Politics Of Pain Domino Effect

In this Aug. 5, 2010 file photo, a pharmacy technician poses for a picture with hydrocodone and acetaminophen tablets, also known as Vicodin, at the Oklahoma Hospital Discount Pharmacy in Edmond, Oklahoma.

(Associated Press file photo)

CLEVELAND, Ohio -- As drug and opioid deaths in Ohio rose 81 percent between 2006 and 2014, prescription painkiller manufacturers and pain-management advocates contributed more than $3 million to the campaigns and political parties of many of the state's politicians.

A cleveland.com analysis of data provided by The Associated Press and The Center for Public Integrity also found that many of the top recipients of campaign donations in Ohio have been increasingly vocal about the opioid crisis in the past few years.

The data shows that while drug deaths -- the majority of which were from heroin and opioids -- spiked nationwide, so did lobbying efforts and campaign contributions from the Pain Care Forum, a coalition of drug makers, trade groups and opioid-friendly nonprofits. The forum's mission was to ensure painkillers remained easy to obtain, and spent hundreds of millions of dollars to deliver its message.

Some of Ohio's senators and U.S. House members and candidates received hundreds of thousands of dollars in campaign contributions from the Pain Care Forum, which includes companies such as Abbott Laboratories, Pfizer, Merck and Johnson & Johnson. Abbott spun off its U.S. pharmaceutical operation in 2013 and no longer lobbies on related issues.

Some state officeholders also saw tens of thousands of dollars in contributions.

And while Ohio's state lawmakers have introduced and pushed measures in recent years designed to address opioid abuse, the money can appear to create a conflict of interest with politicians who accept money from pro-pain management groups and then espouse the problems with said painkillers.

"The concern is that it's awfully difficult to trace any particular dollar given or spent to a particular vote," said Dan Tokaji, a law professor at Ohio State University who studies campaign finance. "The way that money influences politics can be much subtler and insidious than that."

Who got the most?

In Ohio, the most Pain Care Forum money went to former Rep. John Boehner, who served as speaker of the House between 2011 and 2015. The Cincinnati-area Republican received $875,470 between 2006 and midway through 2015, when the last available campaign-finance records were available.

Boehner's total is only exceeded by campaign contributions to President Barack Obama and former Massachusetts Gov. Mitt Romney, who mounted presidential campaigns in 2008 and 2012.

Below Boehner is Rep. Pat Tiberi, a Columbus-area Republican who chairs the House Ways and Means Subcommittee on Health. The subcommittee deals with many of the issues of interest to the pain-management industry. He received nearly $300,000 in contributions from the Pain Care Forum.

Sen. Rob Portman, a Republican from Cincinnati, comes in third with $211,865 between 2009 and mid-2015.

Rounding out the top five are U.S. Reps. Steve Stivers and Marcia Fudge. The Columbus-area Republican received $173,950 between 2007 and mid-2015, while the Warrensville Heights Democrat got $78,750 from 2009 to mid-2015.

Where does Ohio rank?

In the data provided to cleveland.com, members of the Pain Care Forum gave more than $2.3 million in donations, the seventh highest amount in the country, to politicians running for federal office from Ohio. Ohio's state office candidates received more than $885,000 between 2006 through the middle of 2015, the 10th highest amount in the country.

An additional $178,000 went to the state parties, with the majority going to the Republicans, which have controlled the Ohio legislature for most of the past decade.

In all, between 2006 and mid-2015, the Pain Care Forum donated Ohio's political candidates more than $3.4 million, the ninth highest of any state. Forum members also employed, on average, 37 lobbyists a year in the state.

Between 2006 and 2014, Ohio saw 17,152 drug deaths, with the number going up 81 percent during that time period. Most of these were from heroin and opioid overdoses, according to the Centers for Disease Control and Prevention.

Per capita, Ohio had the fifth-highest rate of drug deaths in the country, trailing West Virginia, New Mexico, New Hampshire and Kentucky.

At the same time, the number of prescriptions dropped more than 10 percent between 2013 and 2015, faster than the national rate, according to data from IMS Health.

State action on opioid abuse

The amount of campaign contributions that flowed to Ohio politicians is a bit unique, because lawmakers here were fairly proactive early on in trying to address the opioid epidemic.

Much of that was spearheaded by Republican Gov. John Kasich when he took office in 2011. That year, he signed the "Pill Mill Bill," designed to crack down on pain management clinics that doled out prescription painkillers without merit.

In Ohio, that pushed those who got their drugs from doctors to buying drugs on the street. Law enforcement, recovery experts and medical officials attribute the increased popularity of black market drugs, such as heroin and fentanyl, to the fight against pill mills.

Kasich also created the Cabinet Opiate Action Team within days of his inauguration and has worked with state leaders to expand access to treatments and increase availability of the overdose drug naloxone.

Members of the Pain Care Forum donated nearly $46,000 to Kasich and Lt. Gov. Mary Taylor's election campaign, though a Kasich spokeswoman said the governor does not allow campaigns contributions to affect his work in office.

"Anyone who suggests that's not aggressive isn't paying attention or just wants to play politics," Kasich spokeswoman Emmalee Kalmbach said in an emailed statement. "There's no room for division here, however, Ohio must come together to save lives."

Cheri Walter, head of the Ohio Association of Behavioral Health Authorities, said if the pain-management industry had made a large push in Ohio, it wasn't coming to her mind. She said Kasich and others' actions were proactive as opioid deaths began to spike.

Federal lawmakers

While perhaps not as early as the state politicians, federal politicians have begun to take notice of the opioid scourge.

Portman has been especially visible on this issue. He authored and helped shepherd the Comprehensive Addiction and Recovery Act through the Senate.

The bill, signed by Obama in July, calls for $181 million a year in new spending for addiction and recovery programs.

The junior senator has also put forth other measures aimed at fighting the opioid scourge.

Advocates say Portman's treatment bill is not perfect, though.

It does not guarantee money for programs and there are no restrictions on painkillers or mandatory training for doctors who prescribe medication.

Portman spokesman Emily Benavides said the senator "supports reducing the amount of opioids that are prescribed and increasing physician education about the risks of overprescribing to ensure that happens." She said the bill requires that studies be conducted on how to cut down on the prescribing of painkillers.

William Denihan, the CEO of Cuyahoga County's Alcohol, Drug Addiction and Mental Health Services board, said the bill is a start.

"It's not everything I wanted," he said. "I think at least we have their attention."

Tiberi, who received the second-highest amount from the Pain Care Forum of any Ohio politician, has also taken stances against heroin and opioids in recent years.

His spokeswoman, Olivia Hnat, said in an emailed statement that Tiberi "supports efforts to prevent addiction, stop opioids from being over prescribed and increase education on the risks of opioid medication and drugs."

Still, Tokaji said it can be difficult to show how a campaign donation affects a politician's actions. It rarely is as simple as encouraging a "yes" or "no" vote, he said.

"It's inevitably hard to say how much this money influences legislative decisions, not only the decisions to vote for a particular bill but the decision not to act in the face of a serious and growing problem like opioid abuse," he added.

This story was updated to note that Abbott Laboratories spun off its pharmaceutical wing in 2013.

Cleveland.com reporter Rich Exner, The Associated Press and The Center for Public Integrity contributed to this story.