Drug wholesalers shipped 780 million hydrocodone and oxycodone pills to West Virginia in just six years, a period when 1,728 people fatally overdosed on these two painkillers, according to an investigation by the Charlotte Gazette-Mail.
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That amounts to 433 of the frequently abused opioid pills for every man, woman and child in the state of 1.84 million people.
The Gazette-Mail obtained previously confidential records sent by the U.S. Drug Enforcement Administration to the office of West Virginia Attorney General Patrick Morrisey. They disclose the number of pills sold to every pharmacy and drug shipments to all 55 counties in West Virginia between 2007 and 2012.
Four of these counties — Wyoming, McDowell, Boone and Mingo — lead the nation in fatal overdoses caused by pain pills, according to the U.S. Centers for Disease Control and Prevention.
The records — which leading drug wholesalers had fought in court to keep secret — show the wholesalers shipped ever-higher doses of the pills — a telltale sign of growing addictions — even as the death toll climbed, the newspaper reported on Sunday.
"These numbers will shake even the most cynical observer," former Delegate Don Perdue, D-Wayne, a retired pharmacist who finished his term earlier this month, told the newspaper. "Distributors have fed their greed on human frailties and to criminal effect. There is no excuse and should be no forgiveness."
McKesson Corp., Cardinal Health and AmerisourceBergen Drug Co. together control about 85 percent of the U.S. drug distribution market by revenue and provided more pills to West Virginia than other wholesalers.
As hydrocodone and oxycodone overdose deaths increased 67 percent in West Virginia between 2007 and 2012, their chief executives were paid millions and their companies made billions. McKesson became America's fifth-largest corporation, with the nation's highest-paid CEO in 2012, according to Forbes.
The drug distributors say they're just middlemen in a highly regulated industry and that pills would never get in the hands of addicts and dealers if not for unscrupulous doctors who write illegal prescriptions, and pharmacists who turn a blind eye.
"The two roles that interface directly with the patient — the doctors who write the prescriptions and the pharmacists who fill them — are in a better position to identify and prevent the abuse and diversion of potentially addictive controlled substance," McKesson General Counsel John Saia wrote in a letter released by the company, the newspaper reported.
But the doctors and pharmacists weren't slowing the influx, and the pills being shipped became much more potent, DEA records show.
"It starts with the doctor writing, the pharmacist filling and the wholesaler distributing. They're all three in bed together," said Sam Suppa, a retired Charleston pharmacist who spent 60 years working at retail pharmacies in West Virginia. "The distributors knew what was going on. They just didn't care."
The largest shipments often went to independent drugstores in small towns. The Tug Valley Pharmacy in Mingo County, which had fewer than 24,000 people in 2010, ordered more than 3 million hydrocodone pills in 2009, while franchisees of Rite Aid and Wal-Mart ordered only several thousand each year, the newspaper reported.
Morrisey is a Republican who represented Cardinal Health and lobbied for wholesalers in Washington, D.C., before winning the attorney general's race with strong backing from drug companies. He recused himself from the state's lawsuit after taking office in 2013. Nine smaller wholesalers have settled for more than $7.5 million. Cases against the big three remain pending.
DEA agent Kyle Wright warned Morrisey aides in January 2015 that the wholesalers were shipping both opioids in more potent, commonly abused dosages, according to emails Morrisey released in response to a Freedom of Information Act request from the Gazette-Mail.
McKesson denied paying these incentives. A spokesman for AmerisourceBergen suggested health experts and law enforcement would be better able to comment on whether there's a link between pain-pill volumes and overdose deaths.
"All parties including pharmacies, doctors, hospitals, manufacturers, patients and state officials share the responsibility to fight opioid abuse," said Ellen Barry, a spokeswoman for Cardinal Health.
The newspaper interviewed the family of Mary Kathryn Mullins, who was prescribed OxyContin for pain in her back after a car crash near her home in Boone County.
"They wrote her the pain pills, and she just got hooked," said her mother, Kay Mullins. "She'd get 90 or 120 pills and finish them off in a week."
As her addiction worsened, she went to dozens of doctors, visiting pain clinics that churned out illegal prescriptions by the hundreds and pharmacies that dispensed doses by the millions. She kept most for herself, but sold some to others, Kay Mullins said.
Last December, she got a new prescription for OxyContin and an anti-anxiety medication. Two days later, she stopped breathing. Her brother Nick Mullins, a Madison police officer, responded to the 911 call. He tried chest compressions, but he could not revive his sister. .
Meanwhile, the Gazette-Mail reported on Monday, they disregarded rules to report suspicious orders for controlled substances in West Virginia to the state Board of Pharmacy. And the board, in turn, failed to enforce the same regulations, even as it approved spotless inspection reviews to small-town pharmacies ordering more pills than could possibly be taken by people who really needed medicine for pain.
Only after Morrisey's predecessor as attorney general sued wholesalers in 2012 did these companies begin filing the reports. The newspaper said it found more than 7,000 reports in two boxes at the board's office. The regulations don't say what to do with them, so the board didn't investigate, contact wholesalers or pharmacies, or share them with law enforcement, the newspaper reported on Monday.
"It's not been an item that's ever been enforced by the board," said David Potters, the pharmacy board's executive director.
Drug companies have racked up huge fines for failing to report suspicious orders in other states, but they refused to comment about their reports to West Virginia's board.
Morrisey, a Republican who represented Cardinal Health and lobbied for the drug wholesale industry in Washington, D.C., before taking office in 2013, has recused himself from the state's lawsuit. Nine smaller wholesalers have settled for more than $7.5 million. Cases against the big three remain pending.