Everybody Hurts, Sometimes:
In 1943, the legendary, four-term Louisiana state Senator Dudley LeBlanc- Couzin Dud, as he was known- patented an elixir, a mixture of Vitamin B and a healthy 12% alcoholic concoction, that he claimed to be somewhat of a miracle drug, though he was careful not to use the words “drug” or “medicine.” He called his potion a “dietary supplement.”
It may have seemed like an unlikely venture for a Cajun legislator born in Erath and a man who never had any formal medical education. But Couzin Dud, as it turned out, was one of the most gifted salesmen in the country. He followed in the same tradition as P.T. Barnum, a talented performer who also understood how to produce a good show, even if the whole act was a gimmick. LeBlanc figured out an ingenious way to sell his elixir; he enlisted some of the biggest names in Hollywood and music and took his show on the road. It worked.
Couzin Dud became a multi-millionaire from selling his elixir, which he named Hadacol. Why? “Well, I hadda call it somethin’,” LeBlanc famously quipped.
The whole thing was a scam, though. Hadacol wasn’t a cure-all potion; the American Medical Association had made that clear. But LeBlanc was wily and savvy; he sold his company to a group of investors and pocketed a cool $5 million profit before the new owners realized Couzin Dud had already spent every last dime the company had on marketing.
The Federal Trade Commission eventually issued a report denouncing the advertising for Hadacol as “false, misleading, and deceptive.” Regardless, LeBlanc died a wealthy man, and to some, particularly to Cajuns, Couzin Dud remains a folk hero.
Sen. LeBlanc may have been an utterly unique force of life; his granddaughter produced a documentary about him she titled “The Cajun Renaissance Man.” But his business- selling people a phony elixir he promised would be able to cure all that ails you- is a part of a grand American tradition.
In her 2018 book about OxyContin, “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America,” bestselling author Beth Macy reminds readers of this grand tradition (though she skipped past the story of Hadacol). Our collective willingness to buy- hook, line, and sinker- the boasts made by the developer of the latest and greatest cure-all, she notes, is one of the reasons the author and public intellectual Gore Vidal often referred to the country as “the United States of Amnesia.”
23 years after it was first introduced into the American market, the manufacturers, distributors, and doctors who pushed powerfully addictive and deadly opioids like OxyContin onto the medicine cabinets of millions of Americans are finally being held accountable in the courts.
Last week, an Oklahoma judge ruled the company Johnson & Johnson pay the state $572 million for deceptively marketing the opioids Duragesic and Nucynta; earlier, Purdue Pharma, the manufacturers of OxyContin, had agreed to settle with Oklahoma for $270 million, and Teva Pharmaceuticals of Jerusalem, which manufacturers generic versions of opioids, agreed to pay $85 million.
Two days ago, the Washington Post reported that the Sackler family, which controls ownership of Purdue Pharma, is negotiating a settlement with state governments estimated to be worth between $10 to $12 billion. Such a settlement would almost certainly force the company to declare bankruptcy, but the Sackler’s family wealth would remain virtually in tact. Just like Couzin Dud, except his elixir never killed anyone.
At minimum, the deceptively-marketed and over-prescribed drugs have resulted in the deaths of at least 200,000 Americans. Some studies suggest that number is closer to 500,000.
And while the epidemic has affected every corner of the country, it began in rural, impoverished pockets of Appalachia; Kentucky and West Virginia have both been disproportionately devastated.
However, the crisis has slowly but surely spread to the Deep South. Today, Louisiana has the fifth highest opioid prescribing rate in the country, directly under Mississippi, Tennessee, Arkansas, and Alabama.
Pharmer Abraham Had Many Scripts:
Ralph Lee Abraham is a farmer, a veterinarian, a medical doctor, a pilot, a United States Congressman, and a current candidate for Louisiana governor. Until recently, though, most Louisianians, even those who considered themselves to be well-informed political observers, had never heard of Abraham, who was recruited by allies of then-Gov. Bobby Jindal to run against Republican incumbent Vance McAllister for Louisiana’s Fifth Congressional District. McAllister had been secretly recorded in his office having a romantic affair with a long-time family friend who went to work for his field office after he won election.
McAllister had been dubbed by the media as “the kissing congressman,” and despite the fact that the most senior elected leader of the Louisiana Republican Party at the time was Sen. David Vitter, McAllister had to be defeated. (As a brief digression, at the time, I managed to pull off one of my all-time best pranks. After Republican Party Chairman Roger Villere issued a press statement calling on McAllister’s resignation, I worked up a satirical “follow-up” statement that I claimed to have received later in the night from Villere, and I posted it on my old blog. Villere’s “follow-up” asserted that after prayerful consideration, he believed he had a moral and ethical imperative to be consistent in how he treated leaders who had committed the sin of adultery and that, therefore, he was now also calling for Sen. Vitter’s resignation as well. At the very end of the letter, I let readers know it was satirical, but apparently, conservative talk radio host Moon Griffon didn’t read the whole letter and reported it as news, working himself into a rage against Villere on his radio program that morning, until a caller informed him the letter was a work of satire).
