugs prescribe its mission and many of its "regulatory" tools. In other words the legal edifice of "drug control" is broken
That said, difficult to find much positive to say about ever-growing investments in DEA for the last 4 decades. At home, DEA orchestrated programs like Operation Pipeline, which fueled egregious racial profiling practices we're still living with today nytimes.com/2000/11/29/nyr…
DEA w support of the USDOJ and its state counterparts also pursued decades-long jurisprudential campaign to erode civil liberties, resulting in the so-called Drug War exception to Americans' vital constitutional rights, esp Fourth Amendment and franchise aclu.org/blog/national-… 
Many of these tactics the DEA championed and funded disproportionately targeted people of color, resulting in gaping racial disparities in drug arrests, convictions and sentencing, civil forfeiture seizures, and every other metric of criminal justice involvement
But DEA isn't just a Drug War machine. It also holds the reigns of the production volume, wholesale distribution, prescription, and retail sale of controlled substances--EVERY element of the Rx supply chain. (After a drug is approved, FDA's authority to regulate it is limited)
This is important b/c DEA's mission is to balance adequate medication supply for health care and research purposes w "controlling" unauthorized use and diversion. DEA has summarily failed ON BOTH COUNTS. And it's #NotJustOpioids: benzos, amphetamines, etc. Rx is OUT of control
Enter the OD crisis. If you believe, as many do, that the crisis was "caused" by greedy manufacturers, negligent distributors, and "over-prescribing" by rogue docs, well those are all the DEA's province. It controls the volume of opioid production, distribution, and prescription
(FWIW my take is that over-utilization of opioids is more of a symptom of our broken health care system, which along w other structural factors, positions opioids as "quick fix." It's not just Bad Pharma ajph.aphapublications.org/doi/10.2105/AJ… cc @nabarund @DanCiccarone @AMJPublicHealth)
Recent investigative work by @LennyMBernstein exposed pharma's role in "muzzling" the DEA from going after key distributors. But DEA actions pharma is alleged to have thwarted would have been too little too late. Opioid production, distribution skyrocketed for A DECADE before
Once you've flooded the market w Rx opioids, as had been done for years, simply turning off the faucet as some in the DEA claim to have been blocked from doing, produces more harm than good. Instead, a calibrated response, involving quality pain and addiction treatment is needed
So DEA's policies and practices substantially shaped the initial "prescription drug crisis." But responses to that initial crisis made matters worse. This included enforcement actions, like cracking down on "pill mills." When you close a pill mill, what happens to its customers?
But DEA regulation also helped re-shape the crisis, to our collective detriment. Ex: rescheduling hydrocodone from Schedule III to Schedule II was a regulatory move that slashed prescriptions jamanetwork.com/journals/jamai… but was also implicated in pushing users toward the black market
Around 2010, multiple push/pull factors, including those championed by DEA, caused growing numbers of users to move to the black market. And we mustn't forget that the very EXISTENCE of a thriving black market for pills and cheap heroin is an indictment of DEA's failed strategies
As heroin use and overdose surged, DEA and its law enforcement partners doubled down on interdiction. This pressure, together with overarching economic incentives of a rapidly-growing market brought in a massive influx of illicitly-manufactured fentanyl
This DIDN'T have to happen. DEA oversees all controlled substance prescriptions, but it has special authority over methadone and bupe prescribing to treat opioid addiction. These medications slash OD risk by 50-80%, offering our best hope to bending the curve of the OD crisis
But the DEA (along w SAMHA and state regulators) exercises its oversight of methadone and bupe programs in ways that create huge access bottlenecks and deserts. Instead, it could have long used its discretion to rapidly expand access, as now done in VT na01.safelinks.protection.outlook.com/?url=https%3A%…
In all, w the DEA at the helm, US was ill-equipped to weather the worsst drug crisis in its history. But far from hyperbolic to say that, by repeatedly making wrong turns, DEA caused the crisis to spiral out of control. How we get out of this mess? That's for another thread /FIN
