Pharmland: How a Small-Town Opioid Booster Became a Big-Time Public Health Threat
Ralph Abraham’s forgotten record on opioids, Medicaid, race, and self-dealing is far more alarming than his anti-vaccine posturing.
Preface | Abrahamic Flaws
In Mangham, a small village in northeast Louisiana where Dr. Ralph Lee Abraham, Jr. built his career,1 everyone has a story to tell about their most notable and celebrated native son. For years, Abraham served as one of Richland Parish’s only physicians, operating his medical practice out of a small brick building near the intersection of US Highway 425 and Louisiana Highway 132.
In America’s patriarchal popular imagination, the “country doctor” is almost always an honorable, humble, and deeply respected man. He may not have attended the fanciest medical school or felt comfortable in a big city, but somehow, he was a specialist in everything and a friend to everyone.
Before he became known as “Doc,” Ralph Abraham was a farmer. Like nearly everyone in Richland Parish, Abraham grew up on the family farm. After high school, he crossed the Mississippi River into Natchez, drove two hours south down the Blues Highway back into Louisiana, and eventually found his way to LSU. Abraham had already charted out the next eight years. He knew what he wanted to become: a veterinarian, an in-demand profession in a region where there are nearly as many farm animals as people. He graduated from LSU’s School of Veterinary Medicine in 1980.
For about a decade, Abraham was a full-time veterinarian. In 1990, he decided to switch careers and enroll in medical school at LSU-Shreveport. Although he’s never directly explained his decision, Abraham has spoken about “money being tight.” He finished the program and affixed “M.D.” to the end of his name in 1994.
“I was raised on a farm, a member of 4-H, a practicing veterinarian for 10 years, and am still an active farmer. At one time, I had several head of cattle. My father-in-law still runs a couple of hundred head of cattle,” Abraham told Valerie Goddard in a 2015 interview for the American Veterinary Medicine Association’s trade publication. “So having that base, including all of the things I’ve done in my life, has helped me do two things: It gives me a baseline since I know what it takes to run a ranch or a farm, but it also gives me a wealth of knowledge so that when I am asked in committees on the Hill for my take, I can give them a very educated response, not only from that knowledge base, but also from the practical side.”
When news broke that Abraham had been quietly installed as the number-two official at the Centers for Disease Control and Prevention, nearly all of the national coverage cast him in a single role: the anti-vaccine doctor elevated to de facto command of America’s premier public-health agency. And all of that is accurate.
As Louisiana’s first surgeon general under Gov. Jeff Landry, Abraham ordered the state health department to stand down from mass-vaccination efforts, questioned the safety of COVID vaccines, and championed “natural immunity” in the middle of a pandemic. But if the story stops there, it misses something essential.
Years before he became surgeon general, Abraham built a record that should unsettle anyone who relies on the CDC—meaning everyone.
In a series of investigative reports for The Bayou Brief between 2018 and 2020, I documented a pattern that runs through Abraham’s career as a physician, pharmacist, farmer, and politician: Deep contempt for the poor, aggressive profiteering in the middle of a drug epidemic, casual race-baiting, selective outrage about environmental harm, and a willingness to use the language of charity as political camouflage.
Those stories were written in the heat of a Louisiana governor’s race that Abraham ultimately lost. Once he faded from the national stage, much of that reporting faded with him.
His rise inside the CDC makes those forgotten pieces newly—and nationally—relevant.
The public record of his time as Louisiana surgeon general is stark. Abraham:
Directed the state health department to halt active promotion of vaccines, including basic childhood immunizations and annual flu shots.
Cast doubt on the safety of COVID-19 vaccines, even as they were preventing hospitalizations and deaths.
Emphasized “natural immunity” and personal choice in ways that signaled skepticism about core public-health tools.
Those decisions alone would be enough to question his fitness for national leadership. But my previous reporting establishes that Abraham’s approach to health policy did not suddenly veer off course during COVID. It had been off course for a long time.
Medicaid, contempt, and a fundamental misunderstanding of public health
In March 2019, at a $250-a-plate luncheon in Natchitoches, Louisiana, Abraham was recorded answering a question about Medicaid expansion—specifically, about alleged “waste, fraud, and abuse.” The questioner’s numbers were wildly exaggerated; Abraham did not correct them. Instead, he turned the moment into an indictment of low-income patients and the programs that insure them.
I obtained and published the audio.
On tape, Abraham:
Falsely suggested that people with employer-based insurance had been “mandated” into Medicaid expansion, revealing a shaky grasp of how the program actually functions.