Regardless, the Kissing Congressman was replaced by the Missing Congressman.
Ralph Abraham hadn’t only been unknown throughout the state (almost everyone knows Steve Scalise, Clay Higgins, Mike Johnson, Cedric Richmond and Garret Graves); he was unknown even to the people of his own district.
Moreover, even those who were familiar with Abraham had no idea until last week of another detail in his resume: Pharmacy owner. There isn’t a single print news article about Abraham’s ownership, though I did manage to find one incredibly ironic classified ad he ran in the Richland Beacon.
Abraham was seeking a nurse for his clinic, but above his ad, on the same page, appears this notification:
Abraham has been an outspoken advocate of the drug OxyContin. During a televised congressional debate in 2014, in an answer to a question about whether he would support the legalization of marijuana, he somehow spun his answer into a promo for brand name opioids.
“Again, as a physician, let me tell you. What I see in my practice, from any level of marijuana use, is bad. I’m against recreational, I’m against medical,” he said. “In the medical profession, for these chronic pain, poor cancer patients that need help, we have other alternatives that work better, Dilaudid, OxyContin, you name it, Oxycodone, we have several options that do a much better job for chronic pain, I’ve had hundreds of patients unfortunately with cancer that I’ve treated, they do well with these drugs.” (Emphasis added).
There is a growing body of medical research that suggests Abraham’s answer is demonstrably, provably wrong, and as we recently learned from an extraordinary story by the Advocate’s Tyler Bridges, former Gov. Kathleen Blanco used medicinal marijuana at the very end of her life, which her family believes was a “game-changer” that allowed her to remain lucid and comfortable until only two hours before her death.
Yet, as Beth Macy explains in “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America,” during the mid 1990s, physicians became convinced of the need to continually treat and manage pain. “The 1996 introduction of OxyContin coincided with the moment in medical history when doctors, hospitals, and accreditation boards were adopting the notion of pain as ‘the fifth vital sign,’ developing new standards for pain assessment and treatment that gave pain equal status with blood pressure, heart rate, respiratory rate, and temperature,” Macy writes.
This “moment in medical history” was largely informed and financed by pharmaceutical companies and drug manufacturers, creating a pretense to ensure an immediate market for their new lines of high-powered opioids, and while I have no way of knowing whether or not Ralph Abraham personally met with pharmaceutical reps of opioid manufacturers, physicians like Ralph Abraham were specifically courted by these drug manufacturers, according to Macy.
“From a sales perspective, OxyContin had its greatest early success in rural, small-town America—already full of shuttered factories and Dollar General stores, along with burgeoning disability claims. Purdue handpicked the physicians who were most susceptible to their marketing, using information it bought from a data-mining network, IMS Health, to determine which doctors in which towns prescribed the most competing painkillers,” she writes.
According to data released last month by the Louisiana Department of Health’s Opioid Surveillance Initiative, there are 96 opioid prescriptions for every 100 people living in the state. And that’s good news. Four years ago, there were 116 prescriptions per 100 people. Make no mistake, though, this is still a public health crisis; Louisiana is still ranked as having the fifth highest opioid prescription rate.
While the average number of prescriptions statewide has marginally declined, the epidemic seems to have only worsened. “The number of opioid-involved deaths in Louisiana was 184% times higher in 2018 than in 2012,” the LDH reported in June, and in Abraham’s home of Richland Parish, there are still approximately 106 opioid prescriptions per every 100 residents.
“If a doctor was already prescribing lots of Percocet and Vicodin, a rep was sent out to deliver a pitch about OxyContin’s potency and longer-lasting action,” Macy explains. “The higher the decile—a term reps use as a predictor of a doctor’s potential for prescribing whatever drug they’re hawking—the more visits that doctor received from a rep, who often brought along ‘reminders; such as OxyContin-branded clocks for the exam-room walls.
In Louisiana, the Doctor Appears to Have Been Excused
Be sure you know the conditions of your flocks, give careful attention to your herds; for riches do not endure forever, and a crown is not secure for all generations. Proverbs 27:34-35
Last Wednesday, I published “Pharmland,” a report that revealed two rural pharmacies owned by Ralph Abraham had dispensed nearly 1.5 million doses of opioids from the years 2006 to 2012, according to a comprehensive database assembled by the Drug Enforcement Administration and first published by the Washington Post.
The Post’s decision to make the database publicly available and searchable by county (or parish) allowed me to locate the records of two obscure pharmacies in a remote and sparsely populated area of northeast Louisiana, pharmacies I knew- thanks to the intrepid reporting of my colleague Sue Lincoln- were then owned by a country veterinarian who later became a country doctor and then a member of the United States House of Representatives.
The numbers are staggering, especially considering the two communities in which the pharmacies are located, Mangham in Richland Parish and Winnsboro in Franklin Parish, have a combined population of fewer than 6,000 people and that neither of Abraham’s two pharmacies were the most prolific dispensaries in town.
