Who’s responsible for the opioid epidemic? Doctors or pharmaceutical companies?

 In the annals of “60 Minutes,” we have rarely come across a doctor like Florida physician Barry Schultz Prosecutors say he wantonly prescribed and sold massive quantities of highly addictive opioids As we told you last September, Schultz was sentenced to 157 years for his role in fueling the most devastating public health crisis of the 21 century Last year, more Americans died of drug overdoses than in the entire Vietnam War. While Schultz ended up in jail, Mallinckrodt, the pharmaceutical company that flooded the nation with tens of billions of opioid pills, paid a relatively small penalty The question now being debated in Congress and in federal court is: who is responsible for the opioid epidemic? The doctors who prescribed the pills or the opioid manufacturers and distributors who supplied them? Dr Barry Schultz is an inmate at Florida State Prison, where he will likely be incarcerated until the day he dies  In this, his only interview, Schultz said he wanted to go on camera to explain that he has been singled out unfairly  Barry Schultz: I’m a scapegoat. Bill Whitaker: You’re a scapegoat. Barry Schultz: I mean, I was one of hundreds of doctors that were prescribing medication for chronic pain  Bill Whitaker: The– prosecutor called you a killer. Barry Schultz: I see myself as a healer… In my mind, what I was doing was legitimate Doctor, you prescribed a thousand opioid pills to a pregnant woman. In the early 2000s, Schultz was a pioneer on the wild west frontier of pain treatment Doctors, drug dealers, opioid users and abusers were flocking to Florida, where powerful pain pills were being prescribed and dispensed by a new type of business, pain clinics  Dave Aronberg: We had more pain clinics in the years 2010 and 2011 than we had McDonald’s, in those years There was one street in Broward County, Oakland Park Boulevard, that had 31 different pain clinics on the one street  Florida state attorney Dave Aronberg’s office prosecuted Barry Schultz. He told us pain clinics were loosely regulated medical offices where patients could pick up pills, usually for cash, few questions asked  Dave Aronberg: You could get the prescription and get the drug right there on the spot One-stop shopping. People would race down to Florida, because we didn’t have the same controls as other states We fed the entire nation’s addiction. This mob scene, shot on a cell phone in 2009, is inside a Florida pain clinic Dozens of patients waiting to get their opioids. Schultz operated a clinic like this in Delray Beach, where he treated thousands of patients    Bill Whitaker: How would you describe Dr. Barry Schultz? Dave Aronberg: He was one of the most notorious drug dealers we had He prescribed an egregious amount of pills to his patients. The numbers would shock the conscience  DEA records show in 2010 one patient of Dr. Schultz was prescribed nearly 17,000 of the highest potency oxycodone pills in a seven-month period; another got more than 23,000 over eight months That’s more than 100 pills a day. Business was so good, Schultz was making more than $6,000 a day prescribing and selling opioids to his patients  Bill Whitaker: The numbers of pills that you were prescribing are astronomical. Who takes that many pills and puts them into their body? What were you thinking? Barry Schultz: I was thinking that the patient was a genuine patient who had real chronic pain, whose complaints were legitimate, and that I was prescribing medication that they needed  Bill Whitaker: Doctor, you prescribed a thousand opioid pills to a pregnant woman I don’t think most doctors would prescribe a thousand aspirin to a pregnant woman  Barry Schultz: I would like to stop. Bill Whitaker: I would just like you to explain your thinking… Barry Schultz: I would like to stop This is not what I expected it… I believe it’s unfair.   Bill Whitaker: What is unfair, Doctor? Barry Schultz: I am just uncomfortable with these charged questions  Bill Whitaker: These are questions that people have. This is why you’re sitting here, wearing this jumpsuit  Ultimately, he agreed to continue. He claimed some of his patients needed extremely high doses of opioids for long periods of time to alleviate severe, persistent pain  Barry Schultz: And when I started treating people with chronic non-cancer pain, I felt it was unethical and discriminatory to limit the dose of medication And if I had known that the overdose incidents had increased dramatically the way it had, I would have moderated my approach   Bill Whitaker: Doctor, how could you have not known? All you had to do was pick up the paper  In 2009, more than 2900 people died in Florida of drug overdoses, mostly from prescribed opioid pills In one 16-month period, DEA records showed Barry Schultz dispensed 800,000 opioid pills from his office pharmacy  Bill Whitaker: People have become addicted to these drugs. People have died– Barry Schultz: Okay  Bill Whitaker: –because of these drugs. People in your practice died from overdoses of opioids  Barry Schultz: A person. Bill Whitaker: One is enough. Carol Tain: That monster ended my son’s life  Carol Tain’s son David went to Dr. Schultz for pain management after a car accident Schultz prescribed an assortment of pain pills even after David became addicted. In 2010, David died of an overdose of opioids prescribed by Dr Schultz. Bill Whitaker: So sh– should Dr. Schultz have prescribed these pain pills to him? Carol Tain: No He didn’t even examine him. He hadn’t seen him in four-and-a-half years. He just– just wrote– wrote out these scripts… As far as I’m concerned, he’s a murderer and– and not a doctor He murdered my son. He – he didn’t need a gun. He used his pen to murder my son. Schultz says he was inspired to prescribe high doses of opioids to his