Millions of painkillers flooded local counties

For the first time ever, the public can see details of who manufactured pain pills and which pharmacies stocked them, revealing exactly what drug companies knew as they flooded communities with opioids that fueled a national epidemic.

After a yearlong court battle, The Washington Post and HD Media, which owns the Charleston Gazette-Mail, won public access to a key Drug Enforcement Administration database in July.

The database, which The Washington Post recently released publicly, details 380 million times between 2006 and 2012 that manufacturers sold opioids to pharmacies, physicians or other distributors — including shipments of more than 3.3 billion pills to New York alone.

The Washington Post narrowed the data to oxycodone and hydrocodone pills because research has shown those common prescriptions were the painkillers most often diverted into the black market.

Locally, Steuben County received nearly twice as many pills as Allegany and Livingston counties. In Steuben County, 2.7 million pain pills were sent to pharmacies and physicians in 2006 and the shipments grew each year after that, reaching just under 3.6 million in 2012, a GateHouse Media analysis of the data shows.

In Allegany County, manufacturers shipped nearly 1.5 million pills to the area in 2006. During the seven-year data yet, the number rose and peaked at 1,774,790 in 2011. 

Livingston County started at 1,297,210 pills in 2006, rising each year to a high of 1,962,270 in 2011. Like in Allegany County, the figure dipped slightly in 2012.

Minor differences emerge after accounting for population over that seven-year stretch. While receiving less overall pills, for example, Allegany County actually received the most pills per person based on population. The shipments averaged out to 33 pills per person each year in Allegany County, 32 pills per person in Steuben, and 26 in Livingston.

All three were below the national average of 37 pills per person and near the state average of 30. Three New York counties were shipped fewer than 12 pills per person each year: Queens, Kings and Hamilton. Niagara and Sullivan counties received the largest population-adjusted shipments in the state, both about 50 pills per person each year.

The top 10 counties in the United States all saw annual rates of more than 155 pills per person.

The government and drug industry opposed the release of the data and won the initial court case to block it, but the news organizations prevailed on appeal.

The media groups also convinced the court to unseal depositions and internal documents, such as emails, that show companies’ internal push to increase sales even while opioid-related deaths soared.

Nationally, about 144,000 people died from opioid overdoses between 2006 and 2012 — including 8,230 people in New York — according to data from the Centers for Disease Control and Prevention. An additional 211,000 people — 15,256 in New York — died in the five years since then.

The death rate here usually hovers just below the national average. Nonetheless, the frequency of fatal overdoses has tripled in the last decade, from 5.6 deaths per 100,000 people in 2008 to 16.1 deaths in 2017. It grew by almost half between 2015 and 2016.

Yet, today’s death rate is still just one-third of the rate seen in West Virginia, which went from having one of the nation’s lowest rates to its highest because of the epidemic.

Lawsuits related to drug companies’ role in those deaths already are the largest in American history, with settlements surpassing those made with tobacco companies in the 1980s.

Some of the largest drug companies already have paid more than $1 billion in federal fines and even more to states and counties who sued. Exact deals remain to be reached with most filers.

The State of New York settled with Cardinal Health in 2005 and again in 2016 after finding the Ohio-based company had failed to report suspicious orders to the Drug Enforcement Agency and did not follow proper protocols to flag certain orders for additional review.

But at least one pharmaceutical trade association executive appeared to blame the federal Drug Enforcement Association for the epidemic.

“The DEA has been the only entity to have all of this data at their fingertips, and it could have used the information to consistently monitor the supply of opioids and when appropriate, proactively identify bad actors,” said John Parker, senior vice president of the Healthcare Distribution Alliance, in an email to GateHouse Media.

Healthcare Distribution Alliance is the national trade association representing pharmaceutical distributors. Parker emphasized that HDA members followed rules requiring them to report sales to federal officials.

“Unlike the DEA,” Parker said, “distributors have no authority to stop physicians from writing prescriptions, nor can they take unilateral action to halt pharmacies’ ability to dispense medication.”

The Post reported that oxycodone and hydrocodone pills accounted for three-quarters of all opioid shipments to pharmacies over the seven years of tracking. The newspaper released the original data, as well as an easy-to-use search tool, writing that they want “to help the public understand the impact of years of prescription pill shipments on their communities.”

Communities have long known the tally of resulting overdose deaths. But until now, Americans could not know how many pain killers had been sent to their communities because public officials and drug company attorneys sought to keep the information secret.

The deaths came in three waves.

Manufacturers saturated towns with more painkillers than reasonably could be used for medical purposes and so the pills were diverted to the black market and abused. When access to medical-grade opioids was cut off amid crackdowns and public pressure, people had to switch to street opioids, like heroin, to prevent debilitating withdrawal.

People died.

Overdoses spiked even more as Mexican cartels began mixing often-tainted Chinese fentanyl into heroin and then began selling that powerful opioid on its own.

Court documents show that companies ran marketing campaigns with distorted facts about painkillers' effectiveness and aggressively pushed for increased sales even when they knew more pills were being sold than could legally be used. At least one executive was criminally convicted for trying to bribe doctors to increase pain killer sales.

Internal documents freed as part of the Washington Post’s legal case and shared with the public by the newspaper show that many high-level company officials focused on following the letter of reporting laws but did not see themselves as having a broader duty to halt suspicious sales even as overdose deaths grew.

One of the nation’s largest distributors said as much in an August 2018 court deposition.

“Cardinal Health does not have an obligation to the general public,” said Vice President Jennifer Norris when asked about the opioid epidemic. “Cardinal Health has an obligation to perform its duties in accordance with the law, the statute, regulations, and guidance.”

The State of New York settled with Cardinal Health in 2005 and again in 2016 after finding the Ohio-based company had failed to report suspicious orders to the Drug Enforcement Agency and did not follow proper protocols to flag certain orders for additional review.

An email exchange a decade earlier illustrates the sales-at-any-cost attitude prevalent throughout the documents newly unsealed by the court.

In January 2009, a national account manager for Mallinckrodt told a vice president of KeySource Medical that he had just shipped the company 1,200 bottles of 30mg oxycodone tablets. That particular dosage is preferred by many illicit users and drug traffickers.

“Keep ’em comin’!” said Steve Cochrane of KeySource. “Flyin’ out of there. It’s like people are addicted to these things or something. Oh, wait, people are. . .”

Victor Borelli, from Mallinckrodt, replied: “Just like Doritos keep eating, we’ll make more.”

A spokesperson for Mallinckrodt emailed a condemnation of Borelli’s comments to GateHouse Media.

“This is an outrageously callous email from an individual who has not been employed by the company for many years. It is antithetical to everything that Mallinckrodt stands for and has done to combat opioid abuse and misuse.”

Borelli’s LinkedIn profile shows he left the company in 2012, three years after his Doritos comment, to join Dr. Reddy’s Laboratories, leaving there in June 2017 as Vice President of Sales. He lists his current employment as Vice President of Sales for Edenbridge Pharmaceuticals.