Nearly 1.6 billion prescription pain pills were supplied to Missouri residents from 2006 to 2012, according to a new report on the Drug Enforcement Administration’s (DEA) database that was published by The Washington Post on July 18. In the Meramec Region, an area that includes Crawford and Phelps counties, nearly 70 million pills were supplied during the period.
The Washington Post’s report was the first time the database—which is maintained by the DEA and tracks the path of every single pain pill sold in the United States, by manufacturers and distributors to pharmacies in every town and city—has been made public. The Post sifted through nearly 380 million transactions from 2006 through 2012 that are detailed in the DEA’s database and analyzed shipments of oxycodone and hydrocodone pills, which account for three-quarters of the total opioid pill shipments to pharmacies.
The Post made this data available at the county and state levels in order to help the public understand the impact of years of prescription pill shipments on their communities. You can read their story and find links to the database at: https://www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/?utm_term=.bd286b2d5ec5.
Phelps County was, by far, the leader in pain pill distribution in the region from 2006 to 2012. There were 84.4 pain pills distributed per person every year in Phelps County, with a total of 26,062,525 pills delivered.
In Crawford County, there were 43.9 pills per person distributed for a total of 7,530,870. Data for other Meramec Region counties were: Dent, 60.8 per person, 6,560,850; Gasconade, 41.4, 4,411,910; Washington, 60.2, 10,476,070; Pulaski, 34.7, 11,713,290; Osage 7.9, 761,230; Maries, 35.0, 2,245,410.
The vast majority of pain pills in Phelps County were distributed in Rolla, where four pharmacies combined to receive more than 13.6 million pain pills, while one pharmacy in St. James received 1.86 million.
Pill distribution was widespread throughout Crawford County. Two pharmacies in Steelville combined to receive more than 3.1 million pain pills, while two pharmacies in Cuba received nearly 2.9 million pills, and one in Bourbon 786,000.
Phelps County was also one of the top counties in the state in per capita pain pill distribution. Only Dunklin County at 85.5 pills per person per year, Pemiscot at 89.3, St. Francis at 91.5 and Butler County at 99.7 were higher. The only other county with a rate above 75.0 was Ripley at 79.4. All of those counties are in the Eighth Congressional District of southeast Missouri. The highest rate in the country was reported in Charleston County, S.C., at 248.3 pills per person per year.
These records also provide an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which resulted in nearly 100,000 deaths during the seven-year time frame ending in 2012. A county-level analysis of the cumulative data shows where the most oxycodone and hydrocodone pills were distributed across the country over that time: more than 76 billion in all.
The Post gained access to the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System, known as ARCOS, as the result of a court order. The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, waged a year-long legal battle for access to the database, which the government and the drug industry had sought to keep secret.
The version of the database published by The Post allows readers to learn how much hydrocodone and oxycodone went to individual states and counties, and which companies and distributors were responsible. 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. Yearly county-level maps show how the influx of pills spread.
Just six companies distributed 75 percent of the pills — oxycodone and hydrocodone — during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post. Three companies manufactured about 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.
Comparing county-level maps of opioid overdose deaths and pill shipments reveal a virtual opioid belt of more than 90 counties stretching southwest from Webster County, W.Va., through southern Virginia and ending in Monroe County, Ky. This swath includes 18 of the top 20 counties ranked by per-capita prescription opioid deaths nationwide and 12 of the top 20 counties for opioid pills distributed per capita.