av 女同 止疼药疫疠愈烈，药企巨头麦克森无辜照旧有罪？
发布日期：2024-11-02 05:11 点击次数：188
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止疼药疫疠愈烈，药企巨头麦克森无辜照旧有罪？
Erika Fry | 2017-07-19 21:30
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In January, the Department of Justice announced that McKesson had settled, for $150 million, civil claims that from 2008 to 2013 the company had failed to warn the DEA about the large number of suspicious orders of highly addictive painkillers it had shipped to certain parts of the country. The penalty is the largest of its kind against a wholesaler, greatly exceeding a $44 million settlement the Justice Department reached with Cardinal Health in December on similar charges. And McKesson had run afoul of the feds before. In 2008 the distributor settled similar allegations for $13.25 million. According to the terms of its recent deal with the Justice Department, McKesson will operate under a heightened compliance agreement and the watchful eye of an independent monitor for the next five years. (McKesson and Cardinal Health both say they follow relevant laws and that they resolved claims to move beyond disagreements and work more closely with the government.)
On top of the suit by McDowell County, McKesson is now facing a lawsuit brought in 2016 by West Virginia Attorney General Patrick Morrisey. That suit alleges that the distributor failed to identify, report, and stop the shipment of suspicious orders of opioids in the state from 2007 to the present in violation of West Virginia’s controlled substances act. McKesson is fighting the charges in court.
The other two members of the big three in January settled long-running lawsuits with the State of West Virginia over alleged violations, though neither admitted wrongdoing. Cardinal Health agreed to pay $20 million to the state and issued this statement: “While the company denies the state’s allegations, Cardinal Health recognizes that the epidemic of prescription drug abuse is a multifaceted problem driven by addiction and demand.” And AmerisourceBergen agreed to pay West Virginia $16 million. Says Al Emch, an attorney who represents AmerisourceBergen in West Virginia, “Our job is to create a safe, dependable system to take these drugs that we purchase from the manufacturer and deliver them securely.”
The settlements and pill-dumping allegations have put the previously low-profile wholesaling industry in the hot seat just as public and political outrage over the opioid epidemic reaches a fever pitch. But it’s hardly the first time questions over the role of distributors in the pharmaceutical supply chain have been raised. Indeed, the industry has sparred with the DEA for much of the past decade about the role it should play in monitoring the delivery of drugs.
Today, as the crisis continues to spiral, McKesson and its peers feel misunderstood and unfairly targeted. As they see it, they’re unsung heroes in the American health care system—the quiet, efficient, reliable machine that gets essential medications where they need to go. They offer elaborate reasons for why they’re not to blame, which boil down to “Hey, we’re just middlemen.”
功令部1月文告，因2008年到2013年间麦克森向部分地区运输多量极容易上瘾的止疼药可疑订单，却未向好意思国缉毒局警示，已达成1.5亿好意思元的息争条约。这笔罚金为有史以来金额最高，此前的12月功令部与卡地纳健康也就类似指控达成息争条约，金额为4400好意思元。而且麦克森此前就触犯过联邦法律。2008年麦克森因类似指控被罚1325万好意思元。麦克森与功令部刚刚达成的条约自大，接下来五年麦克森将严格盲从息争条约，而且要经受寂静监督。（麦克森和卡地纳健康都暗示将盲从量度法律，化解争议高出分别，与政府部门保持密切合作。）
除了麦克谈威尔县的指控，麦克森还濒临2016年西弗吉尼亚首席稽查官帕特里克·莫瑞斯提交的诉讼。该指控称2007年于今，麦克森未能识别、文告并退却向西弗吉尼亚运输的止疼药可疑订单，违犯了该州管制药品法。麦克森已出庭应诉。
本年1月三大药企中另外两家也与西弗吉尼亚州息争了漫长的诉讼，不外两家企业都未承认有犯法行为。卡地纳健康欢喜支付2000万好意思元，并发表了以下声明：“本公司否定指控，卡地纳健康认为处方药蹧跶是由成瘾和需求催生的问题，要从多方面琢磨。”好意思源伯根欢喜向西弗吉尼亚支付1600万好意思元。在西弗吉尼亚代表好意思源伯根的讼师阿尔·艾姆什暗示，“咱们的责任即是打造安全可靠的系统，确保从药企正当购买药物，安全投递后合理服用。”
随着公众和政界声讨蹧跶药品的声浪飞扬，不论是息争条约照旧药品推销的谴责都导致此前低调的药品批刊行业心猿意马。不外量度药品经销商在药品供应链中的脚色磋议并非第一次。事实上，当年十年里就药品监督职责，该行业与好意思国缉毒局一直有摩擦。
如今随着危急愈演愈烈，麦克森跟同业们也益发嗅觉受到诬蔑和抵抗允的谴责。药企认为我方是好意思国医疗系统中的无名硬人，不为人知又高效可靠地将必要的药品送到需要的场地。企业回想出好多不该承受职责的事理，说到底即是“嘿，咱们只是中间东谈主辛苦。”
图表自大了对于蹧跶止疼药危急的问卷探询恶果。
The business of opioids undoubtedly presents a tricky balancing act. “It would certainly be simpler if we didn’t sell them anymore, but the reality is there’s a need,” says John Hammergren, McKesson’s longtime CEO, who stresses his company wants to do the right thing. “The reason we distribute these products is that there are legitimate patients that need these medicines and who are being prescribed these medicines by well-informed, well-intended doctors who are caring for these patients.”
In truth, the opioid crisis is a story of colossal, collective failure—an epidemic that no one fully understood until it was too late. The medical establishment didn’t grasp—in some cases, didn’t want to grasp—the destructive potential of the drugs it was giving out to manage pain until they began to wreak havoc. Pharmacists were not as curious as they should have been about doctors doling out prescriptions or patients filling them. Despite warning signs, the DEA consistently raised the national quotas for prescription opioids until 2013. Some argue that when the agency did choke the supply, the epidemic simply got worse, as addicts turned to heroin.
But it’s also true that the drug distributors, including McKesson, played a role in the proliferation of pain pills across America. To better understand how that came to be—and the impact of the company’s behavior on some of the country’s hardest-hit communities—Fortune delved deeply into McKesson’s history with opioids. We interviewed drug enforcement officials, industry executives, prosecutors, and average West Virginians battling the crisis on the front lines.
One thing is clear: It certainly wasn’t all McKesson’s fault. But you can’t have a drug epidemic without a distributor.
There is a favorite motivational saying at McKesson. It’s displayed prominently in the company’s headquarters and over the entrances to the floors of its distribution centers (“DCs”): “It’s not just a package, it’s a patient.”
The slogan serves to humanize the never-ending process of moving pills across America. Seven days a week the company’s 68,000 employees work to efficiently distribute millions of essential medications. Those drugs run the gamut from temperature-sensitive chemotherapy agents to aspirin.