Confused the Emergency Medical Treatment and Labor Act—a 1986 law requiring emergency rooms to stabilize patients regardless of their ability to pay—with the Affordable Care Act, passed in 2010.
And then he went further. Abraham complained that he was “tired of people voting for a living instead of working for a living,” explicitly tying Medicaid recipients to a voting bloc whose supposed crime was using the democratic process to protect their health coverage.
The district he represented, Louisiana’s Fifth, is the tenth-poorest congressional district in the country. Medicaid expansion delivered dramatic coverage gains there, significantly reducing the number of uninsured residents and propping up fragile rural hospitals. Abraham’s constituents were among the main beneficiaries of the policies he misrepresented and mocked.
The portrait that emerges is not of a technocrat quibbling over program design. It is of a physician-legislator who views a key public-health program through a lens of resentment and contempt, and who struggles with basic facts about the most significant domestic-policy changes of the last generation.
That worldview matters when the same man is now in a position to shape how the federal government approaches health coverage, outreach, and trust-building in poor and rural communities.
“Pharmland”: the doctor, the pharmacist, and 1.4 million opioid doses
The most haunting aspect of Abraham’s pre-CDC record may be what I uncovered about his small-town medical empire and the role it played in the opioid crisis.
Abraham is not just a physician. For years, he also owned and operated pharmacies attached to his clinics—most notably Clinic Pharmacy in Mangham and Adams Clinic Pharmacy in Winnsboro, tiny communities in northeast Louisiana. Using Drug Enforcement Administration data released as part of The Washington Post’s “Pill Mill” project, I documented that from 2006 to 2012, those two pharmacies dispensed 1,478,236 doses of opioids.
The combined population of Mangham and Winnsboro is only a few thousand people.
In “Pharmland,” I walked through the numbers: over seven years, Abraham’s pharmacies “doled out 1,478,236 doses of powerful opioids.” The volume placed them far above the national average for per-capita opioid distribution, year after year.
In a follow-up investigation, “Apples to Apples: A Tale of Two Pharmacies,” I compared Clinic Pharmacy to a competitor less than a mile away, Mangham Rx. Both served essentially the same tiny market. Yet:
Abraham’s pharmacy exceeded the national per-capita opioid average in every year studied.
Mangham Rx stayed under that average.
While both pharmacies purchased comparable amounts of certain drugs like OxyContin, Abraham’s operation “dominated the market on hydrocodone,” another widely abused opioid.
I reconstructed the likely “catchment area” for the pharmacies by drawing a 10-mile radius around Mangham and examining Census data for the population within that circle. Even under generous assumptions about who those pharmacies could reasonably serve, the volume of pills moving through Abraham’s businesses strained plausibility.
In a later story, I boiled down the implications: just at the pharmacy level, the numbers worked out to roughly 41 opioid pills per man, woman, and child in the area every year for seven straight years.
The problem was not just that Abraham owned high-volume pharmacies. It was that he was also one of the state’s most enthusiastic prescribers.
The prescriber behind the counter
In “A Bountiful Harvest,” I analyzed Medicare Part D data from 2013, the year before Abraham first ran for Congress. Among more than 700 family-practice physicians in Louisiana, Abraham ranked 11th in total opioid claims.
The raw figures were startling:
Abraham wrote 1,856 opioid prescriptions in 2013 alone.
Those prescriptions went to 400 of his 955 Medicare Part D patients—about 41 percent.
In Richland Parish, where Mangham is located and where Abraham’s clinic is based, the total population over age 65 is only a few thousand; his opioid patient load represented a double-digit share of local seniors.
By 2014, when he was actively campaigning for Congress, Abraham still managed to file 1,286 opioid claims for 343 patients.
The Centers for Medicare & Medicaid Services calculates an “opioid prescriber rate” based on claims, a statistic that can make heavy prescribers look ordinary if they also write large numbers of non-opioid scripts. Abraham’s rate appeared near average by that measure. But simple percentages can mislead: in absolute terms, Abraham was effectively one of the state’s rural opioid super-prescribers.
A salesman for OxyContin
Abraham’s affinity for opioids was not confined to his prescription pad or his pharmacy ledger. In a 2014 congressional debate, he was asked about marijuana legalization. He opposed recreational use and dismissed medical marijuana outright, even as many states were adopting it as a safer, non-addictive alternative for chronic pain.
