Terry H. Schwadron
July 21, 2019
Small towns in West Virginia, Kentucky and Virginia were inundated with opioid pain pills, outstripping the rest of the country as sales and distribution of the pills boomed over several years — all at the hands of a small number of companies and middlemen, The Washington Postreports in a startling series.
The Post got access to a database maintained by the Drug Enforcement Administration that tracks every single pain pill sold in the United States — from manufacturers and distributors to pharmacies in every town and city.
It makes for fascinating and important reading. On Friday, emails released in the case underscored total knowledge by the companies of the scale of the issues.
The data came to light as part of the largest civil action in U.S. history against 10 companies whose sales are reflected in this database, the Automation of Reports and Consolidated Order System, known as ARCOS. The companies fought the release of the information. That data was compared with individual death records from the Centers for Disease Control and Prevention, which were obtained and analyzed by The Post.
The scale of drug sales between 2008 and 2015, the years involved in the overall lawsuit in trial, is staggering, and raises obvious questions about how we all allowed it to happen, about why, in retrospect, it has taken as long as it has to unearth the patterns of manufacture, sales and distribution, and to find a way to seek justice for the tens of thousands of resulting American deaths.
The local and state government plaintiffs in the case argue that the actions of some of America’s biggest and best-known companies — including Mallinckrodt, Cardinal Health, McKesson, Walgreens, CVS, Walmart and Purdue Pharma — amounted to a civil racketeering enterprise that had a devastating effect on the plaintiffs’ communities. The case is a civil action under the Racketeer Influenced and Corrupt Organizations (RICO) Act, making use of a law originally developed to attack organized crime.
For me, the only question is why this is a civil action rather than a criminal one.
What comes across — and clearly at the heart of the consolidated lawsuit being heard in Cleveland — is company greed over the well-being of Americans, and the degree to which the companies involved knew what was going on.
The opioids issue has become a popular bipartisan target in the presidential campaigns, but even these criticisms are focused on providing money for the effects of the opioid epidemic rather than on the sources of the problem itself.
As we all know, opioids are pills for chronic pain that have generally been over-prescribed legally in our pain-resistant society, and extremely addicting, leading to a huge black market in opioid-type drugs. As illegal use of pain pills has skyrocketed, there has been other vast growth in illegally available heroin, fentynal and synthetic mixtures.
The analysis says that the largest drug companies saturated the country with 76 billion oxycodone and hydrocodone pain pills from 2006 through 2012 as the nation’s deadliest drug epidemic spun out of control.
And that where pills grew the most, deaths followed. The highest per capita death rates nationwide from opioids during those years were in rural communities in West Virginia, Kentucky and Virginia. In those seven years, those communities also were flooded with a disproportionate share of the pills.
Analysis of the data showed a surge in sales of legal pain pills that fueled the prescription opioid epidemic, which has resulted in nearly 100,000 deaths from 2006 through 2012.
The Post said that until now, the litigation has proceeded in unusual secrecy with many filings and documents in the case have been sealed under a judicial protective order. The secrecy finally lifted after The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, waged a year-long legal battle for access to documents and data from the case.
According to the Post analysis, just six companies distributed 75 percent of the pills during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart. Three companies manufactured 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.
The database analysis shows that each company knew about the number of pills it was shipping and dispensing and precisely when they were aware of those volumes, year by year, town by town. The Post report said that the companies allowed the growth in opioids despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market, according to the lawsuits.
The Post analysis shows that the volumes of the pills handled by the companies climbed as the epidemic surged, increasing 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. The overall number — 76 billion oxycodone and hydrocodone pills shipped over the seven years — eclipsed what was previously known about opioid distribution by orders of magnitude.
In some small towns, the number of sales per person were in the hundreds of times the population of the towns themselves.
Hundreds of lawsuits have been filed by local authorities over the years. Many have been consolidated into the one centralized case in federal district court in Cleveland. The opioid litigation is now larger in scope than the tobacco litigation of the 1980s, which resulted in a $246 billion settlement over 25 years.
The idea that these companies and the DEA were measuring it all along without action is beyond comprehension.