Most of the action actually happens at night, when the company’s 28 DCs really come alive. During those hours, the floor looks like a miniature amusement park, with red and blue tote bins zipping along an elaborate, multilevel conveyor track. Workers report at 7 p.m. to begin fulfilling the day’s orders, picking medications and depositing them into the corresponding tote. The process is optimized for efficiency: McKesson has planned and timed every human motion required in the picking process.
There are some drugs only certain people can pick. Those include controlled substances, which are locked, monitored, and stored in DEA-regulated spaces. The most addictive drugs, like prescription opioids, are held in a so-called vault and packaged in specially sealed plastic bags by background-checked workers under the gaze of several cameras.
刻下情况下，止疼药生意无疑很难均衡。“不卖最浅易，但试验是确乎有东谈主需要，”长久担任麦克森首席实践官的约翰·哈默格伦暗示，他一直强调麦克森但愿作念正确的事。“咱们之是以分发这些止疼药物，是因为好多病东谈主对药品有合理需求，开具会诊的医师也都是专科常识丰富且出于好意，都是为了病东谈主琢磨。”
事实上，蹧跶止疼药危急是一场弘远的集体失败，没东谈主着实了解危急的本色，比及了解却为时已晚。医药企业不解白，天然有时也不肯意了解止疼药可能的危害，直到蹧跶残忍才察觉。医师开药病东谈主拿药时，药剂师并未保持必要的警惕。天然出现各种警示信号，但好意思国缉毒局一直在提高处方止疼药药物的名额，直到2013年才罢手。也有东谈主暗示，若是缉毒局简直阻断供应情况只可更糟，上瘾的东谈主会转向海洛因。
好意思国之是以止疼药推广，麦克森之类药品经销商确乎有包袱。为了进一步了解近况成因，也为了试验企业行为对某些受创最严重地区的影响，《钞票》杂志深切研究了麦克森与止疼药类药物的历史纠葛。咱们采访了禁毒官员、行业高管、稽查官，还有在一线对抗危急的西弗吉尼亚住户。
不错明确的是，细目不都备是麦克森的错。但离开药品经销商也不能能出现蹧跶推广。
麦克森里面有个激励东谈主的说法稀薄流行。公司总部，还有经销中心进口上方都能看到：“药品不是等闲的货色，每一份背后都是病东谈主的期待。”
有了这个说法，麦克森在全好意思马不断蹄地运输药物仿佛也多了情面味。全公司68000名职工一周七天高效地将数百万药物送往各地。药品种类高贵，从热敏化疗药到等闲的阿司匹林都包括。
大部分分发责任都在夜间进行，全公司28个经销中心晚上格外吵杂。责任时间，地上堆满多样药物，仿佛袖珍的主题公园，红色蓝色的运输箱在复杂多层的输送轨谈上蜿蜒行进。一般晚上7点工东谈主们开动上班，处理应日订单，拣取药物舍弃在相应的运输箱中。整个经由都为了高效优化：麦克森对拣取处理药品每个技艺上职工每个动作花的时候都作念了精准规划。
某些特定的药物惟有特定职工材干拣取。其中就包括管制药品，一般在上锁且密切监控的环境中完成，存放在受缉毒局监管的区域。针对类似处方止疼药之类最容易上瘾的药物，拣放都在所谓的保障库里，用挑升的密封塑料袋存放，量度责任主谈主员都经过布景探询，现场还有好几台监控。
麦克森28个经销中心之一。处方止疼药存储在挑升的“保障库”中，责任区周围都有监控，负责处理药品的工东谈主都要经过严格的布景探询。图片提供：麦克森公司。
Most of McKesson’s DCs serve thousands of pharmacies. The company’s unmarked delivery trucks begin rolling out at midnight to ensure the medications make it to their destination by morning. The company has a 99.996% accurate fill rate, meaning its customers almost always get exactly what they order.
McKesson is in many ways a massive corporation hiding in plain sight. The company is headquartered in a tall gray office tower in downtown San Francisco. It’s called McKesson Plaza, but chances are many of the city’s growth-obsessed tech bros don’t even know the nearly $200 billion company is there. (Periodically there are lively protests at the building, but they’re typically aimed at Sen. Dianne Feinstein, a fellow tenant.)
Its low profile suits the company just fine, but it does mask the corporation’s long and rather extraordinary history.
McKesson was founded 184 years ago in New York as a small Manhattan shop supplying drugs to ships docked in the harbor. A couple of decades later, its sales territory ranged across 17 states, which McKesson served via covered wagon. The company soon started making drugs, tonics, and tinctures, and it became better known as a manufacturer. For a time, during Prohibition, it was owned by a bootlegger. Later it distributed everything from alcohol to pasta to WD-40 before turning its focus exclusively on health care.
麦克森大多数经销中心要作事数千家药房。送货车莫得标识，老是深宵起程以确保药品朝晨可投递。送货准确率高达99.996%，即绝大多数客户都能收到准确的药品。
从好多方面来看，麦克森是家低调行事的大公司。总部在旧金山市中心一座灰色高楼里，天然大楼名字叫麦克森广场，但很可能旧金山好多眼里惟有增长的科技大佬都不知谈这里有一家营收近2000亿好意思元的大公司。（大楼隔壁常常会有抗议，不外一般都是冲着同在楼里办公的究诘院戴安娜·范斯坦。）
低调没什么不好，但确乎障翳了麦克森悠长却光辉的历史。
麦克森成立于184年前的纽约，其时是曼哈顿一家小药店，主要向停在口岸的船只卖药。几十年之后，麦克森已在17个州出售药品，送货用具是大篷马车。很快麦克森开动坐褥药品、补药和酊剂，而且算作制造商的名气越来越大。禁酒令时期（1920年-1933年，译者注），掌控公司的是个私酒贩。自后公司经销商品种类高贵，从酒类到通心粉到WD-40金属保重剂都触及，自后才将要点放在医药产品上。
图片提供：麦克森公司
After an accounting scandal in the late 1990s, Hammergren, a then 40-year-old of modest upbringing from small-town Minnesota, was named co-CEO. He took sole possession of the job in 2001. And under his leadership the company has been one of the biggest beneficiaries of the vastly expanding health care economy. During his tenure, McKesson has grown from a $30 billion business, ranking No. 38 on the Fortune 500, to a nearly $200 billion operation. He has done so in part by insinuating McKesson, once just a supply-chain functionary, more deeply into the business of its customers. McKesson now manages cancer clinics, consults for hospital pharmacies, and makes technology used in managing pharmacies.
