A massive analysis by The Washington Post provides new insights and depth into some of the most formative years of the opioid epidemic that has left hundreds of thousands of Americans dead, including the staggering number of pills that passed through Kaufman County.
Last month, The Post published a database obtained from the United States Drug Enforcement Administration that tracks every Oxycodone and Hydrocodone pill sold in the United States between 2006 and 2012, some of the most formative years that led to the current opioid epidemic. Hydrocodone and Oxycodone pills account for 75 percent of the total opioid shipments to pharmacies over the course of that time. The new data includes the top manufacturers, distributors and pharmacies exchanging these pills in each county in the country.
Overall, more than 76 billion pills were distributed across the United States in the seven-year window from 2006 to 2012. And of those 76 billion, over 5 billion were supplied to Texas alone. Over 29 million of those pills were supplied to Kaufman County, enough for 42 pills per person per year for the county’s population during that time.
The top distributors of these opioids to Kaufman County during that time were AmerisourceBergen Drug with more than 8 million pills, followed by the McKesson Corporation with 6.5 million pills, CVS with 5 million pills, Wal-Mart with 3.5 million pills and Morris and Dickson Co. with 1.4 million pills.
Notably, Purdue Pharma LP, who was recently sued by Kaufman County, was only the fifth-highest manufacturer of the pills that were supplied to Kaufman County. Their 621,000 pills manufactured are a far cry from Actavis Pharma, Inc.’s 13 million pills manufactured that went straight to Kaufman County. Other top manufacturers include SpecGX LLC with 8.2 million pills, Par Pharmaceutical with nearly 5 million, and Amneal Pharmaceuticals LLC with 1.5 million pills.
These opioids were spread pretty evenly among the pharmacies around the county. All of the top five pharmacies that received these pills received them in excess of 2 million over the course of that period from 2006 to 2012 including Gibson Prescription Pharmacy in Seven Point with 2.4 million pills, Wal-Mart Pharmacy in Terrell with 2.4 million pills, Mabank Family Pharmacy with 2.2 million pills, and Medication Station in Kaufman and the Brookshire Pharmacy in Kaufman with just over 2 million pills each.
The Treehouse, an addiction treatment center located in Scurry, and its staff have been working for the last several years to help treat those fighting addiction. And with new CEO Dr. Ted Bender, who is still in his first year with the Treehouse, the campus has renewed its push to lower the rate of overdose deaths in Kaufman County.
Last month, the Treehouse hosted a golf scramble with all of the proceeds going to the purchase of Narcan kits, life-saving drug kits that can pull victims out of potentially deadly drug overdoses, to be used by first responders. But even though the event was a success, with enough funds pulled in to pay for nearly 700 doses of Narcan, Bender and his staff are aware that they still have a long way to go.
Since 1999, overall drug overdose deaths in the United States have been climbing steadily, with a significant spike starting in 2014. By 2017, annual overdose deaths had surpassed 70,000, a staggering increase from the just under 45,000 deaths reported in 2014. And of the 70,000 overdose deaths in 2017, over half were opioid related.
But new data for 2018 has provided activists with their first bit of good news since the epidemic began; overall overdose deaths for the year, while still high at 67,000, marks the first significant downturn in death rate of the century.
But how did things get this bad? How did it get to the point where hundreds of thousands of people have died in the United States in the last five years? According to Dr. Bender, this current epidemic was the result of an amalgamation of factors from unchecked corporate greed to ineffective government regulation.
“It was kind of the perfect storm,” Bender said. “We had the manufacturers creating these pills and distributing them, doctors and pharmacists were giving them to their patients with or without any warning, and as a society we didn’t really do our part to keep them out of the wrong hands. There are many alleged malpractice events that occurred with big pharma from downgrading side effects and addiction potential, but also misleading advertisements and kickbacks to doctors that went unchecked for so long. And during the Obama administration, the DEA was really handicapped by a sweeping legislation that prevented them from being able to do their jobs, which was to stop suspicious large shipments of these types of drugs to small pharmacies. So it was an amalgamation of these things over time that led to this crisis.”
It’s no secret why opioids became as popular with patients as they did. Despite the substantial risk of addiction and overdose, opioids are proven to be effective painkillers, even in cases of extreme, chronic pain. In fact, according to Dr. Bender, these extreme cases are really the only time such powerful medications should be used.
“The medications do relieve pain, there’s no doubt about that,” Bender said. “These kinds of medications are only supposed to be used for severe pain disorders, not just an achey back or because you had a wisdom tooth removed. They just became so overly prescribed in situations where they shouldn’t have been prescribed at all. There are people out there that need these medications, but nowhere near as many as 42 pills per person. These numbers are staggering.”
