by Kate Shunney
Newly-released records from the U.S. Drug Enforcement Agency (DEA) show that Morgan County
pharmacies received 5,096,310 prescription oxycodone and hydrocodone pain pills from four drug distributors between 2006 and 2012.
The data, reported by The Washington Post and released publicly last week, shows that Reed’s Pharmacy in Berkeley Springs received 3,939,400 of the most-used pain pills during that six-year period. Rite Aid Pharmacy in Berkeley Springs received 1,156,910 of the pills during that time, according to the DEA records.
Those pain pill orders were recorded through the DEA’s Automation of Report and Consolidated Orders System, known as ARCOS. The Washington Post and HD Media, a West Virginia media company, gained access to the database of information through a legal battle that resulted in a court ordering the information to be released to the public.
According to the database and maps prepared using the information about pain pill orders, pharmacies in Morgan County received enough of the pain medication during the 2006-2012 reporting period to supply 42.2 pain pills per person in the county per year.
Data analysis and reporting focused on oxycodone and hydrocodone, which accounted for three-fourths of the opioid drug ship-ments during the reporting period.
In neighboring Washington County, Md., pharmacies received 41,473,760 of the pain pills — enough to provide 40.6 pills per person per year. The Home Center Pharmacy in Hancock was the third largest recipient of pain pills in the county during that six-year period, receiving 2,428,560 pills.
Pharmacies in Berkeley County got 31,627,440 pain pills during the same time period. Reed’s Pharmacy in Hedgesville was the fifth largest recipient of those pills in the county from 2006 to 2012. They were supplied 2,503,100 of the pain pills, according to the DEA.
Hampshire County received 5,276,860 prescription pain pills from 2006 to 2012.
Reed’s pharmacies in Romney and Capon Bridge (Hampshire County) were also in the top five recipients of pain pills in that county during the data period. CVS Pharmacy in Romney was the highest recipient, taking in 2,419,200 pills during that time. Reed’s in Capon Bridge received 693,120 and Reed’s in Romney received 682,500, according to the DEA data.
Reed’s Pharmacy in Berryville, Va. (Clarke County) was also listed in the top five recipients in that county. That pharmacy took in just 1,800 pills, while Berryville Pharmacy received 772,000 pain pills during that period.
High volume, more deaths
A map accompanying the drug data shows that areas where large quantities of opioid pain pills were shipped to pharmacies are also the same areas where large numbers of opioid deaths were recorded.
In West Virginia, Mingo County was the highest recipient of the pain medication, taking in 38 million pills — enough to supply 203.5 pills per person per year in that county.
A pharmacist’s perspective
Ken Reed owns multiple pharmacies with his wife Tally, including Reed’s Pharmacy in Berkeley Springs.
He is also a Morgan County Commissioner, elected in 2016.
Reed responded to multiple questions from The Morgan Messenger about the DEA data on pain pill orders in Morgan County, including whether the DEA numbers match his company records and why Reed’s received three times the number of pain pills as Rite-Aid from 2006-2012.
In an email, Reed said he couldn’t compare his records to the DEA data on pain pills to his pharmacies.
According to Reed, their pharmacies transitioned to a new prescription record-keeping system in 2017 and transferred only three years of data to their current server because of cost and data space.
“There is no way I can verify numbers of tablets from 2006-2012,” Reed said.
Reed confirmed that general pharmacy business trends in Morgan County could account for the large proportion of pain pills being shipped to his location rather than to Rite Aid.
“I believe we have the majority of the total market share in Morgan County. I do not have access to Rite Aids numbers so I cannot confirm this. I suspect we have 60-75% of the business in this 2-pharmacy market,” Reed wrote.
He explained that orders from distributors for pain medication and other medicines are “ordered with the goal of keeping any absolute minimum inventory in the store.”
“We get orders on a daily basis. Margins are so tight that any extra inventory is returned once a month and we order only enough tablets to fill legitimate prescriptions,” he said.
Reed said the broad DEA figures about number of pills are very basic, and don’t account for dosage, which varies widely by age or a patient tolerance for pain medication.
“In truth, the per tablet number really doesn’t tell you much. The dosing of these drugs are usually 1-2 tablets every 4-6 hours which is up to 12 tablets per day per patient, and if a cancer patient has grown tolerant to the medications then the doses skyrocket from there,” Reed said.
“I have hospice (end of life) patients that are on so much pain medication that if you or I would take those doses we would probably die.”
Reed said “lots of moving parts” pushed the U.S. toward higher pain pill prescribing over nearly 20 years.
“Years ago, drug manufacturers did a big push to treat pain, and not just end of life pain – any and all pain,” he said.
According to Reed, the move by the Joint Commission on Accreditation of Healthcare Organizations in 2001 to change pain treatment standards pressured hospitals and providers into prescribing more pain medication or face poor patient survey scores.
“The boards of pharmacy were forcing all pharmacies to fill all valid prescriptions. Pharmacists were getting disciplined for not filling prescriptions due to their professional judgement,” said Reed.
“The government and DEA like to point fingers, which is fine as long as they are held to their own ‘should have known standard,’” Reed said. “The DEA did know and did nothing. The DEA had absolute authority over how many opioid tablets are allowed each year for the U.S. market consumption…at any time they could have throttled down the ‘number’ of tablets…they did nothing.”
Reed said he has seen a trend downward in the number of pain pills. He said prescriptions have remained steady as a percentage of pharmacy sales. “[B]ut lately physicians seem to be cutting down drastically on the number of tablets they prescribe per prescription, which is driving down total numbers.”
“As of now, the number of tablets across the board are down…what is being made, what is being prescribed and what is dispensed,” he wrote.
“Opioids when used correctly are a lifesaver and increase the quality of life for millions and millions of people everyday. While it is easy to demonize this class of drug…just think about what these people would do without them,” Reed said.
Federal officials and others have pushed in recent years for changes in prescribing practices, opioid labeling and insurance coverage of alternative treatment for acute and chronic pain.
West Virginia continues to be the state with the highest opioid-related overdose death rates in the nation, according to the Centers for Disease Control (CDC). In 2017, 49.6 persons per 100,000 population died from an opioid-related overdose. Public health officials have said the presence of synthetic drugs like fentanyl in other drugs accounts for part of the continued high death rate.