Hammergren has been rewarded handsomely for this success—some might say obscenely. He has consistently been one of America’s highest-paid executives. Over the past 10 years, according to company filings, Hammergren has taken home $639 million in total compensation.
The skyrocketing price of pharmaceuticals has lifted the fortunes of the wholesalers in recent years. But the distribution business is incredibly competitive. And that’s particularly true when it comes to winning the business of independent pharmacies. These are the mom-and-pop stores off which the industry tends to make the highest margins—and which have featured prominently in the narrative of West Virginia’s opioid epidemic.
Raj Masih is doing what he does every Thursday morning: talking opioids on the radio. It’s just after 9:30 a.m., and he’s in the studio at WELD 960, an AM talk radio station in a barely there town called Fisher. It’s about a 20-minute drive from Masih’s home in Petersburg, another speck on the map in the Potomac Highlands region of West Virginia. This rural, eight-county area in the mountains of the state’s eastern panhandle is the sort of place where everyone knows your name—especially if you’re Raj Masih.
These days, as the director of the Potomac Highlands Guild’s anti-stigma program, Masih (pronounced “Ma-SEE”) clocks a lot of miles, leading trainings and speaking at town halls about addiction. He recently opened the area’s first substance abuse clinic in Petersburg, where he runs dozens of meetings per month. He periodically briefs state politicians on his work, and this year he got a federal grant to study prescription drug monitoring programs.
But before all that, Masih, 53, was the local doctor who got hooked on pain pills and, in 2010, went to prison for prescribing too many opioids. His case led to others, including the federal investigation of the Petersburg, W.Va., pharmacy that filled his many prescriptions—and ultimately of the distributor that supplied the pharmacy: McKesson.
上世纪90年代末出现管帐丑闻后，彼时年仅40岁的汉默格伦担任连结首席实践官。汉默格伦来自明尼苏达一座小镇，为东谈主情切。2001年起追究担任首席实践官。在他攀附下，公司作陪医药行业快速发展获益巨大。他任职时间，麦克森营业收入从300亿好意思元范畴增长到近2000亿好意思元，在《钞票》500强中名挨次38。他的规划理念是冉冉浸透径直面对客户的业务，而不再只当供应链上一个技艺。麦克森面前还料理癌症诊所，向病院药房提供护士，为药品料理开发本事。
随着公司奏凯，汉默格伦也赢得崇高的酬报，薪酬号称天价。他一直是好意思国收入最高的高管之一。凭据当年10年公司报表，汉默格伦总收入达6.39亿好意思元。
频年来药价接续上扬也对公司事迹造成提振。不外经销业务竞争也很热烈，尤其在争取寂静药房方面。所谓寂静药房一般都是家庭规划，利润率常常最高，而在西弗吉尼亚药品蹧跶方面作用十分要道。
拉吉·马辛正类似每周四的旧例：在电台磋议蹧跶止疼药。时候是早上刚过9:30，无线调频WELD 960，播送站位于简直不存在的小镇菲舍尔。菲舍尔距离拉吉在彼得斯伯格的家开车约20分钟，亦然西弗吉尼亚州波多马克高地上另一个小场地。这里位于州东部，狭长地带里散布着80个乡村县城，基本上东谈主东谈主都相互相识。天然类似拉吉·马辛的名东谈主更是大名鼎鼎。
近来算作波多马克高地反愤慨技俩主宰，马辛跑了不少路，主导培训技俩，在镇里发表量度上瘾症的演讲。最近他在彼得斯伯格开设了第一个药物蹧跶诊所，每个月都要主理几十场会议。他向州官员规则文告责任，本年还就处方药品监管研究技俩赢得了联邦基金。
在此之前，53岁的马辛曾是当地的医师，随机堕入止疼药上瘾后， 2010年因开过量止疼药坐牢。他的案子连累甚广，自后因当地药房对他的处方都备放任，联邦政府对西弗吉尼亚彼得斯伯格的药房开展探询，终末还查到当地药房的供应商：麦克森。
图片提供：尼古拉斯·拉普
Today’s subject is naloxone. Also known by the brand name Narcan, it is a medication used as an antidote for opioid overdoses. An analysis in February by the West Virginia Health Statistics Center found that at least 818 people had died of drug overdoses in 2016 in the state. That was 13% more than in 2015, when West Virginia’s overdose death rate led the nation, with 41.5 cases per 100,000 people, according to the Centers for Disease Control and Prevention. (The next highest rate was in New Hampshire, with 34.3, followed by Kentucky with 29.3.) In response to the crisis, last year the West Virginia legislature mandated that all pharmacies in the state carry naloxone and dispense it to certified users, but many pharmacies were refusing to do so.
The host of the show, Steve Davis, wonders aloud whether naloxone enabled addicts, by reducing the threat of fatally overdosing, and he concedes that he’s sympathetic to pharmacists who don’t want to carry it for fear of being blamed later.
Masih, who’s wearing jeans and a white button-down, counters that the resistance by pharmacists is another example of stigmatizing addicts. “Some have an attitude, ‘These people did this to themselves. Just let them die. Why do we want to bring them back from an overdose?’” he says. The same pharmacies, he points out, have no qualms about carrying highly addictive painkillers such as oxycodone. Says Masih, “We need a change of community mindset.”
如今磋议的焦点是烯丙羟吗啡酮，也叫纳洛酮，一种用来颐养蹧跶止疼药上瘾的药物。本年2月西弗吉尼亚州医疗数据中心一项研究发现，2016年至少818东谈主死于用药过量。这一数字比2015年增长了13%。据疾病防治中心府上，西弗吉尼亚用药过量耗损比例也高于世界平均水平，每10万东谈主就有41.5例。（其次是新罕布什尔州，每10万东谈主有34.3例耗损，肯塔基州为29.3例。）为了冒昧危急，昨年西弗吉尼亚强制条件全州悉数出售纳洛酮的药房只卖给持证用户，但好多药房暗示斥逐。
节目主理东谈主史蒂夫·戴维斯高声质疑，天然纳洛酮能裁汰过量用药的要挟，但不会导致新的上瘾。另外他暗示怜悯不肯出售纳洛酮的药房，因为不知谈以后会不会受到谴责。
马辛穿戴牛仔裤和有衣领扣的衬衫，他暗示药剂师的魄力是导致上瘾受愤慨的典型例子。“有些东谈主会想，'上瘾是这些东谈主自找的。让他们去死好了。为什么要帮他们走出蹧跶药物的泥潭？'”他说。马辛指出，持愤慨魄力的药房却对出售极容易上瘾的止疼药，举例氧可酮少量负罪感都莫得。马辛暗示，“整个社区的想维神色都应该调度。”
西弗吉尼亚州彼得斯伯格，马辛在鲁斯·亨德里克药品蹧跶资源中心。图片提供/影相：马特·艾希
Masih didn’t know what to expect when he moved his family from Texas to this corner of West Virginia in 2000. He relocated there to run the emergency room in a local hospital, a small brick building that shares a hill with a Civil War memorial site. The son of an Indian surgeon and a British homemaker, Masih stuck out in Petersburg, a town of 2,500. He had a taste for flashy cars—his fleet included a Porsche, a Hummer, and a Mustang convertible—and thrill-seeking hobbies like IndyCar racing and hunting with an AK-47.
