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Consulting Firm McKinsey's Role in VA Opioid Prescriptions Sparks New Concerns Among Lawmakers

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Consulting Firm McKinsey's Role in VA Opioid Prescriptions Sparks New Concerns Among Lawmakers


House lawmakers are demanding answers from the Department of Veterans Affairs about consulting firm McKinsey and Company's role in the department's decisions to prescribe opioids to veterans while it was also advising opioid manufacturers on how to push the highly addictive pain medications for VA care.


In a Tuesday letter to the VA, which was obtained by Military.com, four congressmen said they were dismayed by the apparent conflict of interest, which was first reported by The Wall Street Journal. McKinsey consulted for the VA while also advising pharmaceutical companies such as Purdue Pharma and Endo on how to sell opioids to the department for veterans, according to the newspaper, though McKinsey denied a conflict of interest.


"It has become increasingly clear that McKinsey's unprecedented access to VA decision

making, strategy and policy formulation allowed them to exploit their consulting contracts to the benefit of their opioid manufacturer clients and to the detriment of many veterans suffering from injuries sustained during their service," the letter said.


The letter was spearheaded by California Rep. David Valadao and signed by Reps. John Carter of Texas, Ryan Zinke of Montana and John Rutherford of Florida, all Republicans.


"Given the immense societal damage caused by prescription opioids, it is unacceptable that any private entity involved in the proliferation of these medications had the ability to influence the VA in its medical treatments of American veterans," they wrote.


All of the signatories on the letter are members of the House Appropriations subcommittee on military construction and veterans affairs.


More than 600,000 people have died in the U.S. from opioid abuse since 1999, according to the Centers for Disease Control and Prevention. Veterans were at the forefront of the opioid epidemic in the 2010s, with almost 900,000 veterans prescribed an opioid in 2012, according to data provided by the VA.


Of those veterans, more than half in 2012 were prescribed long-term opioid use, with 569,207 on long-term prescriptions and 162,444 prescribed both opioids and benzodiazepines, strong depressant drugs commonly used to treat anxiety. Those numbers have since dropped to 162,261 and 15,981, respectively, the VA said.


During that time, McKinsey was working for opioid companies Purdue Pharma and Endo while advising the VA on matters such as its health-care backlog and information technology (IT) management system used for appointment wait times.


In the 2023 report by the Journal, a McKinsey spokesman told the publication that the company had since ceased its work within the opioid industry in 2019. In court, McKinsey’s legal team has repeatedly argued the firm’s lack of guilt by pointing out that plaintiffs haven’t been able to quantify the harm they allege McKinsey caused compared to that done by drug distributors and doctors who provided opioids.


“We are proud to support VA in its work to provide veterans and others who rely on the department with world-class care,” a spokesperson for McKinsey told Military.com on Wednesday. “Our recent work includes helping VA respond to the COVID-19 pandemic by prioritizing where to increase beds, nursing and clinical support staff, and critical PPE across the system. We have also supported VA on other department priorities such as helping define a five year strategy to recruit and retain nurses.”


According to documents released as part of a $641.5 million settlement by McKinsey in 2021 with the state attorneys general of all 50 states, the company had to release documents relative to its work with opioid companies. In doing so, the consulting firm inadvertently provided evidence of a potential conflict of interest; the legal documents showcased how McKinsey used its advisory role within the VA to leverage contracts for its other clients, according to The Wall Street Journal.


A 2013 company email showed McKinsey had worked on a 10-year strategy plan for Mallinckrodt PLC, also an opioid producer, on how to boost sales of products, including hydrocodone and morphine, the Journal reported. Several months later, a Mallinckrodt executive said in an email to his colleagues that "we are looking at ways to instigate collaborative advocacy efforts with VA/DoD."


That same year, McKinsey consultants made a presentation for Purdue titled "OxyContin growth opportunities," in which consultants wrote the company should "explore institutional sales channels and ways to engage large institutions (e.g. long-term care, VA hospitals)." A second presentation given in July 2013 said Purdue should specifically target the VA for increased sales.


McKinsey, in a 2016 presentation for Endo, said the first step to get one of the company's opioid products accepted by the VA was to conduct an "assessment of select decision makers and key influencers" and the likelihood of their support of the drug's use for veterans.


"It is ridiculous that the VA has handed over so much of the decision making to contractors like McKinsey whose chief objective is profits, not veterans' well-being," Rep. Zinke said in a statement to Military.com. "I am proud to be working alongside Congressman Valadao in making sure we hold the VA accountable in best serving vets."


McKinsey and Co. has banked about $117 million consulting for the VA since at least 2009, according to government documents cited by The Wall Street Journal.


Studies show that veterans are more likely to face substance addiction issues. A 2020 study published by the National Bureau of Economic Research on the Global War on Terror's impact on the opioid use of veterans found that regardless of whether troops saw combat while overseas, a forward deployment meant they were more likely to abuse opioids than their civilian counterparts.


This was based on a threefold set of factors, the study said. The legitimate prescription of opioids for pain management stemming from injuries suffered during service; the use of opioids due to psychological traumas; and the ease of access to cheaper opioids in producing-countries like Afghanistan.


And while the VA has made significant strides in decreasing the number of opioids prescribed to veterans -- dropping the prescription rate a whopping 67% since 2012, going from 874,897 to 288,820 veterans with prescriptions in 2023 -- a report released by the VA inspector general in early December suggested the department was still failing to care for newly discharged troops suffering from opioid addiction.


The study found that almost 78% of recently discharged veterans with known opioid addictions did not have the condition listed in their VA medical records, despite having been included in their military medical records.


Weeks after The Wall Street Journal report came out last year, McKinsey settled yet another massive lawsuit regarding its role in the opioid epidemic. The company agreed to pay $78 million after settling claims from health-care insurers and health plans that they knowingly fueled the opioid addiction epidemic through deceptive marketing work.


In response to the latest claim, McKinsey reiterated that it continued to believe there was no wrongdoing in the company's past conduct, as reported by Reuters.


Despite McKinsey's claim of innocence, the lawmakers said they wanted the VA to immediately take account of its relationship with McKinsey. In the letter, they strongly suggested the VA investigate every department initiative that McKinsey has ever consulted on, seeking signs for similarly harmful conflicts of interest.


Furthermore, the representatives suggested a review of the vetting procedures used by the VA in regard to McKinsey's past and present advisory roles, in addition to providing a written response to the letter that details how the department ensures its advisers have no conflicts of interest.


A source close to those involved with the letter told Military.com that there were concerns over recent internal claims that the VA was not following its own conflict-of-interest process for McKinsey contracts it entered over the last few years. After the House Veterans Affairs Committee -- which sent a similar letter last year -- didn't receive a "sufficient" response from the VA, and recent reports that McKinsey has also been working for the Chinese Communist Party, the situation merited another look, the source said.


In an email to Military.com, Terrence Hayes spokesperson for the VA, said the department didn’t believe there was crossover with McKinsey's advisory role within the opioid industry and its work at the VA.


“VA shares Congress’s concerns regarding McKinsey’s alleged role in exacerbating the opioid crisis,” Hayes said. “VA did not award any contracts to McKinsey where the scope of work involved decision making for or influence on medication prescribing protocols.”


"Our veterans deserve answers," Valadao told Military.com in an email, "and I look forward to hearing from [VA] Secretary [Denis] McDonough about how the VA is prioritizing transparency and accountability in all contracts moving forward."


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