They are both right. Every high-profile death related to fentanyl had it purchased illegally, that is due to crime syndicates, while the other side argues that it doctors and pharmaceutical companies caused the addiction which forced them to go the illegal route.
A new paper sides with the Big Pharma Conspiracy side. They contend that the Drug Enforcement Administration really tried to regulate supply but corporations exploited loopholes to "saturate the country with massive quantities of opioids."
![](https://www.science20.com/files/images/freddie_krueger_doll.jpg)
What a lot of academics see when there is no centralized government program controlling the private sector. Herval, CC BY
The tactic was using supply chain complexity that baffled government union employees and the authors say they did what DEA and its $3 billion per year could not - by looking at the DEA’s own Automation of Reports and Consolidated Orders System database from 2006 to 2014.
How criminals are the problem is obvious, but how can government be blamed? Conspiracies always find a way. The DEA ARCOS database requires manufacturers and distributors to report all orders of large size and frequency, and tracks every order. The authors say Big Pharma must have colluded with pharmacies to split orders across multiple distributors, so no orders were large enough to be flagged.
That's right, this conspiracy involves highly-paid CEOs in their corporation-y buildings risking a lifetime federal prison sentence to make money and Indiana University discovered something no one else could detect. Except the database debunks their own conspiracy. Pharmacies only order what they can order from distributors, which don't carry warehouses full of the stuff because companies don't make a 10-year supply. If you need X a distributor may not have that much, so they order 20% of X from five.
The authors instead contend that regional distributors would have naturally consolidated to achieve 'scale', so segmentation must be intentional, which only shows they have never run an actual company. And somehow DEA being in 23 regional areas, and knowing their regions better than any centralized group could, made them even less competent. Because they don't 'talk' to each other and only someone looking at their data 10 years later can see the data right there for anyone to see. 'Scale' is not magic, as Warner Bros Discovery and General Electric and Google learned. There is no Starbucks of martial arts studios yet using a naïve belief about "scale", there must be. Even Galileo would've seen through the logic of that, and he denied the existence of the moon's impact on tides because it conflicted with his uninformed data.
Scientists disagree that Big Pharma or DEA is malicious or incompetent, they instead point the finger at Congress, which dragged CEOs in front of them for sound bites geared toward placating the kooky fringe of their base that claims Big Pharma and Western medicine in general are the problem. They demanded that companies roll out "abuse-resistant" Oxycontin, and that plus government micromanagement and hostility toward every pain doctor, including oncologists with terminal cancer patients, created the surge in illegal products.
Despite all that, the authors argue that companies not be allowed to distribute their own products. Basically, they want to do for drug availability what California did to electricity - create high prices and chronic shortages in the name of social justice.
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