But even if he was something apart, Petersburg suited Masih. He convinced his brother Ravi to move there as well. He coached youth soccer. He earned a reputation as a good and caring doctor.
In 2007, the Masih brothers opened an urgent care clinic atop a tanning salon in neighboring Moorefield. It was strategically close to the area’s major employers—a Pilgrim’s Pride turkey plant, an American Woodmark factory—and it was outfitted with all the trappings of an ER, from surgical suction pumps to a trauma bay. There was even a helipad out back.
There was just one problem with this American dream. Masih was addicted to hydrocodone, the powerful opioid in pain medicines like Vicodin and Lortab. His addiction began in 2004, when he hurt his back in an IndyCar wreck. When he couldn’t find someone to cover his ER shift the next day, he turned to the hospital’s supply room and took a sample of the drug. He felt amazing on it—not only unburdened of his physical pain, but also of the fatigue and burnout he typically felt on the job. “Everything evaporated,” he says.
He kept taking the samples, only in higher doses and more frequently, and while he knew he was on a slippery slope, he told himself he was in control. He vowed each day that he’d quit the next. But then, inevitably, he found a reason to take the drugs again. When he did manage to “quit,” he experienced the horrible and debilitating sensations of withdrawal within a few hours. He quickly ran through the hospital’s samples and began writing prescriptions for his friends and family members—all of which he’d get filled himself at the area’s various pharmacies.
2000年马辛全家从得克萨斯搬到西弗吉尼亚小镇时，并未预见到自后的变故。刚搬过来时他在当地病院的急诊室责任，病院范畴不大，一座砖石建筑，跟南北斗争哀痛馆同在一座小山上。马辛父亲是印第安医师，母亲则是英式主妇，一家东谈主就此在惟有2500东谈主的彼得斯伯格假寓。以前马辛很喜欢豪车，他有一辆保时捷，一辆悍马，还有一辆马自达敞篷车。他喜欢追求刺激的行为，举例印地赛车和用AK-47打猎。
即便偶有不得意之处，但总体来说马辛喜欢在彼得斯伯格的活命。他劝兄弟拉维也搬了当年。他还教小一又友踢足球。别东谈主看来他是个遵法且顾惜东谈主的医师。
2007年，马辛的兄弟在隔壁的穆尔菲尔德开了一家急诊诊所兼日光浴沙龙。地址距离当地最主要的老板都很近，包括火鸡肉厂Pilgrim’s Pride，一家好意思国Woodmark产物厂，而且诊所里配备了全套开采，从手术吸泵到创伤处理室一应俱全。后院甚而还有直升机停机坪。
这个好意思国梦距离已毕惟有一个问题。马辛对氢可酮上瘾了，氢可酮是一种强效止疼药，举例维柯丁Vicodin和Lortab。他上瘾是从2004年开动的，一次印地赛车中他背部受伤。他发现找不到东谈主替第二天的急诊班氢可酮，就去病院库房吃了一剂。吃完嗅觉稀薄好，不仅体格的痛苦消亡不见，责任中常常困扰的窘况疲困感也一扫而光。“悉数苦闷无影无踪，”他说。
自后他一直暗暗吃药，剂量越来越大，也愈加频繁。他也深知我方在铩羽，告诉我方要节制。每天他都发誓第二天戒掉，但到了第二天总能找到事理连续吃药。有时能限定住“戒掉”，没几个小时就会嗅觉极其倒霉而且体格很病弱。很快他就吃结束病院的库存，于是开动频繁给一又友和家里其他东谈主开处方，从当地各种药房买药，开来的药天然都是我方吃了。
在彼得斯伯格开办的诊所里，奋力开脱上瘾的拉吉·马辛（穿白衬衫面对镜头者）参加匿名的药物成瘾互助会。图片提供/影相：马特·艾希
His secret and the shame of it exhausted him. “I’d be driving and thinking, ‘Where am I going to get my next script from?’ I so badly wanted to be out of it.”
Even while trapped in this cycle of addiction, Masih continued to practice medicine. Indeed, on hydrocodone, he felt at the top of his medical game, energized and hypercompetent. He also became very lax in doling out powerful narcotics like the painkillers that had him so hooked. He’d send patients away with a prescription rubber-stamped with the words FILL AT JUDY’S. “My threshold for prescribing was very low,” he tells me. “I prescribed recklessly. I did.”
It all caught up with him in August 2009, when a SWAT team burst into Masih Medical and handcuffed him to a chair while they searched his files. He was hauled to jail where in a few days’ time he says he contemplated suicide, found God, and resolved to get clean. By the time he pleaded guilty to one count of misprescribing a controlled substance, he felt free. He was sentenced to 48 months in prison.
Masih might have been ready to start over, but the U.S. Attorney’s Office in the Northern District of West Virginia hadn’t quite let go of his case. They thought it might lead to something bigger.
The office, which is based in Wheeling, a sleepy and picturesque town just south of the Ohio border, had for years been aggressive in going after the bad actors involved in the region’s opioid crisis. But it seemed to make little difference. The epidemic raged on.
好意思妙和羞辱感让他饱受折磨。“开车的时候都在想，‘从哪能多开一张处方？’我简直很想开脱那种气象。”
一边深受药瘾折磨，马辛还连续行医。在氢可酮作用下，他老是嗅觉将医学捉弄股掌之上，精神百倍而且超等颖慧。开处方时他的模范也变得十分缩小，常常空闲给别东谈主开止疼药之类强效药物。他常常空闲地在处方上盖上“去JUDY’S开药”。“我开处方的模范稀薄低，”他告诉我。“极其空闲，简直。”
寄明月 裸舞事情终于在2009年8月透露。一群特警闯进马辛的诊所，把他铐在椅子上，搜查了悉数文献。他被关进监狱，没过几天就想自尽，受到天主感召之后下决心戒除药瘾。法院宣判他欠妥开具管制药品处方的罪名成赶紧，他反而嗅觉安稳。刑期是48个月。
马辛想明晰了要从新开动，但西弗吉尼亚周北部稽查院办公室并未浅易放下这个案子。他们以为这条陈迹背后没准能钓到大鱼。
稽查院办公室位于惠灵市，一座慵懒且征象如画的小镇，就在与俄亥俄州交壤的南部。好多年来这个办公室一直积极跟踪蹧跶止疼药危急背后的黑手。但见效不大。危急仍在推广。
西弗吉尼亚州贝克利隔壁的煤矿原址。图片提供/影相：马特·艾希
To Alan McGonigal, an Assistant U.S. Attorney in the district’s civil division, the rampant abuse of prescription drugs required a more holistic strategy, one that he had often used in prosecuting health care fraud: Find the gatekeepers. Someone had been filling Masih’s many illegitimate scripts, and some company had been sending more and more drugs to rural West Virginia. “We had to stop the flow,” he says.
