Rayburn House Office Building, Washington, D.C., 2014
On April 7, an overcast Monday afternoon, Joe Rannazzisi drove across the Potomac River to appear before the House Energy and Commerce Subcommittee on Health. He had testified on the Hill more than thirty times, explaining an array of drug issues to members of Congress. But this time he knew he was walking into hostile territory.
Joe sat down at a long table in Room 2123 and fingered his blue-and-silver club tie. He surveyed the vast hearing room inside the Rayburn House Office Building, named for Sam Rayburn of Texas, the longest-serving House Speaker. Joe wore an orange wristband. “Families Against Narcotics,” it read.
Members of Congress took their seats on the dais as the 3 p.m. hearing began. Its title was bland and bureaucratic: “Improving Predictability and Transparency in DEA and FDA Regulation.” But the goal was far from anodyne. The drug industry wanted to build support for the legislation that Tom Marino and Marsha Blackburn had introduced on February 18. The industry smoothed the way with tens of thousands of dollars in contributions to several of those who now sat before Joe.
Congressional hearings have their own choreography. Government officials, experts, and representatives of special interests are called to testify at a witness table in the well of the chamber. Members of Congress ask questions, but in their allotted five minutes, they are mostly playing to the television cameras, their constituents, and the companies that donate to their campaigns.
Joe delivered his opening statement. Mimi Paredes, his trusted counsel, sat behind him.
“The DEA’s sole interest is protecting the public from harm,” Joe said. He explained some of the tools at the agency’s disposal. One was the Immediate Suspension Order he had used to bar the Cardinal warehouse and the CVS stores from selling opioids. Without those tools, he said, it “would be tremendously more difficult to protect the public health and safety.”
The Alliance had already identified members of Congress who were willing to ask questions on behalf of the industry. Among them was the vice chairman of the subcommittee, Texas Republican Michael Burgess.
“Sometimes it seems that all the DEA cares about is the number of enforcement actions and not real solutions to stop the abuse,” Burgess said from the dais.
“That’s not correct,” said Joe, who tried to explain all the steps the DEA tried to take before issuing a suspension order.
Blackburn took her turn. She said she only had a couple of questions. “I want us to be able to move on so we can get to the second panel.” That panel included John Gray, the president of The Alliance, and Linden Barber.
Blackburn looked down at some papers on the dais and started to read her first question. “Let me just ask you if you can list for us what you are doing, articulate what the efforts are that the DEA is engaged in to promulgate some clear standards for the prescribers, for the pharmacies, for the distributors?”
The question, almost word for word, was one written by the Washington lobbying firm hired by The Alliance and passed to Blackburn and other members of Congress for them to parrot.
Joe briefly answered the first part of Blackburn’s question about prescribers, in the process citing one of his favorite U.S. Supreme Court cases that ruled doctors must issue prescriptions for legitimate medical purposes as part of their professional practice. He was starting to talk about how pharmacists had a similar responsibility and to address the responsibilities of the distributors when Blackburn cut him off.
“We were looking for a little bit of new information,” she said. “And I guess it’s kind of a Monday attitude sort of day, so let me move on.”
“Well, I’d like to finish,” Joe said.
Blackburn cut him off again.
“I guess not,” Joe said.
Blackburn moved quickly to her next question—another that had been written by the lobbying firm: “What are you doing to help well-intentioned registrants determine who they can do business with?” Registrants are manufacturers, distributors, pharmacies, and doctors who have been given a DEA registration to handle controlled substances.
“I’m sorry?” Joe responded. “We don’t dictate who the registrant does business with.” The agency did, however, tell them what red flags to look for to comply with the law prohibiting enormous shipments of narcotics to pharmacies, he said.
“Well, let me move on, then,” Blackburn said.
“I mean, we—” Joe said, trying to finish his answer.
The congresswoman cut him off again.
Joe was becoming agitated. “Sixteen thousand six hundred and fifty-one people in 2010 died of opiate overdose, okay, opiate-associated overdose,” he said, looking straight at Blackburn. “This is not a game. We’re not playing a game.”
Blackburn cut Joe off again. “Nobody is saying it is a game, sir,” she said testily. “We’re just trying to craft some legislation. Let me ask you this.”
“Especially in Tennessee—” Joe started to say, trying to point out how many people had died in Blackburn’s home state, which had been hit hard by the opioid epidemic.
“What is DEA doing to help registrants identify the prescribers and pharmacies that they should refuse to do business with?” Blackburn asked, repeating another version of the question scripted by The Alliance’s lobbying firm.
Joe repeated his answer. The DEA cannot direct a drug company to sell or not to sell to a particular customer, he said. The companies are required to catch and report suspicious orders and not ship them. “That’s a due process issue,” he said. “We can’t direct a wholesaler or distributor or a pharmacy not to sell to a particular person.”
“Okay, my time has expired,” Blackburn said.
“That’s what—” Joe started to say before Blackburn cut him off a sixth time.
“I yield back,” she told the committee chairman.
Paredes was appalled by the lack of respect Blackburn showed her boss. After college, she had worked on the Hill as a staffer, assigned to the same congressional committee. She had seen sparring between members of Congress and witnesses, but this exchange seemed particularly rude.
Joe looked up at the dais in dismay. All he could see were mouthpieces for the drug industry. Where were the members of Congress who were on the side of the DEA and the communities being victimized by the epidemic? Hundreds of thousands of Americans were dead.
Where is the outrage? he wondered.