Resistance to FDA’s opioid-disposal plan raises concerns about CADCA, a powerful advocacy group

At its surface, it seems like a simple problem with a simple solution. Across the country, medicine cabinets are littered with unused, potentially addictive opioids. So the federal government wants to distribute prepaid envelopes alongside new painkiller prescriptions, allowing Americans to mail back their leftovers.

But the seemingly innocuous proposal has generated opposition from a surprising source: the Community Anti-Drug Coalitions of America, a powerful nonprofit organization that has dominated drug policy advocacy in Washington for decades.

CADCA has argued that the plan is dangerous — largely on the grounds that putting the pills in the mail creates opportunities to steal them. Instead of requiring that opioid prescriptions include a prepaid envelope, the group says, they should include “environmentally safe drug deactivation devices,” or at-home kits that render prescription drugs inert.

Other advocates, however, see a different motive: CADCA’s cozy relationship with Deterra, a private company that manufactures and markets drug deactivation devices.

“There’s very clearly a conflict of interest,” said Jim Crotty, the former deputy chief of staff of the Drug Enforcement Administration. “I’m sure there are mixed motives, because I know that these people mean well and want to save lives. But there is also a business interest involved.”

Deterra, which launched in 2011, markets a “pouch” full of activated carbon that allows users to disintegrate prescription pills at home by simply adding warm water. A pack of three costs $21 on Amazon.

The pouches can help Americans avoid leaving unused prescription opioids, which are sometimes misused and can lead to addiction, around their house and available to anyone with access to the medicine cabinet.

Some experts, however, say the need for Deterra’s product is exaggerated — including Crotty, who called the drug disposal kits “almost a solution in need of a problem.”

CADCA’s enthusiasm for the product has raised questions in Washington addiction policy circles about its connections to Deterra and its Minnesota-based parent company, Verde Technologies. The company is a major CADCA donor, and is listed as a presenting sponsor of the group’s annual Drug-Free Kids Campaign Awards Dinner.

The two organizations are also intertwined on a far deeper level. CADCA’s president and CEO, the former U.S. Army Gen. Barrye Price, sits on Deterra’s board. Mary Bono, the former Republican congresswoman who chairs CADCA’s board of directors, also sits on Deterra’s board of directors.

In an interview, Price pushed back strongly against suggestions of a conflict of interest, calling them “absolute bullshit.” But he declined to disclose how much money Deterra has donated to CADCA, saying he was bound by a non-disclosure agreement.

He said that while he supports the use of at-home drug disposal devices, he has “never specified a brand or a company.”

Price’s past advocacy paints a different picture. While CADCA, as a nonprofit, does not market or endorse specific products, it made an exception in 2020. In an effusive statement, Price noted that CADCA’s endorsement of Deterra’s drug-deactivation system was the organization’s first product endorsement in its 30-year history.

“CADCA trusts Deterra products over other products in the market to deactivate and dispose of unused medications because the Deterra products’ effectiveness is proven by multiple independent scientific studies,” Price wrote then. He added, “Only Deterra products accomplish what they say they can do.”

Others are more skeptical.

Margaret Shield, a Ph.D. biochemist and policy consultant who has advised numerous local governments on drug-disposal strategies, said products like Deterra’s could be useful in some settings, but hadn’t been adequately studied.

Referring to Deterra, she said: “I believe it’s part of their overall lobbying strategy to work themselves into a position where, for example, the FDA might require that their products are distributed. Because boy, wouldn’t that be a high-volume, profitable place for them to be?”

A Deterra spokesperson declined to comment, and referred STAT’s requests for comment to CADCA.

CADCA’s relationship with Deterra — and its opposition to a proposal that would doubtlessly cut into Deterra’s bottom line — is a case study in the murky world of Washington advocacy. But it is also noteworthy because of CADCA’s sheer influence. The nonprofit is seen as a heavyweight when it comes to drug and addiction policy, and it has received roughly $60 million in federal contracts and grants in the past decade alone.

Even if at-home drug disposal kits are as effective as advertised, experts say, they should be viewed as just one of many potential tools used to prevent addiction.

“There’s not going to be a one-size-fits-all approach to this,” said Anish Agarwal, a physician-researcher at the University of Pennsylvania who has studied opioid take-back programs, including at-home disposal kits. “Increasing the options for patients to dispose, and making it really easy, is important. The proposal to include mail-back kits is going to inherently increase the odds that some patients will mail them back.”

Besides, Shield said, suggesting that opioid mail-back programs are dangerous is misleading. Opioid mail-back is not particularly new. It is already allowed under a regulation from 2014, and numerous states, including California, New York, and Washington, already allow prescription opioids to be returned via the mail.

“The FDA proposal to require prepaid mailers be provided with opioid prescriptions — I think it’s another tool in our toolbox, and I think it’s worth doing,” Shield said. “The evidence that I’m aware of from mail-back programs is that they are safe, and I don’t believe they’ll lead to diversion. Quite the opposite: They’re a tool to prevent diversion of medicines from the home.”

In its public comment in response to the FDA’s proposal, CADCA charged that allowing opioid mail-back would create opportunities for the drugs to be stolen.

“Congress has worked hard to keep opioids out of the mail,” the organization wrote. Such efforts, however, have largely focused on illicit fentanyl sent in bulk from China — not small handfuls of prescription medication like Percocet or Vicodin.

“I’m an honorable man,” Price, CADCA’s CEO, told STAT. “I only want the problem to go away. And the thing is: I believe the envelopes are a dumb idea. And I told the FDA that. I think it’s a stupid idea.”

Price, and others who commented publicly on the FDA’s proposal, also argued that the FDA’s mail-back envelopes would be easily recognizable, making things easy for would-be thieves. Price cited statistics showing that assaults on U.S. mail carriers have increased in recent years, and said putting more narcotics in the mail would only put postal workers at greater risk.

Many experts interviewed by STAT — including some who declined to speak on the record for fear of angering CADCA — were skeptical that putting opioids in the mail posed any significant risk. Even those who did see a danger said the proposal’s benefits probably outweighed its costs.

“I can absolutely see criminals taking advantage of that,” said Crotty, the former DEA official. “But is that risk greater than the nephew, the teenager, [accessing the pills]? My gut would say probably not.”

In a statement, an FDA spokesperson stressed that the agency is developing the proposal in close consultation with the U.S. Postal Service.

“The Drug Enforcement Agency and United States Postal Services have regulations and policies to ensure that mail-back envelopes are fit for purpose,” she wrote. USPS, she added, “has longstanding policies in place to safely and securely transport mail-back envelopes to the location where they will be destroyed.”

It’s not yet clear whether, or when, the FDA will move forward with the proposal. But some drug and addiction policy experts say they’ve become disillusioned with the process — and with CADCA in particular.

“I’ve been working on drug take-back since 2008, and over the years, CADCA’s positions on drug disposal have been a bit confusing,” Shield said. “I’ve wondered before about any influence from their corporate sponsors. But I would certainly say: They’re not the only entity working in this space where I have those questions.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.

Get your daily dose of health and medicine every weekday with STAT’s free newsletter Morning Rounds. Sign up here.