That strategy wasn’t unique to Wheeling. The DEA had begun contemplating how it regulated the broader pharmaceutical supply chain back in the mid-2000s as the online pharmacies flourished and the opioid epidemic took root. The DEA viewed distributors—the nation’s pharmaceutical fire hose—as key to its efforts to stop criminal misuse of pain pills. By law, in fact, it’s something distributors are required to help prevent.
That law is the decades-old Controlled Substances Act, which requires wholesalers like McKesson to maintain a system to detect and prevent “diversion,” or the nonsanctioned use of prescription drugs. Distributors are required to report any “suspicious orders”—those of unusual size, frequency, or deviating from normal patterns—to the DEA.
阿兰·麦格尼格尔是当地民事法庭助理稽查官，他认为冒昧处方药苟且蹧跶需要全盘政策，亦然他常常用来处理医疗诓骗的步骤：找到守门东谈主。有些东谈主任由马辛罪犯开具处方，还有些企业将越来越多药品送往西弗吉尼亚。“要阻断罪犯链条，”他说。
这项策略绝非仅在惠灵适用。本世纪初随着采集售药兴起，蹧跶止疼药开动推广，好意思国缉毒局就琢磨过若何监管边境医药供应链。缉毒局认为药品经销商是世界医药行业的要道，要退却止疼药蹧跶问题就得抓经销商。事实上，凭据法律条件药品经销商本就应该提供协助。
量度法律即是已稀有十年历史的管制药品法案，条件麦克森之类的批发商成就系统检测并贯注出现药品销售“偏离正轨”，或是未经许可使用处方药。出现“可疑订单”经销商要向好意思国缉毒局文告，包括订单范畴、频次非常，或是有违平方形态。
西弗吉尼亚州麦迪逊，麦克森向Larry’s免下车药房运输药品。据《查尔斯顿邮报》探询，2007年到2012年间Larry’s是州内卖止疼药最多的药房之一。图片提供/影相：马特·艾希
But until 2005, these rules had never really been enforced. Distributors generally didn’t identify suspicious orders and the DEA didn’t investigate them, says Larry Cote, a former lawyer for the agency who now represents the industry at the firm Brady & Quarles. Instead, wholesalers were in the habit of submitting monthly “Excessive Purchase Reports”—thick files that sometimes included every order a wholesaler had processed during the period.
With prescription drug abuse spreading, the agency attempted a reset. In the fall of 2005, the DEA’s Office of Diversion Control launched its “Distributor Initiative,” an effort to engage with wholesalers over their legal responsibilities and the severity of the country’s diversion problem. Then, in 2006 and 2007, the DEA sent three separate letters reminding distributors of their obligations. Noting that the country faced epidemic levels of prescription drug abuse, the letters also contained more explicit expectations that registrants “know their customers”—i.e., engage in due diligence to ensure pharmacies and dispensers were aboveboard—and that they report and refrain from shipping suspicious orders.
This new guidance was not well received by the distributors. As the industry saw it, this sort of investigative work fell beyond their purview: They were in the business of moving FDA-approved drugs that had been prescribed by licensed physicians to DEA-registered pharmacies. Tasking them with determining whether or not a particular customer or order was legitimate was, in their view, asking them to meddle in medical decision-making. Plus, distributors don’t have full visibility of a pharmacy’s orders of controlled substances; they only know what they deliver.
There were plenty of other complaints that the DEA’s guidance was unclear or too vague—claims that proved to have some merit. In 2016, DEA administrator Chuck Rosenberg conceded the agency had been “opaque” in dealing with the wholesalers.
By the time Masih was in prison, the DEA had begun aggressively ramping up enforcement. And by the agency’s book, Masih’s criminal overprescribing hadn’t happened in a vacuum. He’d been aided and abetted, as they saw it, by the pharmaceutical supply chain. More specifically, his accomplices had been a third-generation mom-and-pop outlet on Main Street in Petersburg called Judy’s Drug Store—as well as the pharmacy’s primary supplier, McKesson.
That was the argument that criminal prosecutors and DEA agents made to McGonigal in May 2012. McGonigal agreed to look into it.
The Petersburg area has a few pharmacies to choose from. But most of Masih’s pain patients went to Judy’s, where he also stopped some mornings to pick up medical supplies. The relationship seemed suspicious to McGonigal (as did the fact that Judy’s had recently opened a second outlet in Moorefield close to Masih’s clinic). The prosecutor was convinced that something wasn’t right about the small-town pharmacy.
“There is nothing you don’t know about what is going on in these counties if you live there,” says McGonigal, who’s trim, mild-mannered, and occasionally reveals a dry wit. “The idea that this pharmacy didn’t know what Dr. Masih was about held no water with me.”
