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Deputy Attorney General Rosenstein Delivers Remarks at the America’s Health Insurance Plans' National Health Policy Conference


Washington, DC
United States

Remarks as prepared for delivery.

Thank you, Marilyn, for that kind introduction.  I appreciate your commitment to addressing the opioid epidemic. I am honored to be here to join you this morning.

I want to thank America’s Health Insurance Plans for hosting this event and for inviting me to speak.  Your member companies provide health insurance to millions of families. Those families rely on your organizations to help them in difficult times.

In 1900, life expectancy in the United States was 47.  Today, it is 78.  We made great progress in enhancing the average lifespan for over a century.

But in 2015 and 2016, life expectancy dropped in America. 

One reason is that we are experiencing the deadliest drug crisis in our history.  Approximately 64,000 Americans lost their lives to drug overdoses in 2016 – the highest drug death toll and the most rapid increase in the death toll on record. 

For reference, that’s more Americans than we lost in the entire Vietnam War.  It is the equivalent of the entire population of Rockville, Maryland, dying in a single year.  Or Daytona Beach, Florida.  Or Palo Alto, California. 

And the impact extends beyond the victims.  64,000 families are missing a mom or a dad, a wife or a husband, a son or a daughter.

Preliminary data show that the death toll continued to rise in 2017.  For Americans under the age of 50, drug overdoses are now the leading cause of death.

The increase in life expectancy over the past century resulted in large part from medical advances. Pharmaceutical companies and medical professionals have done a tremendous amount of good, and they achieve great things. Unfortunately, the opioid epidemic is attributable in part to actions of medical professionals. The misuse of pharmaceutical opioid drugs contradicts the fundamental pledge of the medical profession: first, do no harm. Those drugs have caused a lot of collateral damage.

The surge in drug overdose deaths is driven primarily by opioids – prescription painkillers, heroin, and increasingly, synthetic drugs like fentanyl.  In 2016, opioid overdoses killed 42,000 Americans –five times the number from 17 years ago. 

On an average day, 115 people died from an opioid overdose.  That means that by the time I have finished speaking, another American will have died from an opioid overdose. 

And by the time I have finished speaking, another baby will be born in the United States suffering from opioid withdrawal. 

Every day brings more heartbreaking stories about parents burying teenage children, Neonatal Intensive Care Units overflowing with opioid-addicted babies, EMS workers racing from one drug overdose to another, and medical examiners running short of resources to handle the somber extra business.

Beyond the devastating human costs, the epidemic causes enormous financial burdens.  A recent study found that the opioid crisis cost the United States more than $1 trillion between 2001 and last year.

Nearly a quarter of that cost represents health care expenses, because your organizations paid much of the $200 billion tab.  The expenses include treatment of non-fatal overdoses and rehabilitation programs.

If  the number of addictions and overdoses continues to increase, we may incur another $500 billion in costs by 2020. But people caused this problem, and people can solve it.

This epidemic did not develop overnight.  Sales of prescription painkillers quadrupled between 1999 and 2010.  The prescribing rate for prescription opioids among adolescents and young adults nearly doubled from 1994 to 2007.  By 2015, an estimated 119 million Americans aged 12 or older used prescription psychotherapeutic drugs – 44.5 percent of the entire U.S. population.

Indisputably, such widespread use of prescription drugs was ill-advised: a 2014 survey found that each day nearly 6,000 Americans abuse prescription drugs for the first time. 

And all too often, that misuse gives way to addiction.  Nearly four out of five heroin users reported using prescription drugs prior to heroin.

This situation is daunting.  But the Department of Justice is taking action to turn the tide. 

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 directed us to make ending the epidemic a top priority. 

Attorney General Sessions has heeded the call. The Department of Justice will do everything we can to reduce the number of opioid overdose deaths in the country.  

Last week, the White House hosted an Opioid Summit that brought together top public health and safety officials, and community members impacted by this epidemic.  Attorney General Sessions joined other Cabinet members at the summit.  He spoke about the Department’s efforts, and he took questions from parents who lost their children to the epidemic.

Our goal is to halt the increase in addiction and overdoses, and to halt it this year.  Through close cooperation among federal, state and local law enforcement, and the private sector, we are confident that can achieve that. We intend to see to it that the drug overdose death totals decline.

The Justice Department’s primary role in combatting the opioid crisis is to enforce the law.  We identify the wrongdoers responsible for supplying the drugs – corrupt manufacturers, distributors and providers, as well as criminal traffickers – and pursue them to the fullest extent of the law.  We aim to reduce the availability of deadly drugs, drive up the price of illicit drugs, and reduce the purity and addictiveness.

In the past year, we have achieved a number of successes.

Last summer, the Department announced the largest health care fraud takedown in American history.  We coordinated the efforts of more than 1,000 state and federal law enforcement agents to arrest more than 400 defendants—including more than 50 doctors.  The defendants allegedly committed more than $1 billion in fraud.

We charged more than 120 of the defendants with opioid-related crimes, which makes it the largest opioid-related fraud enforcement action in American history.

A few days later, the Department announced the seizure of the largest dark net marketplace in history.  The site hosted some 220,000 drug listings and was responsible for countless synthetic opioid overdoses, including the tragic death of a 13 year old.