Bender calls the opioid epidemic “one of the worst” he has ever seen in his lifetime. And while he is heartened by the fact that overdose deaths were down overall in 2018, he is concerned that in Texas things are only getting worse.
“We’re looking at a 1.5 percent increase in Texas,” Bender said. “So while some areas in the country that were the hardest hit are making some gains, we’re not seeing that same trend in Texas. We’re seeing it get a little worse, which is concerning.”
Many individual states saw dramatic decreases in opioid deaths from 2017 to 2018 including Ohio with a 22 percent reduction, North Dakota with a 25 percent reduction, and Iowa and Pennsylvania both with 20 percent reductions. Bender attributes this to federal dollars going to places that were hit the worst by the epidemic as well as new state guidelines and regulations improving the situation in specific areas. In particular, Bender praises the efforts of Ohio and measures like prescription guideline overhauls and drug monitoring programs to ensure people aren’t getting the same prescriptions from multiple doctors.
“There is a formula for success,” Bender said. “I think Ohio is demonstrating that. But I think the funding has to come from the federal government. I’m glad that certain states are taking charge and not waiting around; I certainly would encourage them all to do so. But while this problem has decreased a little bit, we’re far from over. We’re still talking about 67,000 human lives in 2018. I think we need $100 billion over the next five years to make an immediate impact on the overdose epidemic in the United States and that’s got to come from the federal government.”
Much of those funds, Bender argues, should go toward increasing access to care for those addicted, utilizing medication-assisted therapy and educating the public on the dangers of such medications. But he also thinks that some funding should be reserved to research non-addictive pain medication. In the meantime, Bender isn’t calling for a complete elimination of opioid prescriptions, but he does think doctors and providers need to be extremely careful.
“It’s not an all or nothing thing,” Bender said. “They just need to be careful about who they’re prescribing to and how much. It’s really about responsible practice; informing patients of all of the pros and cons of these types of medication, eliminating any type of advertising that could persuade people or dampen the effects of this stuff.”
Bender also reiterates the importance of having life-saving drugs like Narcan on hand to help save those who are in the midst of an overdose. He’s hopeful that directives like the Treehouse’s goal of getting Narcan in the hands of every first responder in Kaufman County can help reverse the growing trend of overdose deaths in Texas.
“It’s imperative that all first responders in the United States have Narcan on them at all times because it’s making a difference,” Bender said. “We’re going to work hard to make sure that every first responder in our county is equipped with Narcan because every single time one of those are used, that’s a potential life saved. To put that in perspective, the overdose rate in Texas went up by 1.5 percent. We’re talking about 50 to 60 more overdoses than the previous year. How many of those could have been saved if Narcan was available?
“What we’re doing right now, getting education out to the public, is a crucial component of all of this because not only do people need to learn the dangers of these medications, but there’s a big opportunity in the preventative side. We can start early with kids and parents. A lot of these kids and teens who are getting hooked on these medications, the first place they get it from is Mom and Dad’s medicine cabinet. And that’s an easy thing to prevent. You keep that stuff locked up or you dispose of it properly. Never should these drugs just be sitting around in your house unguarded when there are teens or other adults in the house that could abuse them.”
Overall, even though overdose deaths did increase slightly in Texas from 2017 to 2018, Dr. Bender is optimistic about the significant decreases in deaths in states that have been hit the hardest by the epidemic over the last decade.
“That’s not something that is shared by all of my colleagues,” Bender admits. “But I really want to see the hope in all of this and I really want to give hope to people. I think what we can safely say here is that it didn’t get worse. That alone is a monumental feat because if you look at the overdose death rate in the United States since 1999, it’s pretty much been a continuous rise. So the fact that we got to 2018 and it went down a little bit suggests that we may have peaked and that the increased focus on the opioid epidemic in the United States is making a difference. Now if we come back next year and it’s higher again, that opinion might change. But I’m encouraged specifically by the states that have been so hammered by this and the significant decreases that we’re seeing. These aren’t small reductions. Now, it’s not as uniform across the country and some states are seeing increases, but it does suggest to me that we’re making progress.
“While I am cautiously optimistic about this, we can’t let our guard down. We have to push even harder on the gas because while we’ve made some progress, we’re still losing 67,000 lives every year. And if we let off or think we’ve got this, it could easily spike back up.”
For a detailed breakdown of opioid supply figures to other counties or information about the year-long legal battle that led to the publishing of these figures, check out The Washington Post's original story here: https://www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/?utm_term=.66ff060c563e