但2005年之前，轨则并未着实实践。前讼师拉里·科特暗示，经销商不会检测可疑订单，缉毒局也不会去探询。拉里曾为Brady & Quarles讼师事务所责任，如今该事务所代表医药行业。药品经销商只是每月上交一份“过量购买叙述”，常常是厚厚一份，有时即是浅易把当月收到的悉数订单列一列。
随着处方药蹧跶四处推广，缉毒局开动行动。2005年秋天，好意思国缉毒局贯通料理办公室启动了“经销商行动”，主要为了强调批发商的法律包袱，明确药品蹧跶问题的严重性。之后的2006年和2007年，缉毒局又单独发了三封信辅导经销商应付的包袱。信中不仅指出世界濒临处方药蹧跶推广的严重问题，还明确提倡了期许，但愿量度单元“切实了解客户”，举例遴选尽责探询神色确保药房和药剂师正确行事，一朝发现可疑订单要实时文告和加以限定。
但经销商对新轨则并不十分买账。行业认为，这种探询责任超出了合理范围：药品经销商的责任即是将食物药品料理局批准的药物送到在缉毒局注册的药房，经由事业医师开处方给病东谈主。在他们看来，让药品经销商判定某个客户或某个订单是否正当，等于让他们介入临床有磋商。此外，经销商对药房的管制药品使用也不会都备掌捏，只知谈送货情况。
还有好多东谈主牢骚缉毒局的轨则太不解确或太朦胧，好多牢骚其实很有利想。2016年，缉毒局主宰恰克·罗森伯格承认对批发商的处理有些“朦胧”。
马辛在监狱里服刑，缉毒局正紧锣密饱读地吩咐实践盘算推算。凭据缉毒局的档案，马辛的蹧跶药物处方并非捏造发生。缉毒局认为有东谈主协助，也有东谈主怂恿马辛。最明确地说，马辛的协谋包括彼得斯伯格生意街上链接三代家庭规划的药店Judy’s，另外一个即是该药房东要供应商，麦克森。
这即是2012年罪犯检举东谈主和缉毒局差佬向麦格尼格尔文告的内容。麦格尼格尔批准详查。
彼得斯伯格没几家药店。马辛大部分需要止疼的病东谈主都会去Judy’s开药，他我方也常常早上当年取药。这种关系在麦格尼格尔看来有些可疑（另外值得怀疑的是Judy’s最近在穆尔菲尔德新开了一家店面，离马辛的诊所很近）。稽查官嗅觉小镇上这家药店有些不合劲。
“在这种小镇上住，细目什么事都知谈，”马格尼格尔说。他形体修长，本性和睦，偶尔有些冷幽默。“要说这家药房不知谈马辛作念了些什么，我可不信托。”
西弗吉尼亚州彼得斯伯格的Judy’s药房，马辛好多处方都在此开药。2014年，Judy’s因欠妥配药遭联邦政府指控，后支付200万好意思元息争。图片提供/影相：马特·艾希
In December 2014, Judy’s reached a $2 million civil settlement with the Justice Department for claims of improper dispensing. The pharmacy, which did not admit to any wrongdoing, also agreed to a stricter reporting arrangement, under which it still operates. A lawyer for Judy’s says the store’s pharmacists believed they were filling legitimate prescriptions, and points out that no DEA enforcement action was ever taken against the pharmacists.
The original Judy’s remains in business today, operating as it has since 1965, out of a brick building in the heart of Petersburg. (Its Moorefield location has closed.) On a recent Friday afternoon when I stopped in, an elderly woman stood ready at the cash register in front of a row of neatly hung plastic bags, all filled with prescription medications ready for pickup.
Having dealt with Judy’s, the next target for McGonigal and his team was the McKesson distribution center, three hours away in Landover, Md., which delivered the bulk of the pharmacy’s drugs.
The Landover facility had separately landed on the radar of a DEA investigator named Lindsey Malocu. Malocu, who worked out of the agency’s Washington Field Office, had noticed something strange about McKesson’s suspicious-order reporting in her district—there hadn’t been any. Nothing about Judy’s or any of the other hundreds of pharmacies it serviced, even as the amount of prescription opioids the company delivered to the region climbed. Zero suspicious orders would be unusual for any wholesaler. But it was especially true for McKesson, the country’s biggest drug distributor. (Upon a more careful check of its records, the DEA later found a handful of reports it had missed.)
The conspicuous absence of suspicious-order reports harked back to an earlier investigation of McKesson. That incident had involved six districts where McKesson had allegedly shipped excessive volumes of hydrocodone and other controlled substances to tiny mom-and-pop customers that filled orders for online pharmacies. Those suspicious orders had gone unreported by McKesson. The company settled those claims with the DOJ for $13.25 million in 2008 without admitting wrongdoing. But the DEA’s acting administrator at the time, Michele Leonhart, had offered a brutal condemnation of the company’s conduct: “McKesson Corporation fueled the explosive prescription drug abuse problem we have in this country.”
The 2008 settlement agreement also dictated that McKesson develop an effective system to ensure it didn’t do so in the future. So that year the company launched its Controlled Substance Monitoring Program (CSMP). Under this three-tier system, each of McKesson’s pharmacy customers were assigned monthly threshold levels for their controlled substance orders. Orders at the threshold would block the order and trigger a review process. If the reason for reaching the threshold level was compelling, McKesson would supply the drugs and in some cases raise the threshold; if not, the matter would be passed to a regional compliance officer. If that officer deemed it suspicious, the order would be kicked up to McKesson’s corporate compliance team. If they also judged it suspicious, the company would then report the order to the DEA.
When Malocu examined the DEA’s records for the Landover DC, however, it was clear to her that McKesson’s compliance system had fallen down on the job. In July 2011, she requested customer files for 20 or so suspect pharmacies that had landed on her radar. That winter, McKesson apparently realized there was a problem; in a short period of time, the Landover distribution center filed 318 suspicious orders with the DEA that covered the previous months and weeks. The government considered that number to be relatively few for a distribution center of that size and the untimely filing to be something like an admission of guilt.
McGonigal and Malocu didn’t know it at the time, but across the country, there was a similar investigation taking shape. This one involved McKesson’s Aurora, Colo., distribution center, one of the facilities that had also been at the center of the company’s 2008 settlement. The Colorado facility had drawn the attention of prosecutors again in March 2012, when it alerted the DEA to a handful of suspicious orders related to one pharmacy—the only suspicious orders the facility had reported since 2009. (For more on the Colorado investigation, read Fortune's story here.)
Both the Landover and Aurora facilities had shipped lots of controlled substances. Neither had done much to determine whether the orders were “suspicious,” according to the government, or to call the DEA’s attention to them when they were.
The compliance files were especially revealing. They showed the company’s casual approach to administering its compliance program. When pharmacies hit thresholds, they typically breezed through the review process. Customers offered vague, flimsy reasons for needing more oxycodone supply—“increase in foot traffic”; “more business”—and they’d get it.
