Pain Hustlers: Crime and Punishment at an Opioid Startup Originally published as The Hard Sell

by Evan Hughes

A medication typically travels along a three-step supply chain—from the drugmaker’s shipper to a wholesale distributor and finally to retail pharmacies. With controlled substances, the entire chain is tightly regulated. Since the beginning of the opioid epidemic, drug distributors—including all of the “big three” of McKesson, Cardinal Health, and AmerisourceBergen—have paid hefty fines and settlements for failing to notify the Drug Enforcement Administration of “suspicious orders” of controlled substances from particular pharmacies, as required by law. Under mounting scrutiny, distributors have put in place monitoring systems in which controlled-substance orders from a given pharmacy that exceed a monthly threshold, or “cap,” are put on hold and, barring some innocent explanation, reported to the DEA.