Instead of acknowledging the growing body of evidence about cannabis and pain management, Abraham pivoted to a defense of brand-name opioids. He touted drugs like Dilaudid and OxyContin as doing “a much better job” than marijuana for chronic pain—this at a time when lawsuits, exposés, and academic research had already established OxyContin’s central role in fueling a national addiction crisis.
It was an extraordinary statement for a physician from a rural state ravaged by opioid overdoses and dependence.
Taken together, the pharmacy data, prescription data, and public remarks depict a lawmaker-doctor who profited handsomely from the very drugs now at the heart of a nationwide wave of suffering—and who dismissed safer alternatives even as the crisis mounted.
That history is now stapled to the résumé of a man helping oversee the CDC’s work on addiction, pain management, and pharmaceutical guidance.
“Pharmland” hypocrisy: preaching against “handouts” while cashing them
I also looked into Abraham’s role as a farmer and recipient of federal subsidies.
Publicly, Abraham has embraced the usual conservative gospel about “handouts” and dependency. In 2018, he told a Louisiana newspaper, “No one will ever break the cycle of poverty by relying on the government for a handout.” At the time, he was pushing to impose stricter work requirements on recipients of the Supplemental Nutrition Assistance Program (SNAP), the main federal food-assistance program.
The change he championed would have stripped benefits from more than a million Americans, including tens of thousands of families in his own district—one of the poorest in the country.
I obtained federal data on farm payments and discovered that Abraham and his immediate family had personally received more than $2.6 million in agricultural subsidies over the years. The same politician who derided “handouts” had built a quiet fortune, in part, on exactly that: predictable, annually renewed government payments.
This pattern was not unique to him. Multiple Republican candidates, including Abraham’s preferred successors, campaigned on fighting “socialism” while collecting large federal farm checks. Abraham simply functioned as an early, particularly vivid example.
In the context of the CDC, this hypocrisy matters because public health rests on the premise that collective action is sometimes necessary and legitimate: vaccines, sanitary infrastructure, disease surveillance, food support during recessions, and disaster response. Abraham’s rhetoric has consistently painted such interventions as corrosive when they help the poor, even as he quietly embraced them when they flowed into his own accounts.
The “Abra-Scam”: charity as a campaign prop
In one of the most detailed investigations of Abraham’s career, I dug into a campaign promise that the congressman made in 2014 and then appeared to abandon: a pledge to donate his entire congressional salary to two charities, St. Jude Children’s Research Hospital and the Independence Fund, which aids severely wounded veterans.
The pledge was widely touted during his first run for Congress. A letter to the editor in a local paper, shared and amplified by Abraham’s campaign, described him as a man who did not need the money and had “dedicated his salary as congressman” to those causes. It was an effective piece of political theater, burnishing his image as a selfless public servant.
I tried to track what happened to that promise. If Abraham had followed through, the numbers would have been substantial:
Roughly $348,000 in donations during his first term alone.
Around $696,000 by the end of his second term.
Yet when I combed through campaign materials, charity records, and public disclosures, I found no evidence that Abraham had made contributions anywhere near that scale. By then, references to the pledge had quietly vanished from Abraham’s website. The letter that once touted it had been scrubbed or downplayed.
I dubbed the episode “the Abra-Scam,” not because Abraham had never donated anything—he had made smaller contributions—but because the sweeping, vote-winning promise to give away his entire salary appears to have morphed into something far more modest once he was safely in office.
Public health depends on public trust. When federal officials tell people to line up for a vaccine, avoid a dangerous drug, or evacuate ahead of a storm, those commands land differently if the officials have a record of weaponizing charity as a campaign device while quietly hedging on the actual follow-through.
Abraham’s salary gambit suggests a comfort with exactly that sort of sleight-of-hand.
Missing in action: when the work collides with ambition
I also chronicled a simpler, but telling, pattern: Abraham’s tendency to go missing when congressional duty conflicted with his political ambitions or social calendar.
In January 2018, during a partial federal government shutdown, Abraham skipped several votes in the U.S. House of Representatives to attend an “Elephant Gala” fundraiser in New Orleans featuring former White House chief of staff Reince Priebus. Other members of the state’s congressional delegation, aware of the optics, stayed in Washington. Abraham chose the gala.
As the 2019 Louisiana governor’s race heated up, his absenteeism grew. I tracked Abraham’s voting record and found that, beginning in early April 2019, he missed roughly 70 percent of House votes for months while he campaigned, an absentee rate far higher than that of other members running for higher office, including some seeking the presidency.
The congressional salary that he had once promised to donate continued to be paid. The votes that salary was meant to buy went uncast.
