ROBERT SIEGEL, HOST:
The federal government estimates that 80 percent of heroin users start by using prescription opioids first. That figure raises questions about doctors who prescribe pain medications, and a new Department of Justice task force is using data analysis to identify and prosecute among others these two groups – physicians who are writing opioid prescriptions at a rate that far exceeds their peers and doctors who have a high rate of patients dying within 60 days of receiving a prescription.
Well, here to talk with me about the work of the task force is Deputy Attorney General Rod Rosenstein. Mr. Rosenstein, welcome to the program.
ROD ROSENSTEIN: Thank you, Robert. Glad to be with you.
SIEGEL: What do you see? What’s the picture that’s emerging? Is it a few rotten apples in every part of the country? Is it a pervasive problem everywhere? Is it concentrated in poor areas? What would you say?
ROSENSTEIN: Well, the data are very troubling in terms of the overall trend. And the most significant number, of course, is the number of overdose-related deaths. And if you just look historically, in 2008 we had about 36,000 Americans who died of drug overdose, in 2015 it was 52,000, and in 2016 it was 64,000. And so one of the highest priorities of this Department of Justice and of this administration is to turn that around. We need to see that drug overdose death number start to fall. And that will be an indication that we’re succeeding in our goal.
SIEGEL: How do you understand the motives for overprescription? Are they financial? Is it driven by the belief that patients want to be pain-free and you should give them medicine? What’s at work? How do you think we’ve gotten to this point?
ROSENSTEIN: I think there are a lot of different causes of the problem. We have prosecuted a number of cases around the country involving doctors who are simply doing it out of greed, supplying patients who either have no medical need or people who they know are abusing prescriptions, sometimes not even using them themselves but getting the pills and then distributing them for profit to other abusers. There are some cases where doctors have differences of opinion about what medical necessity may be. Those aren’t cases we prosecute. But we try to educate doctors.
SIEGEL: Are you concerned that as you crack down on unethical doctors – or, for that matter, lawbreaking doctors – you risk sending addicts to other street drugs, to heroin or to illegal fentanyl and that that’s mostly what’s achieved by cracking down on the opioid prescriptions?
ROSENSTEIN: No, I do not think that’s a fair critique. I think that it’s critical for us to try to deal with the root cause of the problem here, which begins with the abuse and overuse of prescription medications. And I think that, you know, setting aside whether or not there’s any particular crackdown you certainly see a natural progression of abusers toward heroin and fentanyl. And it’s often driven not by law enforcement, but by cost because people, once they get addicted to these powerful and expensive medications, they find that they have a craving or a need for the drug that may – and they may not be able to afford it.
SIEGEL: On the topic of illegal opioids, this fall the Department of Justice charged two I believe Chinese fentanyl traffickers who were using the Internet to reach buyers in the U.S. and sending the drugs through the mail, actually. Have those people been arrested? Have they been apprehended?
ROSENSTEIN: I’m very glad that you asked about that because in two cases this summer we indicted Chinese nationals by name in the United States. Now, we do not have an extradition treaty with China, and therefore it’s not likely that they’re going to come to the United States to stand trial. It’s possible that they may travel outside China and be arrested and then brought to the United States. But there are a number of goals in returning those indictments, and one of them is that they may spur the Chinese to action.
And so we share our evidence with Chinese authorities. Although they may be unwilling to extradite those suspects to the United States, they may be willing to take action in China and hold those folks accountable. So that’s an important component of what we’re doing. We’re also working with Chinese authorities to try to get them to crack down on their own and prevent those Chinese labs from sending drugs that are killing Americans.
SIEGEL: Has there been any progress on that?
ROSENSTEIN: There has been some progress. The Chinese authorities have been receptive. I traveled to China myself in August and I asked them to consider scheduling all fentanyls as a class, which would enhance their ability to shut down the laboratories that are producing fentanyl. At the moment, many forms of fentanyl are produced legally in China and then shipped the United States, where it’s illegal. Our goal is to make it illegal in both places, which will enhance the likelihood of cutting off that supply.
SIEGEL: I’m just curious, though, if you were to venture an estimate of how many illicit fentanyl producers and traffickers there are in China who are selling to the U.S. – I mean, you’ve charged two of them. Are we talking about a couple of dozen people, hundreds of people? How big is the trade in China?
ROSENSTEIN: You know, I do not have a precise number, Robert, but it’s very large. And the reason is that, you know, much of the fentanyl that’s produced in China is produced legally there, although it’s illegal under United States law to ship it here. So that’s the challenge we face, is that there are people who are openly producing fentanyl in China. And we need the Chinese to support us by cracking down and making that illegal in their country.
SIEGEL: Deputy Attorney General Rod Rosenstein, thank you very much for talking with us.
ROSENSTEIN: Thank you, Robert, enjoyed being with you.
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