Recently released opioid data shows millions of pain pills were dispensed here 2006-2012
More than 2 million oxycodone and hydrocodone pills, the equivalent of 34.3 pills per person per year, were dispensed in Ozark County from 2006 through 2012, according to a recently released Drug Enforcement Administration data base that “tracked the path of every single pain pill sold in the United States — by manufacturers and distributors to pharmacies in every town and city.”
The data base was made public last week by the Washington Post after a year-long legal battle in which the Post and the Charleston (W. Va.) Gazette-Mail sought access to the DEA’s Automation of Reports and Consolidated Orders System (ARCOS), “which the government and the drug industry had sought to keep secret,” the Post says in its online story with links to the easy-to-use interactive map (visit https://wapo.st/DEA-pain-pill-database?tid=ss_mail).
The database was accessed by the newspapers as the result of a court order in what is being described as the “largest civil action in U.S. history. About two dozen companies are being sued in federal court in Cleveland by nearly 2,000 cities, town and counties,” the Post said, adding that the “defendants in the case include giant drug distribution companies … and manufacturers….”
Ozark County Presiding Commissioner John Turner said Monday that Ozark County is not participating in the Ohio civil case. However, he added that the commission is considering a similar suit that’s being organized and the commissioners may decide to join it.
Using the DEA’s ARCOS information, the Post analyzed shipments of oxycodone and hydrocodone pills, “which account for three-quarters of the total opioid pill shipments to pharmacies,” the Post says on its database website. The newspaper “is making this data available at the county and state levels in order to help the public understand the impact of years of prescription pill shipments on their communities,” it says.
Opioid distribution in Ozark County was relatively low, compared with other counties along the Arkansas line in southeast Missouri. In neighboring Howell County, 19.7 million prescription pain pills were dispensed, enough for 71 pills per person per year. The highest numbers were supplied to Butler County, where 29.5 million pills, enough for 99 pills per person per year.
Changing trends in pain management
During the years covered by the database, 2006 through 2012, more hydrocodone\APAP (hydrocodone with acetaminophen) was dispensed in Ozark County than any other drug, pharmacist Craig Atkins told the Times Monday. He added that Ozark County pharmacies dispense many prescriptions written outside the county, especially from Howell and Greene County, as well as from Baxter County, Arkansas – places where many Ozark Countians seek medical care.
Atkins, who owns Court Square Pharmacy in Gainesville and Theodosia Pharmacy in Theodosia, said the situation has improved in the last few years. “Here in Ozark County, the number [of hydrocodone pills dispensed] has definitely gone down,” he said.
Atkins said when he began his pharmacy career in 1990, a lot of the opioid pain meds that have made headlines recently were prescribed only rarely, usually in end-of-life situations. “When I first started, we didn’t dispense narcotic pain meds anything like we did later. Things like fentanyl patches, you just didn’t see except maybe end-stage cancer,” he said.
Then, around the year 2000, the prevailing attitude in the medical community seemed to change, he said. “The mindset became, let’s help people with pain issues and treat the pain more aggressively,” he said.
That aggressive mindset led to the situation where, from 2006 to 2012, 76 billion oxycodone and hydrocodone pills were distributed to Americans throughout the country, with places like the rural town of Norton, Virginia, becoming hot beds of opioid distribution, addiction and overdose deaths. The ARCOS database shows that, from 2006 to 2012, 8.3 million prescription pain pills, enough for 305 pills per person per year, were distributed in Norton, a city with a population of 4,000 people. The Post reported that during that time in Norton “the per capita death rate from prescription opioid overdoses was 18 times the national rate.”
The numbers were smaller here in Ozark County, where “only” 2.3 million prescription pain pills were dispensed, enough for 34 pills per person per year. But the grim tragedy of death by prescription-drug overdose is equally familiar. For example, a 2010 story in the Times reported that three people had died of overdoses since 2008, one each year, at what then-Sheriff Raymond Pace called “a known drug house” in Tecumseh. At least one, and possibly two, other previous deaths were also thought to be linked to the house.
By the time a fourth person had died of an overdose in the house in 2013, Darrin Reed was sheriff. “I’m madder than hell over it, but what can you do when it’s prescription drugs?” Reed said at the time. “They’re not illegal.”
“All of these families, they’re good people – good parents, good kids – but they’ve had a hard way to go because that person in their family got messed up with these drugs,” previous sheriff Pace added.
“It’s hard to combat prescription drug abuse because they’re legal,” Reed said. “We’ve been to that house [where the four people had died] before, and what we found is exactly what we found when we worked the death last week: bottles of prescription meds with the names of the people in the house. You can’t take someone’s prescription medicine away from them,” he said.
Reed, who could not be reached for comment on this story, said in 2013 in Ozark County homes where drug abuse is suspected, he’d found multiple bottles of the same drug issued to the same person by different doctors.
“Or you go into a home and you know they’re abusing when they have a prescription for 100 pills, and it’s the third day and only 10 pills are left,” he said. “That’s what happens when insurance companies let drug abusers have prescriptions for a three-month supply. Then after a couple of weeks they come crying to me that their drugs were stolen, and they can’t get another refill unless they can show a police report. That’s why the sheriff’s office won’t take reports on stolen narcotics. We’re just not going to be a part of that,” Reed said back then. “I’m not saying this is the case 100 percent of the time, but the majority of the time, it’s drug seekers.” (Editor's update: Pharmacist Craig Atkins asked the Times to make this clarification in reference to Sheriff Reed's 2013 comment about three-month supplies of prescribed drugs. "Sometimes three-month supplied are allowed for controlled substances, but never for a Schedule II controlled substance. That includes oxycodone and hydrocodone narcotics (and narcotics in general). Only a one-month supply is allowed per federal and state law.")
The Tecumseh “drug house” burned in September 2013. Arson was suspected.
A growing awareness of the risk of dependency
Atkins attributes the trending reduction in opioid painkillers being dispensed here to the fact that “practitioners – and everyone – is more aware of the issues surrounding narcotics and their use. For some people, they’re very appropriate, but you have to be careful.”
Being “careful” may mean being aware of figures issued by the Centers for Disease Control and Prevention, developed by Sarah Frostenson and reported by Vox, that say the risk of opioid dependence spikes after just four or five days on the narcotic.
“For instance,” said one physician, “you sprain your ankle, get a prescription for five days of narcotic, and there’s a 10 percent chance you’ll still be on an opioid in a year. If you get 10 days’ worth, there’s a 25 percent chance.”
Atkins credits the growing awareness of these risks for helping people and medical practitioners be more mindful of the dangers linked to opioids.
“Now that everything’s been in the news about the dangers, the DEA is very aware of the issues and is letting practitioners know we have a problem,” Atkins said. “I think that’s the biggest reason why we can say with confidence that the last few years, we’ve seen a pretty steep decline in the amount of narcotics prescriptions that are being dispensed.”