Deputy Attorney General Rod J. Rosenstein Delivers Remarks at America’s Health Insurance Plans 2018 National Conference on Medicaid

Thank you, Matt for that kind introduction. 

I want to thank America’s Health Insurance Plans for inviting me to speak.  Your member companies provide health insurance to millions of American families that rely on your organizations in difficult times.

I know that some of you were here in March when I spoke at the National Health Policy Conference. That was only seven months ago, but a lot has happened since then. You may have noticed. We have been very busy at the Department of Justice. 

Today, I want to talk about ending the opioid epidemic, and the important roles that the Department of Justice and the private sector play in that effort. 

President Donald Trump and Attorney General Jeff Sessions understand that the extent of opioid addiction in America is staggering.  In 2017, there were more than 72,000 drug overdose deaths in the United States.  More than two-thirds of the total involved opioid drugs, about 49,000 deaths.  That equates to 134 people dying every day from opioids, or one person every eleven minutes. That does not count the toll in non-fatal overdoses and the agony of addiction. The human costs are enormous.

The financial costs are also shocking.  A recent study found that the opioid crisis cost the United States more than $1 trillion between 2001 and 2017— from lost productivity, health care expenses, and other losses.  The study predicts that the problem may grow, costing another $500 billion over the next two years.  

This is a man-made disaster. In order to solve it, we need to understand how and why it happened. Many people became addicts as a result of misuse of pharmaceutical opioid medications, marketed without full disclosure and prescribed without full appreciation of the risks. The supply of heroin also increased. Meanwhile, the increased production of synthetic opioid drugs, mostly from China, fueled an unprecedented surge in drug overdose deaths.

In 2001, the total number of homicides in the United States was almost identical to the total number of drug overdose deaths. About 20,000 people were murdered, and about 20,000 people died of drug overdoses. The homicide total remained relatively stable – it fell slightly, then rose from 2014 to 2016 – but we devoted additional resources to violent crime enforcement last year and now have it back under control.

In contrast, the drug overdose death total rose dramatically and will be more difficult to reduce. It doubled to about 40,000 in 2010, remained relatively steady for a few years, and then rose dramatically from 2013 to reach the previously-unimaginable total of 72,000 deaths.

Last year, synthetic opioids killed about 29,000 Americans, a six-fold increase over four years. Synthetic opioids, such as fentanyl, are extremely dangerous.

As drug-related deaths were increasing, the Department of Justice made a policy decision in 2011 to limit federal drug prosecutions and support lower drug sentences.

The correlation is indisputable. Drug overdose deaths spiked after federal drug prosecutions fell. Correlation does not prove causation. But if you believe that one of the most important purposes of criminal law is deterrence, then an increase in crime should be followed by an increase in prosecutions. So reinvigorating federal criminal drug enforcement is one important part of our strategy.

In October 2001, just one month after the deadly September 11^th attacks, Attorney General John Ashcroft recalled a time when Attorney General Robert Kennedy confronted the scourge of organized crime.  As a result, Ashcroft explained, “[p]rosecutors were action oriented — pursuing cases rather than waiting for the cases to come to them.  Investigators focused on function, not form — they focused on doing what was necessary to get the job done rather than what was dictated by the organizational chart.”  “Attorney General Kennedy made no apologies for using all of the available resources” to solve the problem. 

Attorney General Ashcroft warned that “[h]istory’s judgment will be harsh … if we fail to use every available resource” to confront an imminent threat to American lives.

I am proud that the Department of Justice is fighting the opioid epidemic with the same spirit of determination. 

President Trump made clear from the start of his administration that fighting the opioid epidemic is a priority.  The President declared the opioid epidemic a Public Health Emergency, and he directed the administration to control it. He wants action, not talk.

Last year, Attorney General Sessions restored the traditional principle that prosecutors generally should charge defendants with the most serious, readily provable offense, and disclose to the sentencing court all facts that impact mandatory minimum sentences. And he ordered the DEA and our U.S. Attorneys to devote additional resources to drug cases.

After we revised the Department’s charging policy and instructed federal prosecutors and agents to step up their work on drug cases, the number of defendants charged with federal drug crimes started to increase. 

Each of our 93 United States Attorneys designated a federal prosecutor to serve as an Opioid Coordinator. They were tasked to facilitate intake of cases involving prescription opioids, heroin, and fentanyl; and to convene a task force of federal, state, local, and tribal law enforcement.

In July, Attorney General Sessions announced a Synthetic Opioid Surge, an initiative to devote additional resources to prosecute synthetic opioid dealers in several struggling areas of the country.

At the Department of Justice headquarters, we established an Opioid Fraud and Abuse Detection Unit to mine federal health care databases and identify suspicious outliers – including doctors writing opioid prescriptions at a rate that far exceeds their peers; and pharmacies dispensing unusually large amounts of opioids. That information helps us develop potential suspects for federal prosecutors and agents to investigate.

We now use every tool — including both criminal and civil enforcement powers — to stop illegal drug dealers and cut off the supply of pills from corrupt doctors and pharmacists. 

Last month, a Texas physician received a sentence of 35 years in prison for running an illegal pill mill.  The doctor wrote 34,000 prescriptions for more than 3.4 million doses of hydrocodone and another Schedule IV drug to customers with no legitimate medical need. 

Also last month, a Florida physician was sentenced to more than six years in prison for providing improper prescriptions in exchange for cash payments. 