patients after attending a lecture by Dr Russell Portenoy, who was the influential president of the American Pain Society Portenoy traveled around the country giving lectures and made promotional videos like this one in 2000 touting opioids as wonder drugs, urging doctors to use them aggressively to relieve pain  Dr. Russell Portenoy: The likelihood that the treatment of pain using an opioid drug which is prescribed by a doctor will lead to addiction is extremely low… But ten years later, as opioid addiction exploded, Dr Portenoy said he had been part of a broad campaign funded by pharmaceutical companies to encourage the widespread use of opioids  Dr. Russell Portenoy: I gave innumerable lectures in the late 1980s and 1990s, in which I said things about addiction that weren’t true  He said he believed at the time he was operating in good faith and was not unduly influenced by the pharmaceutical industry, still he has been named in dozens of lawsuits How can you not be responsible? How could you walk away from 500 million pills to a geographic area like the size of Florida? Bill Whitaker: Dr Russell Portenoy was paid by the drug companies and has said that there is no proof that these– that high doses of opioids are effective in treating chronic pain  Barry Schultz: That may be true. But there is a doctor– Bill Whitaker: It is true So, there’s no science to back up what you were doing. Barry Schultz: There’s only anecdotal information  Bill Whitaker: I– I guess what I found troubling is (SIGH) your lack of– acceptance that what you did was wrong  Barry Schultz: I don’t believe it was wrong. Bill Whitaker: When you’re giving somebody 60 oxycodone a day, how could they not abuse it? Barry Schultz: 60 a day is a large number, I admit  Bill Whitaker: That’s a very large number. Barry Schultz: But if it’s taken properly… Bill Whitaker: How can you take 60– oxycodone a day properly? Barry Schultz: Some people need that dose  There is no scientific evidence to support that claim. With so many opioids prescribed by Schultz and other unscrupulous doctors, pills started flowing in to the streets and resold for profit, what the DEA calls diversion 66 percent Of all the oxycodone in Florida came from just one company: Mallinckrodt, one of the country’s largest opioid suppliers Florida state attorney Aronberg told us, between 2008 and 2012, the company flooded the state with pain pills   Dave Aronberg: Mallinckrodt sent 500 million oxycodone pills to the State of Florida, a state with the population of 20 million people We’re talking about enough pills to give every resident of Florida 25 oxycodone pills  Bill Whitaker: How is that possible? Dave Aronberg: I mean, you’re talking about enough pills to create an entire state of addicts  Internal Justice Department documents, obtained by “60 Minutes,” reveal that, “Mallinckrodt’s own data on Barry Schultz indicated that he was purchasing large amounts of oxycodone in a suspicious pattern indicating diversion ” Yet the company kept shipping the drugs to the distributor it knew was supplying Schultz The company’s behavior was so flagrant it triggered a DEA investigation led by Jim Rafalski  Bill Whitaker: So what role does Mallinckrodt play in this opioid crisis? Jim Rafalski: They’re responsible  Bill Whitaker: They are responsible. Jim Rafalski: It– especially for the conduct in Florida  Bill Whitaker: That’s a big statement. Jim Rafalski: How can you not be responsible? How could you walk away from 500 million pills to a geographic area like the size of Florida? And knowing at the time this was occurring there was an opioid crisis there That wasn’t a secret. Rafalski, now an expert witness for states and municipalities suing drug companies, told us his team identified almost 44,000 orders Mallinckrodt should have reported as suspicious, which, the government says the company is required to do by law Rafalski says Mallinckrodt reported none. But when DEA investigators handed their evidence to the Justice Department, government lawyers, fearing a long uncertain legal battle, decided not to pursue the case in court, but to settle instead  Bill Whitaker: If you’d’ve gone after Mallinckrodt for everything you saw them doing, what would the fine have been? Jim Rafalski: $2 4 billion. Bill Whitaker: And the actual fine was? Jim Rafalski: $35 million. The penalty amounted to less than one week of the company’s annual revenue Mallinckrodt declined to do an on-camera interview but told us it never sold oxycodone directly to Dr Schultz, only to distributors. In a press release, the company denied ”it violated any applicable laws,” but said going forward, it would analyze all internal data and identify suspicious sales  Now the pharmaceutical industry is coming under scrutiny. Last year, a congressional committee called the heads of the five leading drug distributors, the middlemen that ship the pain pills from manufacturers like Mallinckrodt to drug stores around the country Mississippi congressman Greg Harper asked if they were complicit in causing the drug crisis  Congressman Greg Harper: Do you believe that the actions that you or your company took actions that contributed to the opioid epidemic? Mr Barrett? CEO #1: No sir I do not believe we contributed to the opioid crisis. Congressman Greg Harper: Dr Mistandria? CEO #2: Yes. Only one of the five said yes. Now this House committee has launched an investigation into Mallinckrodt and other drug manufacturers The Justice Department has formed a task force targeting opioid manufacturers and distributors  As for Barry Schultz, shortly after our interview, he received a final sentence: 157 years The longest sentence of anyone so far in this opioid crisis. Produced by Ira Rosen and Sam Hornblower Associate producer, LaCrai Mitchell.

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