For a CDC leader, the analogy is grim. Epidemics, outbreaks, and chronic health crises do not pause for election cycles. The agency’s senior leadership is expected to show up—physically and politically—even when it is difficult or unpopular. Abraham’s record suggests that when forced to choose, he has often prioritized optics and personal advancement over the unglamorous work of governing.
“Go back” politics: race, nativism, and the public-health divide
Public health does not exist in a vacuum; it is braided tightly with race, immigration, and civil rights. In “Flying in the Wrong Direction,” I dissected Abraham’s response to one of the most notorious racist outbursts of the Trump era.
In July 2019, President Donald Trump attacked four Democratic congresswomen of color—Alexandria Ocasio-Cortez, Ilhan Omar, Ayanna Pressley, and Rashida Tlaib—telling them to “go back” to the countries they came from, even though three of the four were born in the United States. The phrase “go back where you came from” has a long history as a white-supremacist taunt.
Rather than distance himself, Abraham amplified the cruelty. He publicly offered to pay for their plane tickets to “another country of their choice,” embracing the same language that had been used for generations to marginalize Black Americans, Jews, immigrants, and political dissidents.
Ironically, Abraham himself is the grandson of Lebanese immigrants and, earlier in his career, had proudly participated in Arab-American political organizations and co-founded a congressional caucus focused on U.S.–Lebanon relations. Under Trump, he repositioned himself, aligning with an administration that aggressively targeted Muslim-majority nations and refugees.
That dissonance matters for public health. Communities of color and immigrant communities have enduring reasons to distrust federal authority; they have been subjects of experimentation, neglect, and hostility. Any credible CDC strategy must acknowledge and work to repair that history. Abraham’s record suggests a different instinct: exploiting racial and nativist resentment when it is politically convenient.
Suing Big Oil—for himself
Another piece, “After a Pipeline Ravaged His Farm, Rep. Ralph Abraham Sued Big Oil,” highlights a very specific sort of environmental conscience.
For years, Abraham presented himself as a staunch ally of the oil and gas industry, dismissing coastal land-loss lawsuits and environmental regulations as job-killing overreach. Politically, he aligned with those who mocked Louisiana parishes and levee authorities for suing energy companies over wetlands destruction and pipeline damage.
Yet when a pipeline company crossed his own land and allegedly damaged it, Abraham and his son-in-law quickly turned to the courts.
Their lawsuit against Gulf South Pipeline Company accused it of failing to restore the property, interfering with irrigation and drainage, and causing crop losses and diminished yields. The description could have been lifted from the legal complaints filed by fishermen and coastal landowners along Louisiana’s vanishing wetlands—people whose grievances Abraham and his allies often portrayed as frivolous or greedy.
Out of all the major candidates in Louisiana’s 2019 governor’s race, Abraham was the only one who had personally sued an oil and gas company. The gap between his public rhetoric and private actions was not subtle. It was the kind of contradiction that only looks normal in a political culture where different rules are assumed to apply to people with enough land, enough money, or enough clout.
In a CDC role, where the agency must increasingly address climate-driven health risks, environmental contamination, and industrial disasters, Abraham’s pattern is cause for concern. His empathy for environmental damage appears strongest when his own property is at stake.
The money loop: flying himself and paying himself
My reporting also zoomed in on the smaller grifts that can reveal a politician’s instincts.
Abraham is a licensed pilot. During his gubernatorial campaign, his campaign committee reimbursed him for substantial amounts of “flight time” on a private plane he piloted himself. In campaign-finance reports, payments to Abraham Aviation, LLC eventually reached into the tens of thousands of dollars.
There is nothing inherently illegal about a candidate’s campaign renting services from a business he owns, provided it is transparently reported and priced at fair-market value. But the arrangement reinforces a theme: when public or political funds are in play, Abraham often finds a way to position himself on both sides of the transaction—as payer and payee.
Paired with his behavior on farm subsidies and the congressional salary pledge, a portrait emerges of a politician who sees public money and campaign money as tools to be optimized for personal benefit, not as resources held in trust for the public.
Inside the CDC, where partnerships with pharmaceutical companies, hospital systems, and research institutions are constant, that mindset has implications. The lines between public interest and private gain must be rigorously enforced. Abraham’s career to date offers little evidence that he sees those lines as sacred.
The pattern, not the anecdotes
Taken individually, each of these stories could be dismissed as “local politics” or explained away by spin: a misunderstood speech here, an overzealous pharmacy there, a sloppy promise to charity, a single ugly tweet.