2014年12月，Judy’s因欠妥配药与功令部达成200万好意思元的民事息争条约。Judy’s未承认有犯法行为，不外欢喜盲从更严格的文告轨制，面前仍在实践。Judy’s的一位代理讼师暗示药剂师都认为悉数配药行为都是正当的，还指出缉毒局莫得遴选行动针对药剂师。
Judy’s最老一家店成立于1965年，直到今天仍在营业，是彼得斯伯格中心一座小砖房。（在穆尔菲尔德的店面仍是关闭。）最近有个周五我途经药店，看到一位老年女性站在收款台后，面前是一滑陈设整都的塑料袋，里面都装好了药等东谈主来取。
处理完Judy’s之后，麦格尼格尔和团队下一个指标即是麦克森的经销中心，距离马里兰州兰都弗车程三小时的经销中西负责向Judy’s送货。
其实缉毒局探询员林德赛·马洛库早就贵重到麦克森在兰都弗的经销中心。马克森在缉毒局驻华盛顿办公室责任，之前就发现麦克森的可疑订单文告有些奇怪，因为一个都莫得。从来没提过Judy’s，也没提过其他几百个送货的药房，天然送往该地的处方止疼药数目接续攀升。对任何批发商来说，一笔可疑订单都莫得也不太平方。但麦克森真这样干了，照旧世界最大的药品经销商。（自后经过仔细检查纪录，缉毒局发现了好些漏掉的叙述。）
麦克森可疑订单叙述的显著缺失让东谈主想起之前一次探询。其时探询内容是麦克森向六个地区的袖珍家庭客户运输过量氢可酮和其他管制药品，客户作事对象是采集药店。麦克森并未叙述量度可疑订单。2008年麦克森跟功令部达成1325万好意思元的息争条约，但莫得承认罪犯行为。但其时缉毒局代理负责东谈主米歇尔·雷昂哈特强烈谴责了麦克森的行为：“麦克森公司鼓吹了世界处方药蹧跶问题的爆发性增长。”
2008年的息争条约中还条件麦克森打造灵验的防控系统，确保以后不再犯相通的乖谬。是以当年麦克森启动了管制药品监控技俩（CSMP）。三层系统中，麦克森每类客户每月购买管制药品都有相应模范。若是高出模范，订单会遭屏蔽而且激勉审核经由。若是导致高出模范的原因很迫切，麦克森会提供药品况且在特定情况下会培植模范；若是莫得合理原因，该订单会转往当地的合规官员。若是合规官认为订单可疑，订单将转回麦克森的企业合规团队。若是该团队相通认为订单可疑，麦克森将文告给缉毒局。
不外，马洛库审查缉毒局处理兰都弗经销中心的案例时发现，很显著麦克森的合规系统没起到作用。2011年7月，她条件麦克森提供20分傍边量度可疑药房的府上。当年冬天，麦克森显著也相识到出了问题；很短时候里，麦克森兰都弗经销中心就向缉毒局提交了318份可疑订单，设想之前的月份和星期。政府则认为对于如斯大范畴的经销中心，可疑订单的数目太少了，而且急遽中补交显得仿佛承认有问题。
麦格尼格尔和马洛库其时都不知谈，但其时世界其他场地也在进行类似探询。另整个位于科罗拉多州奥罗拉，麦克森在当地的经销中心亦然2008年息争条约中提到过的。2012年3月科罗拉多经销中心有一次引起稽查官的关注，其时该经销中心向缉毒局文告了一些可疑订单，都是对于吞并个药房，这亦然2009年以来公司初度提交可疑订单。
不论在兰都弗照旧奥罗拉，两地经销中心都发出了不少管制药品。政府叙述自大，两家中心都没想过订单“可不能疑”，也没辅导缉毒局贵重。
合规文献表示了好多信息。文献自大麦克森料理合规技俩魄力很恣意。药房触及模范后，经销中心老是很容易就能通过审核经由。客户需要氢可酮的事理常常很朦胧，而且绝不能信——“不错培植客流量”；“增多生意”等。他们就这样拿到了药。
图片提供：马特·艾希
For McGonigal, the matter was simple. “They didn’t care enough about the issue,” he says. “I’m sure there was no malevolent desire to flood the street with narcotics. There was just too much emphasis on sales numbers and not enough with keeping an eye on suspicious ordering.”
McKesson calls those unfounded allegations and says the company complies with laws and regulations. Furthermore, a spokesman says that “at no point has there ever been a direct correlation between the sale of controlled substances and incentive compensation for McKesson sales personnel.”
The investigations of McKesson were multiplying. By the summer of 2014, prosecutors in 12 districts around the country were looking into possible violations of the Controlled Substances Act at McKesson distribution centers.
According to McGonigal, the government’s conservative estimate is that over a roughly four-year period McKesson had failed to report tens of thousands of suspicious orders in those districts. The question was how big the penalty should be. Prosecutors thought a large penalty was needed to send a message, and the $150 million figure accomplished that. “Recidivism was a real problem,” says McGonigal. “Not only with them but with others. If they’re not going to learn from a $13 million settlement, they have to learn from something, right? Dollars and suspensions and heightened compliance arrangements are the only way it’s going to get done.”
In the aftermath, McKesson has once again overhauled its monitoring programs. And by all accounts the company is redoubling its efforts on compliance.
Leading the effort has been Gary Boggs, who spent four decades as a DEA agent before joining McKesson in 2013 as the senior director of regulatory affairs, in the midst of the government’s investigations into McKesson. There are now some 40 individuals dedicated to McKesson’s controlled substance monitoring program, and many of them, like Boggs, came from an enforcement background.
The company has made significant investments in technology, such as more sophisticated analytics systems to identify suspicious orders. Under Boggs’ leadership, it has started doing deeper, more rigorous due diligence—a change that can be traced through a trail of lawsuits involving McKesson customers who suddenly had their controlled substances cut off in 2013 and 2014.
The settlement process has had a way of bringing McKesson and the DEA together. Both sides say they’re working together productively now. (DEA Diversion Control has also made a concerted effort to engage far more with the industry in the past few years.)
In 2015, Hammergren decided that it was time for McKesson to wade into broader policy conversations about the opioid epidemic. While some may see McKesson as part of the problem, Hammergren believes that his company, given its position in the health care system, might have insights to help with the solution. So last year he formed a task force of several dozen employees, and developed a white paper that McKesson is now circulating in Washington. The document offers six recommendations. Among them: the development of a National Patient Safety System, a data-driven, real-time tool to help pharmacists and physicians to identify patients most at risk of misusing medications.
Odd as it may seem, Masih thrived in prison. At the medium-high security facility in Glenville, W.Va., he quickly became known as “Doc,” and his fellow inmates regaled him with stories of how they’d once scammed physicians into prescribing them oxycodone and other narcotics. Masih was blown away by the variety and ingenuity of their methods, and he obtained permission from the Federal Bureau of Prisons to write a textbook on how drug diversion happens. (His son, who sent him research, and his cell mate, a onetime heroin dealer, both earned author credits.) By the time Masih was released in 2014—early, for good behavior—the team had written a second manual on how prisoners abuse drugs in prison.
When he’s not doing his addiction work, Masih devotes time to a company he started with his friend Wade Rohrbaugh to develop a product he calls “Raptor.” The system, which involves biometrics, electronic health records, and video-recording eyeglasses, is designed to help physicians prevent prescription drug diversion. Right now he’s shopping Raptor to medical boards.
Masih thanks his brush with the law for saving his life—in more ways than one. Not only did he kick opioids, but he was also able to manage a personal health crisis that might have killed him if he’d been using. Last year, Masih learned he had a life-threatening aneurysm. (His father had suffered a ruptured aneurysm and was disabled for the rest of his life.) Masih’s primary symptom was terrible headaches, which he says he never felt when he was on pain meds. In July 2015, he was one of the first patients to undergo a radical, not-yet-FDA-approved, minimally invasive surgical procedure at the West Virginia University hospital with a device called a WEB Aneurysm Embolization System.