In August, an Ohio doctor was sentenced to five and a half years in prison.  The doctor distributed nearly 4,000 units of oxycodone with no medical purpose. He charged Medicare and Medicaid, and fraudulently collected up to $10,000 per day from taxpayers.

In June, we announced charges for more than $2 billion in false billings against 601 defendants — including 165 doctors, nurses, and other licensed medical professionals.  It was the largest health care fraud takedown in U.S. history.  One hundred sixty-two of the defendants allegedly prescribed and distributed opioids and other dangerous narcotics. 

That announcement involved the most doctors and the most medical personnel ever included in a single law enforcement initiative, and the most defendants ever charged with health care fraud. 

All that work is adding up.  Since January 2017, the Department of Justice has charged more than 200 doctors and 220 other medical personnel for opioid-related crimes. The cases involved tens of millions of pills prescribed illegally.

But law enforcement is not just about chasing criminals and punishing guilty defendants.  Law enforcement is about crime prevention.  The cases are important because they have a deterrent effect. They send a message about the consequences of illegal drug dealing.

We also need to send a message to foreign countries that allow the manufacture and distribution of synthetic opioid drugs. In August, we indicted two leaders of the Zheng drug trafficking organization.  They allegedly produced more than 250 types of synthetic drugs in China, including synthetic opioids and fentanyl analogues. Using shell companies, they shipped synthetic opioids to more than 25 countries and 37 U.S. states. 

Obtaining illegal drugs no longer requires you to visit a pharmacy or walk into a dark alley.  The internet allows people to purchase drugs from anywhere in the world with the click of a mouse.  Most fentanyl and other illicit opioids are ordered using the internet and shipped through the mail. 

The internet provides a degree of anonymity and distance that may give criminals a sense of security.  We are working to overcome that and create a credible threat of exposure and prosecution.

Earlier this year, the Department established the Joint Criminal Opioid Darknet Enforcement Team, to focus on web-based drug trafficking. 

Under that initiative, the FBI effectively doubled its investment in the fight against online drug trafficking by devoting more than 50 Special Agents, Intelligence Analysts, and professional staff to help disrupt the sale of synthetic opioids. 

Our team coordinates with FBI offices all around the world to target internet drug traffickers.  It will help us arrest more of the criminals selling deadly substances online, shut down the marketplaces drug dealers use, and ultimately reduce addiction and overdoses. 

In 2017, we tripled the number of federal fentanyl prosecutions. And in the first three months of 2018, the DEA seized a total of more than 200 pounds of suspected fentanyl. 

We also use civil enforcement authorities to stop the flow of illegal drugs as quickly as possible.  In August, the Attorney General announced the first-ever civil injunctions under the Controlled Substances Act against doctors who allegedly prescribed opioids illegally.  Temporary restraining orders immediately stop the unlawful conduct, without waiting for a criminal prosecution. 

In May, the Department intervened in five civil lawsuits accusing a manufacturer of violating the False Claims Act in connection with marketing an opioid painkiller.  We allege that the manufacturer paid kickbacks to induce physicians and nurse practitioners to prescribe the drug, and that the manufacturer lied to insurers about patients’ diagnoses in order to obtain Medicare reimbursements.  

The opioid epidemic grew deliberately.  Sales of prescription painkillers quadruped from 1999 to 2010.  By 2015, an estimated 119 million Americans aged 12 or older used prescription psychotherapeutic drugs — that is 44.5 percent of the adult population. 

President Trump set the bold and ambitious goal of reducing opioid prescription rates by one-third in three years.  That will make a major impact.

Under the Controlled Substances Act, Congress gave the Attorney General authority to set production limits for certain drugs, including opioids. The authority generally has been delegated to the Drug Enforcement Administration. At the request of Attorney General Sessions, the DEA is lowering opioid production limits significantly, and it is modernizing the process used to set the limits.

We recently announced a reduction in opioid production for next year by an average of 10 percent. That will bring us to about a 44 percent decrease in opioid production since 2016.

DEA takes into consideration the extent to which a drug is diverted for abuse before setting the annual limit.  And DEA is now considering a broader range of information.  In addition to using its own databases and records, DEA now matches those records with information from the Department of Health and Human Services, the FDA, Medicare and Medicaid, as well as the states.  More information allows better decisions.

According to the DEA’s National Prescription Audit, opioid prescriptions were down by nearly 12 percent in the first quarter of 2018.  That supplements a seven percent decline last year.

The evidence also shows that our work is starting to stem the tide of rising overdose deaths.  According to data from the Centers for Disease Control, overdose deaths may have plateaued. The reports are preliminary, but we have cause for optimism.

Two weeks ago, Congress passed new legislation to fight the opioid crisis on a bipartisan basis.  The legislation provides for enhanced security measures governing parcels entering the United States through the international mail.  That will help us interdict and investigate synthetic drugs smuggled into our country. 

John Ashcroft observed that law enforcement used several assets in the successful campaign against organized crime: “A constructive anger.  An intimate knowledge of his subject.  A talented team of prosecutors.  And, finally, a partner in the White House.”  We find ourselves today armed with the same advantages in the fight against opioid abuse.

So I want to conclude by asking you to do your part to help end the opioid overdose epidemic. Help us promote the safe and responsible use of prescription drugs, and help us deter overprescribing, diversion and abuse.

By working together, we can save lives.

Thank you.