The COVID-19 pandemic may have pushed public attention away from the opioid epidemic, but Christina E. Nolan, the U.S. attorney for Vermont, says her office has kept up the heat on the drug trade, both legal and illegal.
In a Nov. 6 interview with Vermont Business Magazine, Nolan discussed two federal cases that were resolved in October that addressed both sides of the opioid trade.
The biggest was an $8 billion settlement with Purdue Pharma, the makers of OxyContin, after federal authorities in Vermont discovered the pharmaceutical company was involved in a kickback scheme designed to boost sales of the drug.
On the illegal drug front, federal, state, and local law-enforcement agencies from Vermont and Massachusetts recently completed an 18-month operation that targeted the “guns-for-drugs” pipeline - guns from Vermont going south, drugs from southern New England going north - which has long been a problem in the communities along Interstate 91.
Nolan said that the exercise - “Operation Fury Road” - has resulted in the prosecution of 82 defendants in federal court for charges related to drug trafficking, unlawful possession of firearms, using firearms in furtherance of drug trafficking, and other federal criminal violations.
“About 55 percent of our work is drug-related,” said Nolan. “Obviously, we have a drug crisis in Vermont. And we have an opioid epidemic. And unfortunately, we've got other drugs that are presenting challenges. So I've had to focus on that.”
A simple plan
The opioid battle is one with many fronts, one of them being the abuse of prescription drugs.
“I've met so many people whose addiction started with OxyContin,” Nolan said.
So when Owen Foster, an assistant U.S. attorney in Nolan's office, discovered that in 2016, Purdue Pharma paid Practice Fusion Inc., a San Francisco-based electronic health-records company, to create an alert system in its software to boost Purdue's prescription sales, Nolan knew it would be something big.
“Purdue paid Practice Fusion nearly a million dollars to have prompts installed in the software that the health care doctors would see while they were treating a patient,” Nolan said. “It encouraged the doctors to focus more on pain and to potentially select Purdue's extended release opioids, like oxycodone, as treatment, even when it wasn't medically necessary or appropriate.”
The messages were “a clinical suggestion” -which can be “perfectly legal,” she said, “if such alerts or prompts are “clinically based.”
“But this was an opioid profit generator masquerading as a clinical tool,” Nolan said. “This was a form of influence and, I would argue, manipulation.”
“It was subtle. They knew they couldn't advertise it as a profit generator. They sort of had to masquerade it as a clinical function. But, yes, over time, certain doctors were influenced. The doctors who received the prompts prescribed extended-release opioids at a higher rate than those that did not.”
Foster and another assistant U.S. attorney, Michael Drescher, spent two years on the investigation, starting in August 2018. Nolan would not talk about the specifics of how they did their work, but was pleased with what it accomplished.
Earlier this year, Nolan reached a $145 million settlement with Practice Fusion to resolve claims against that company stemming from the kickback scheme.
And her office's work soon led the federal settlement last month, where Purdue agreed to plead guilty in a federal court in New Jersey to two counts of conspiracy to violate the federal anti-kickback statute, plus charges of conspiring to defraud the federal government and the Food, Drug, and Cosmetic Act. The company will also pay more than $8 billion in civil penalties.
“To be able to be to be in one of the smallest offices in the country, with comparatively few resources, and get a conviction of that company, that's something we're very proud of,” said Nolan.
And she also hopes this case “sends a message to Big Pharma and Big Tech that we do have the determination and the talent and resources to investigate these. And we're hoping it stops this from happening again.”
“Remember, these are opioids causing addictions that sometimes end in death,” she said. “You can't do one of these prompts just based on selling your opioids. It has to be based in medicine.”
Small-town guns, big-city crimes
In April 2019, Nolan stood in the briefing room of the Brattleboro Police Department. Flanked by representatives of federal, state, and local law enforcement, she spoke to reporters on the results of a series of drug raids in the region.
“We are coming after those who prey on the lives of Vermonters by peddling poison and profiting from addiction,” Nolan said at the news briefing. “I promise we will be relentless.”
Nolan also issued this warning: “If you are on Interstate 91 north headed for Brattleboro or St. Johnsbury or anywhere else in the state with drugs, turn around and go home. You will be targets of collaborative investigations, criminal charges, and stiff penalties. And, by that, I mean jail time.”
But that threat turned out to be just a small preview of a much bigger investigation.
Operation Fury Road included three law-enforcement surges around Vermont, during which federal, state, and local law-enforcement agencies flooded into communities hit hard by the effects of the opioid epidemic.
The surges targeted drug and firearm trafficking in the Brattleboro area, in April 2019; the Northeast Kingdom, in November 2019; and the Rutland area, in January 2020. They involved law-enforcement agencies at all levels in Vermont, Massachusetts, and Connecticut.
“We asked them for help stopping drugs, deadly drugs, from coming to Vermont,” Nolan said. “We asked them for help interdicting dealers before they get here. We have to help them when it comes to Vermont guns [that were] illegally acquired ending up in crime scenes in their cities, which happens too frequently.”
During Operation Fury Road, Nolan said law enforcement seized 128 firearms and 7,511 rounds of ammunition. Of those firearms, 57 were handguns.
Several firearms were assault-style rifles and short-barreled weapons that were not registered, as required by the National Firearms Act. Many of the firearms had been stolen from local Vermonters, purchased illegally at Vermont gun stores, or otherwise illegally possessed.
In addition to the firearms, law enforcement also seized approximately 40,200 bags of heroin (which equates to approximately 870 grams), 141 grams of bulk heroin, 1,489 grams of cocaine base, and 78 grams of powder cocaine. Much of the heroin seized during the operation was laced with fentanyl.
While the opioid crisis has taken a back seat to the COVID-19 crisis, Nolan said she believes that the drug trade “hasn't abated during COVID” and that during the pandemic “lockdown” period, “overdose deaths were actually up from the previous year.”
She's right. According to the Vermont Department of Health's weekly opioid report, “As of Nov. 18, there have been 118 opioid-related deaths among Vermont residents. The number of opioid deaths each month is higher than previous years.”
Nolan added that “another thing that we have to be tuned into is that the isolation, based on the numbers, could be causing people to turn to drugs even more than they were. And they're getting them from somebody, so the dealing is still happening.”
“We can't take our foot off the gas even during the pandemic,” she said. “You have to be as vigilant as ever about crime during this time.”
In her role as the state's top federal law-enforcement official, Nolan said she takes the opioid crisis seriously and as something more than just a matter of violating the law.
“There need to be consequences,” she said. “And the message needs to be, 'Don't come to Vermont, if that's what you're gonna do.'”
“We're losing these precious lives to this poison, and people are profiting from it,” Nolan said. ”It's just wrong.”