Healthy and sober, Masih says he’s “thrilled and grateful to be given a second chance to work in this field helping many people suffering from the disease of addiction.”
Back in McDowell County, Sheriff West is waiting for some good news. Since the county filed suit against the distributors, a number of counties and towns in West Virginia—and a few entities beyond, such as the Cherokee Nation, in Oklahoma—have followed with their own lawsuits. The big three are fighting those, too, and dispute the merits of the claims.
Questions are also being asked about the practices of McKesson and its peers by Congress, where the dire public health crisis is increasingly top of mind. In May, the House Energy and Commerce Committee launched an investigation into the wholesaler industry’s “pill dumping” practices in West Virginia. The big three each received letters of inquiry, which they were required to answer by June 8.
West isn’t sure the lawsuits will accomplish much, but at least he tried something to counter the opioid scourge. “I’m hoping and praying we can alleviate some of the suffering, not only in West Virginia, but everywhere across the nation just about now,” he says. “It’s a major epidemic, and it’s got to be treated that way.”
A version of this article appears in the June 15, 2017 issue of Fortune.
对麦格尼格尔来说，事情很浅易。“他们不够喜欢，”他说。“我敢细目没东谈主奸险地但愿大街上止痛药泛滥。企业有时即是太追求销售获利，忽略了可疑订单。”
麦克森方面则暗示此类谴责都是莫须有，声称公司盲从悉数法律法例。此外，麦克森一位发言东谈主还暗示“在麦克森，管制药品销售从来莫得跟销售东谈主员激励径直挂过钩。”
对于麦克森的探询一直在加码。到2014年夏天，全好意思12个地区的稽查官都在探询麦克森是否存在违犯《管制药品法》的行为。
麦格尼格尔暗示，据政府保守意想，近四年时候里麦克森在12个地区瞒报的可疑订单数目达数万笔。问题只剩下会罚若干。稽查官认为罚金应该天价材干起到显著的警告作用，1.5亿好意思元应该可疑。“一犯再犯是着实的大问题，” 麦格尼格尔暗示。“不仅麦克森，别家也一样。若是1300万好意思元罚金没让他们吸取训导，那就得给点别的处罚，是吧？惟有高额罚金、歇业和严格盲从轨则材干根底处理问题。”
自后，麦克森从新梳理了一遍监控技俩，而且传闻在盲从轨则方面加倍奋力。
负责具体责任的是加里·博格斯，2013年加入麦克森之前曾在好意思国缉毒局责任四十年，在政府对麦克森启动探询时间担任监作事务高等主任。面前麦克森的管制药品监管技俩已有40名责任主谈主员，其中好多都跟博格斯一样具有监管部门布景。
此外麦克森也在本事方面进入巨大，举例完善的分析系统以识别可疑订单。在博格斯攀附下，麦克森开动进入更深切也更积极的尽责探询责任，不错一系列跟麦克森客户量度的诉讼看出来，量度客户都是2013年到2014年间管制药品短暂遭麦克森断供的。
息争过程也促进了麦克森跟缉毒局的合作。两边都暗示如今合作比拟顺畅。（当年几年里缉毒局药品蹧跶管控办公室与行业的互助稀薄深切。）
2015年，汉默格伦认为麦克森应该就止疼药蹧跶问题积极与监管层张开对话。有些东谈主可能认为麦克森只是问题一部分，但汉默格伦认为鉴于麦克森在医疗系统中的攀附地位，应该为处理问题孝敬力量。是以昨年他调派几十名职工成立责任组，草拟了一份白皮书，主要在华盛顿刊行。文献提倡六点建议。其中包括打造世界病患安全系统，该系统基于数据，匡助药剂师和医师实时辩认可能存在蹧跶药物风险的病东谈主。
可能有些奇怪，但马辛在监狱里过得很好。监狱位于西弗吉尼亚格伦威尔，监控级别为中高等，狱中东谈主们叫他“医师”，其他囚犯跟他讲了好多若何骗医师开出氧可酮之类处方药的故事。东谈主们为了弄药无所无谓其极，让马辛买妻耻樵，自后他赢得好意思国联邦监狱局批准撰写了药物蹧跶若何发生的讲义。（他的犬子提供了好多研究材料，他在狱中的牢友之前是海洛因估客。两东谈主都在书中赢得了作家致谢。）2014年马辛因发扬考究提前获释，其时马辛跟团队仍是写出了第二本手册，内容是犯东谈主在狱中蹧跶药物。
平时不作念宣传注重药物上瘾责任时，马辛的时候都花在跟一又友韦德·罗哈波夫合作开设的公司上，主要产品叫“猛禽”。“猛禽”是一套系统，其中包括生物识别、电子病历，还有可录制视频的眼镜，主要用来匡助医师幸免开出蹧跶药物的处方。如今他正向医学委员会推介“猛禽”。
马辛对照章服刑心存戴德，不单是是因为救了他一命。他不仅戒除了药瘾，而且了若是他连续蹧跶药物，可能仍是因病丧命。昨年马辛发现罹患致命的血管瘤。（马辛的父亲曾因动脉瘤冲破导致自后一直瘫痪。）马辛主要的症状是剧烈头痛，他之前吃止疼药时从来没嗅觉过。2015年7月，他在西弗吉尼亚大学从属病院经受了微创手术，名叫WEB血管瘤栓塞系统。这是一种全新的手术，尚未赢得食物药品监督局批准，马辛是首批经受手术的患者。
如今马辛健康且澄莹，他暗示“能重获契机在对抗药品蹧跶边界责任稀薄欢腾，也充满戴德，今后要奋力匡助更多深陷上瘾症的东谈主们。”
再回到麦克谈威尔，警长韦斯特正等着好音书。自从县里提交了对药品经销商的诉讼，西弗吉尼亚好几个县和镇，还有一些外地的机构也随着提交了诉讼，举例奥克拉荷马州的切诺基部落。三大经销商也在忙着应诉，均暗示指控莫得凭据。
随着全球医疗危急日益严重，议会也在扣问麦克森和同业的行为是否欠妥。本年5月，众议院动力和生意委员会启动探询，珍视查药品经销商在西弗吉尼亚的“药品推销”行为。三大经销商都已收到质询函，条件6月8日之前恢复。
韦斯特服气诉讼会收到很大成效，至少他在奋力对抗药品蹧跶之灾。“此刻我满怀但愿，也忠心祈祷减轻东谈主们的祸殃，不仅为西弗吉尼亚东谈主，更是为好意思国各地的东谈主们。”他暗示。“这是一场大型疫疠，值得严肃对待。”
本文另一版块刊登于2017年6月15日出书的《钞票》杂志。（钞票汉文网）
译者：Pessy
审稿：夏林
量度阅读：av 女同
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