In 2017, federal prosecutors charged more than 3,000 defendants with opioid-related crimes.

Our efforts to root out fraud make our health care system more stable, and our streets more safe.

Technology is helping us catch wrongdoers. In August, Attorney General Sessions created the Opioid Fraud and Abuse Detection Unit, which employs data analytics to find outliers and the tell-tale signs of crime – such as which doctor is prescribing the most drugs, what pharmacy is dispensing the most drugs, and whose patients are dying from overdoses.

The Attorney General also assigned a dozen experienced prosecutors in districts experiencing large numbers of opioid overdose deaths. Those prosecutors focus on investigating and prosecuting opioid-related health care fraud.

Our experienced prosecutors work with DEA, FBI, the Department of Health and Human Services, and partners in state and local law enforcement. They prosecute doctors, pharmacies, and medical providers who exploit the drug epidemic to line their pockets.  They already started presenting indictments.

The Department is committed to combatting the prescription opioid crisis at every level of the distribution chain.  Just last week, the Attorney General announced the Prescription Interdiction & Litigation Task Force.  The task force will coordinate criminal and civil enforcement efforts to hold accountable prescription drug manufacturers, distributors, pharmacies, pain management clinics, drug testing facilities, and individual physicians for unlawful actions.

We will use all available tools to hold people accountable, including criminal penalties and civil penalties. 

We took another important step last week, when the Attorney General directed the DEA to reconsider its regulations governing the quantity of drugs the manufacturers can produce. 

Those steps will help us reduce the flow of prescription drugs to people who do not have a medical need for them.

But prescription drugs are not the only force contributing to the opioid crisis. Heroin and fentanyl are the major causes of opioid overdose deaths.

The most lethal substance is  fentanyl, a synthetic drug produced primarily in China that is up to 50 times more potent than heroin.  It is so powerful that a quantity equal to a few grains of table salt can kill you.  In 2016, fentanyl and other synthetics killed more than 23,000 Americans.  Fentanyl caused a third of all fatal overdoses.  The total nearly doubled from 2015 to 2016.

Chinese chemists try to stay a step ahead of law enforcement by making chemical analogues of fentanyl, such as carfentanil.  It is 100 times more potent than fentanyl and 10,000 times more potent than morphine.  Carfentanil is literally elephant tranquilizer.  It is manufactured in Chinese laboratories, shipped to the United States or Mexico, mixed with heroin or other substances, and then sold to addicts who are often unaware of what they are ingesting.

We are working with the Chinese government to stem the flow of illegal fentanyl and fentanyl analogues into the United States.  Last September, I traveled to China to meet with government officials.  My goal was to ask for Chinese cooperation in shutting down fentanyl labs and halting the export of fentanyl to the U.S.  China agreed to schedule a variety of fentanyl class substances last year.  And after our dialogue, China took the important step of restricting two fentanyl precursors.  We hope that China’s cooperation on this issue will continue.

Meanwhile, we will hold criminals who smuggle fentanyl into the U.S. accountable.  Last October, we announced two indictments of Chinese defendants who were using the Internet to sell illicit fentanyl and fentanyl analogues to drug traffickers and to individual customers in the United States. 

They are the first Chinese fentanyl manufacturers and distributors to be designated as Consolidated Priority Organizational Targets, the most significant drug trafficking threats in the world. 

Last month, DEA placed all illicit fentanyl analogues not already regulated by the Controlled Substances Act into Schedule I – the category for substances with no currently accepted medical use.  That makes it harder for people to acquire illicit fentanyl and easier for law enforcement to investigate and prosecute drug traffickers.

Most fentanyl is purchased through the Internet and shipped through the mail.  With just a few clicks of a button, you can go online and have the most dangerous drugs in the world shipped right to your door.

That anonymity and distance gives criminals a sense of security – but it is a false sense of security.

Building on our success last summer, the Department announced a new strategy last month to investigate and stop online drug markets: the Joint Criminal Opioid Darknet Enforcement team.

The FBI effectively doubled its investment in the fight against online drug trafficking by dedicating more than 50 Special Agents, Intelligence Analysts, and Professional Staff to help disrupt the sale of synthetic opioids.

The team will coordinate across the FBI’s offices all around the world to target drug traffickers on the internet.

It will help us arrest more criminals who sell deadly substances online, and shut down the marketplaces that the drug dealers use.  Ultimately it will help us reduce drug addiction and overdoses.

To coordinate all of our efforts, we created a new position in my office of Opioid Coordinator. Mary Daly, a long-time federal prosecutor who is with me here today, now serves in that important role.  Her mission is to reduce opioid abuse. That is how we intend to define success.

The new resources and enhancements to existing programs will save lives.

The federal government alone cannot end this crisis.  We are counting on a lot of help. Some of that help is funded by the Department of Justice’s Office of Justice Programs. We extend grants to states that fund life-saving naloxone, connect people to treatment services, and establish drug courts and Veterans Treatment Courts as alternatives to incarceration.      

We also need your help.  Health insurers can help prevent excessive medical use of opioid drugs, and also can detect fraud and other potentially illegal conduct, and report it to law enforcement.   

I hope that we can count on you and the organizations you represent to help end this crisis and save lives.  From now on, let us recommit to first, do no harm.

I look forward to your questions.  

Prescription Drugs
Updated March 7, 2018