During the past few days, hundreds of people in Louisiana have reached out online to share their shock and outrage. National reporters from the Washington Post, the Los Angeles Times, CNBC, the Miami Herald, and MSNBC shared the article on Twitter. The journalist Jerry Lambe picked up the story for the national publication Law & Crime, a terrific new outlet founded by Dan Abrams. A couple of celebrity actors took notice, as did dozens of medical researchers and prominent physicians.
Late last night, the journalist Sarah Burris amplified it even more significantly, publishing a front-page account on the popular online news site Raw Story (Burris’ summary is actually backdated on August 28th, which suggests it had been written shortly after I broke the news here on the Bayou Brief).
The report also caught the attention of at least two of Abraham’s colleagues in Congress, Joaquin Castro of Texas and Ruben Gallego of Arizona. Rep. Gallego pulled no punches. “If his name was of Latino origin he would have been in jail by now. The difference between being a drug dealer and a criminal is whether or not you are incorporated in Delaware,” he tweeted.
As of this writing, however, only one news organization in Louisiana has even acknowledged its existence, the Westside Reader in Port Allen, which should be commended both for its willingness to cover the story and for writing one of the best headlines of the year, notwithstanding the fact they misspelled the word pharmacies.
My concerns and frustrations with the lack of coverage in the state media have nothing to do with some sort of vainglorious desire for personal attention. Rather, they are about our institutional failures to ensure voters are fully informed about those elected to lead or seek to be elected; in Abraham’s case, it’s both.
The original report has generated hundreds and hundreds of shares and comments, almost exclusively from voters in Louisiana. As a consequence, I’ve gained a better appreciation of how widespread and common opioid use and addiction are, particularly in the Fifth District. I was born and raised in the district, and my home parish, Rapides, has- by a wide margin- been more affected than any other place in Louisiana.
Yesterday, a woman from the area attempted to argue that 41 opioid pills for every man, woman, and child for every year over the course of seven consecutive years is a “non-story.” Others have twisted themselves into rhetorical knots in an effort to argue the volume of doses is not nearly as bad as it sounds if one were to make the assumption that Abraham’s pharmacies served the entire regional population; it was unfair, they argued, to look only at the populations of the municipalities.
I can appreciate the argument, but the truth is that there are multiple pharmacies in the region, some of which dispense more opioids than the two owned- or once owned- by the congressman. If anything, the assumption that they serve a population of 6,000 residents is inflated, not diminished.
Regardless, this is the methodology employed by the DEA. It’s not something I cooked up out of thin air. And it is a reasonable, logical approach.
No matter how one attempts to excuse the raw numbers, they are still incredibly problematic, because Richland Parish, in particular, has a disproportionate number of opioid prescriptions per person.
Indeed, the primary cause of the opioid epidemic was overprescribing medication.
During the years in which Abraham practiced medicine in Mangham (now he’s operating out of Rayville), the proliferation of prescription opioids created the first wave in overdose deaths. They were still the leading cause when he was elected to Congress.
It’s also worth noting that opioid prescriptions decreased in both Richland and Franklin Parishes since Abraham limited his medical practice, though Richland still exceeds the state average.
Fortunately, the Louisiana Department of Health keeps track of this information.
The Total Number of Opioid Prescriptions in Franklin Parish from 2014-18
The Total Number of Opioid Prescriptions in Richland Parish from 2014-18
Louisiana is exactly forty days out from its primary election, and typically, campaign seasons begin in earnest after Labor Day. There is no question that the closer we get to an election, the more we learn about candidates.
Ralph Abraham has consistently placed his experience as a medical doctor at the center of his message to voters, so there is nothing unreasonable or malicious about providing information on his strong and outspoken support of opioids; it’s relevant.
His record in Congress on the epidemic is also relevant.
He has repeatedly gone out of his way to publicly repudiate lawsuits against pharmaceutical companies who have acknowledged their culpability and deception. He invited a man whose business was under active investigation by the DEA to be his guest at last year’s State of the Union address; the company was forced to pay $22 million in fines. The man who owns it is now a chairman of Abraham’s campaign. “As a doctor, I can tell you there are only two genders,” he said at the end of a recent campaign commercial, the exact opposite of what the medical profession knows to be true about gender.
According to his personal financial reports, he is still earning a sizable income from a pharmacy he ostensibly sold. When he was asked in January about how America could end the opioid crisis, he simply said, “Build a border wall,” which may be red meat to his political base but should call into question whether he understands what created the demand for fentanyl in the first place.
And considering his comments about opposing medical marijuana, it’s worth asking if he would have charged former Gov. Blanco with a crime as she spent her final days or whether he still believes that all of the drugs he praised when he ran for Congress, drugs made by companies now being forced to pay billions in fines for lying about the potency and risks, are less “dangerous” than medical marijuana.
These aren’t malicious questions; they are imminently fair and reasonable. The Advocate and the Gannett papers may not be interested, but the Missing Congressman routine won’t work forever.