Laid side by side, however, they reveal a consistent pattern:
On health policy, Abraham has displayed basic misunderstandings of core programs like Medicaid and the Affordable Care Act while framing low-income patients as freeloaders and voters as parasites when they support those programs.
On addiction and pharmaceutical ethics, he has been both an aggressive prescriber and a profitable dispenser of opioids in a region devastated by addiction, all while publicly touting OxyContin and similar drugs as superior to safer alternatives.
On economic justice, he has collected millions in federal farm subsidies while vilifying “handouts” to poor families and pushing to restrict food aid in one of America’s poorest districts.
On personal ethics, he leveraged a promise to donate his salary into a powerful campaign branding device and then failed to deliver the scale of generosity he implied, skipped work for fundraisers, and used campaign funds to reimburse his own aviation company.
On race and belonging, he aligned himself with some of the harshest nativist rhetoric of the Trump era, offering to pay for congresswomen of color to “go back” to other countries, even as he benefited from an immigrant family story of his own.
On environmental responsibility, he mocked or minimized lawsuits against industry until his own land was affected, then embraced the same legal tools he had condemned.
Overlay that record with his more recent tenure as Louisiana surgeon general—cutting back vaccine outreach, elevating ideological talking points over epidemiological evidence, and feeding public confusion—and the implications for the CDC become hard to ignore.
This is not merely a story about one man’s opinions on vaccines. It is about a cluster of habits and loyalties that are fundamentally at odds with the mission of any public-health agency:
The habit of punching down at the poor while quietly cashing government checks.
The habit of blurring the line between healer and profiteer in the middle of a drug crisis.
The habit of treating racial resentment and nativism as useful tools.
The habit of turning charity and patriotism into campaign props rather than guiding principles.
Americans often encounter the CDC in its most sterile form: as a website, a chart, a set of recommendations about which shots to get and when, which foods to avoid, and which behaviors increase risk. It is easy to forget that those recommendations are shaped by people—fallible, political, ambitious people—who bring their histories into the building with them.
My reporting on Ralph Abraham, produced years before anyone imagined him near the upper ranks of the CDC, functions now as an X-ray. It shows not just a politician with bad vaccine takes, but a long-standing pattern of decisions that privilege profit and ideology over evidence and empathy.
That pattern did not start in Atlanta. It started on a pharmacy counter in Mangham, in committee rooms in Washington, on a family farm flush with subsidies, in lawsuit filings against a pipeline company, and at gala fundraisers held while the government he was elected to serve ground to a halt.
The question, as Abraham settles into his position near the top of America’s public-health hierarchy, is whether that pattern will be allowed to shape the next generation of decisions about who gets care, who gets believed, and who gets left behind.
Bibliography:
https://www.bayoubrief.com/2019/03/23/in-audio-clip-rep-abraham-blames-medicaid-recipients-for-voting-for-a-living-instead-of-working/
https://www.bayoubrief.com/2019/08/28/pharmland-ralph-abraham-opiods/
https://www.bayoubrief.com/2019/09/06/apples-to-apples-a-tale-of-two-pharmacies/
https://www.bayoubrief.com/2019/05/08/__trashed-3/
https://www.bayoubrief.com/2019/04/06/after-a-pipeline-ravaged-his-farm-rep-ralph-abraham-sued-big-oil/
https://www.bayoubrief.com/2019/07/17/flying-in-the-wrong-direction/
https://www.bayoubrief.com/2019/09/02/excuses-for-the-doctor/
https://www.bayoubrief.com/2019/01/18/abraham-won-by-pledging-salary-to-veterans-group-and-st-judes-hospital-he-now-owes-them-between-348k-696k/
https://www.bayoubrief.com/2018/01/21/hours-after-the-government-shut-down-rep-abraham-skipped-town-and-skipped-votes-to-attend-fundraiser/
https://www.bayoubrief.com/2019/09/08/a-bountiful-harvest/
https://www.bayoubrief.com/2020/10/23/in-louisianas-fifth-district-gop-candidates-pledge-to-fight-socialism-while-subsidizing-farmers/
Mangham may claim him, but Abraham is actually from the unincorporated community of Alto, about nine minutes away. The community’s musical name, which means “high” in Italian, refers to its perch above the Boeuf River and the surrounding flat farmland. Alto had been spared during the devastating floods of 1927. “We remained high and dry whereas all the surrounding lands went under,” the artist Lucy H. Sartor remembered decades later.
Alto’s most notable and celebrated native son is the internationally renowned artist, Don Cincone.