Where Did All the Pills Go?

On the left, number of pills per capita by county
On the right, opioid overdose death rates by county

 

The Washington Post has written some amazing stories this month about our present opioid epidemic. One of their articles described how they accessed data about the distribution of all the prescription opioid pills manufactured and consumed in the U.S. https://www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/?utm_term=.f9fb5fdb26b7

This data is amazing. There’s a box where you can enter your state or county and learn how many pain pills were sold, how many that averages per person, and which pharmacy sold the most.

For my state of North Carolina, around 2.5 billion pills were sold from 2006 until 2012. Most of these pills were distributed by Cardinal Health. Omnicare Pharmacy of Hickory, NC sold the most pills of any pharmacy, at over 9 million pills.

In my county, 26 million pills were prescribed from 2006 until 2012, enough for 55 pills per person. SpecGx pharmaceutical company manufactured the most pills sold in our county. (They make Roxicodone, called “roxies” by the patients I admit to treatment.)

The data, while interesting, needs to be interpreted with caution. For example, we could jump to the conclusion that Omnicare Pharmacy of Hickory, NC, which sold more pain pills than any other pharmacy in NC, is doing something wrong or inappropriate. But this pharmacy doesn’t sell directly to the public. It supplies opioid pain medications to assisted and skilled nursing facilities. This means the pharmacy may supply pain pill to facilities where patients stay to recuperate after orthopedic surgeries, for example. For such patients, opioid pain pills may be not only appropriate but necessary. The data is also seven years old, but that’s the way data is obtained; it takes time to collect and process information.

But the data gives overall trends and shows the staggering numbers of opioid pain pills consumed by residents of certain areas.

The Washington Post website also published two maps: one shows the number of opioid pills sold, and the other shows opioid deaths by county. The overlap, though not absolute, is striking.

The Washington Post’s recent articles contain valuable information for us, if we chose to learn from them and act on them. To me, they have given us maps of where to concentrate opioid use disorder treatment programs. Unfortunately, some of the most severely affected counties are rural, with few providers who know how to treat opioid use disorder. We’ve got to continue to focus resources on these areas.

The Washington Post also published an article about which pharmaceutical companies made the most opioid pills, which corporations distributed the most prescription opioid pills, and which pharmacy chains sold the most pills. Right now, lawsuits are proceeding against all these participants in the opioid epidemic.

The biggest manufacturers include Janssen Pharmaceutical, Purdue Pharma, Endo Health Solutions, Teva Pharmaceuticals, Allergan, and Mallinckrodt. Some of the biggest distributors were AmerisourceBergen, Cardinal Health, and McKesson Corp. The biggest pharmacy chains are CVS, Rite Aid Corp., Walgreen’s, and Walmart Inc.

The lawsuits against these companies allege that they should have notified the DEA of suspicious orders for large amounts of opioids, and that they violated the Controlled Substances Act by failing to report. Some lawsuits against pharmacies allege the pharmacies had to know that medications were being diverted to the street.

Other than that, I’m not sure I understand the basis of these lawsuits.

For sure, if a company mislead physicians in its marketing, as many people feel that Purdue Pharma did, I understand that as a crime.

But I don’t know enough about what manufacturers and distributors and pharmacies are supposed to do when supplying opioids. This must be driven by physicians’ prescriptions, I would think. I doubt drug companies would manufacture opioids unless there was a demand, or that distributors would distribute and pharmacies would sell, unless there are legitimate physicians’ prescriptions.

I don’t understand how we can expect manufacturers, distributors and pharmacies to know more about good prescribing than physicians should. And physicians surely did underestimate the dangers of these medications, thanks in part to the so-called experts, who downplayed the risks of long-term opioid prescribing for chronic pain. Also, the “under-treatment of pain” movement accused doctors of being callous to suffering and encouraged them to view pain as the “fifth vital sign.”

At any rate, Washington Posts’ series of articles bring some facets of the opioid epidemic to light.

 

 

 

3 responses to this post.

  1. Posted by Chuck on July 28, 2019 at 8:16 pm

    Bottom line is everyone knew opiates were dangerous, doctors and so called experts are the only ones that should be going to prison , they took a oath to do no harm. The people selling them were doing their jobs , this is the American way . Sell as much of your product as possible no matter what the cost . Capitalism!!! Now every penny made off opiate sales during that time should be given to everyone addicted to opiates , methadone/bupe treatment should be funded so it’s free ! Like every other country does . But our greedy government will keep settlements going that fine these crooks pennies on the dollar , what’s 500 million when they made 8 billion? But people need to know that a lot of money was given to lobbyists and to campaigns to buy FDA approval . It’s sad how after the government helped cause the epidemic now people who need medication to treat the disease have to do the medication shuffle , go to a clinic to beg for the life saving medication they need , don’t miss a useless counselor session or no meds for you , and it’s a life sentence, no matter how well you do the best you can hope for after 20 years of doing everything right and functioning on a low dose is 13 take homes and monthly counseling, child molesters are treated better by our government. Sex offenders get off with checking in once a year . There needs to be changes , if it is a disease then after you have shown you can live your life as good as anyone else you should be able to go to the dr like everyone else. Fact is if they just did away with clinics it would save millions , people would go to a dr and cvs for methadone and if they need counseling great but most don’t , they just need medication. A simple thing . Obviously there will be people who still use and sell it but no one looks for these meds to abuse , they seek them out to get clean , to stop withdrawal. But we have old crusty politicians who let stigma and discrimination dictate . I think so many overdoses would of been prevented if methadone could of been easier to get . It’s a fact people are better off taking it and using because it prevents overdose, especially with new powerful opiates today .nothing will change though because no one cares about a drug addict until it’s someone they love !

    Reply

    • Data says otherwise. Back in 2007, when methadone was being prescribed as cheaper pain medication, methadone overdoses increased dramatically.

      Reply

  2. Posted by Trudy Duffy on July 29, 2019 at 3:03 pm

    Possibly some of the questions you are raising, are the same ones the distributors should have been questioning. All pills are not equal, marketing drove overprescribing of potent and addictive medications. I recently read the 2003 GAO report on OxyContin and was astounded to realize how much was already known 15 years ago. Would be interested in your opinion as it’s driving me crazy to think of the lives lost and destroyed.

    Reply

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