Opioid manufacturers distributed more than 40 million oxycodone and hydrocodone pills in Cowlitz County between 2006 and 2012, making the county one of Washington’s largest consumers of the legal but addictive painkillers in the state, according to previously unpublished data reported Thursday by the Washington Post.
The number of oxycodone and hydrocodone pills sold in Cowlitz County during the seven-year span was enough to give every man, woman and child here 65 opioid pills annually. That’s nearly double the national rate — 36 pills a year per person.
The data shows that rural Southwest Washington was a pocket of saturation for opioid distribution and use, with Lewis and Pacific counties showing similar levels of opioid distribution. By comparison, Clark County’s rate was 41.2 pills per person; King County’s rate was 34.5 pills per person; and Pierce County’s rate was 38.6 pills per person.
In fact, the data show that opioid distribution is far more pervasive in rural America than urban America.
The information comes from a database maintained by the U.S. Drug Enforcement Administration that tracks every pain pill sold in the nation, from manufacturers and distributors to pharmacies in every town and city. In all, 76 billion oxycodone and hydrocodone pills were sold nationwide in the seven-year period.
“The data provides an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which has resulted in nearly 100,000 deaths from 2006 through 2012,” according to the Post’s article.
Nationwide, six companies distributed 75% of the pills from 2006 to 2012: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to the Washington Post's analysis of the database.
The drug companies, along with the DEA and the Justice Department, fought to keep the database secret, but the Post and other news organizations successfully appealed for the release to the U.S. Court of Appeals. The post made the data available online for other news organizations and citizens to examine the data for their own communities.
The volume of the pills handled by manufacturers and distributors skyrocketed as the epidemic surged, increasing about 51 percent, from 8.4 billion in 2006 to 12.6 billion in 2012. By contrast, doses of morphine, a well-known treatment for severe pain, averaged slightly more than 500 million a year during the period, according to the Post.
The states that received the highest concentrations of pills per person per year were: West Virginia with 66.5, Kentucky with 63.3, South Carolina with 58, Tennessee with 57.7 and Nevada with 54.7. West Virginia also had the highest opioid death rate during this period.
Oregon was the eighth highest among the states at 51 pills per person per year.
Rural areas were hit particularly hard: Norton, Va., with 306 pills per person; Martinsville, Va., with 242; Mingo County, W.Va., with 203; and Perry County, Ky., with 175, according to the Post.
Those numbers make even Cowlitz County’s opioid concentration seem small, yet the use of pills here was nearly equal to the West Virginia average, which was the highest in the nation.
The data helps shed light on why Cowlitz County has had one of the state’s highest rates of opioid overdose deaths for about a decade.
Drug overdose deaths fell nationwide last year for the first time in nearly three decades, according to preliminary data from the Centers for Disease Control and Prevention. The improvement was driven by a drop in deaths from heroin and prescription painkillers. The number of drug-related deaths had been jumping by about 5,000 a year from 2014 to 2017, when deaths peaked at 70,000. Last year it dipped to 68,000, according to preliminary data.
The rate of opioid overdose deaths in Cowlitz County has also declined, from an annual average of 19 overdose deaths during 2008-2012 to an annual average of 14 deaths during 2013-2017, according to the state Department of Health.
Given its small number of pharmacies and limited number of healthcare providers, it's no surprise where the pills were distributed. The Kaiser Foundation Health Plan distributed the largest number of pills, followed by the two Longview Safeway Pharmacies and then Fred Meyer. Olympic Drug, a now shuttered Longview drug store on 15th Avenue, also was among the largest distributors.
According to Kaiser Permanente’s website, it has “dramatically reduced our members’ risk for opioid abuse and addiction through improved prescribing and dispensing policies, monitoring and follow up processes and coordination across departments and specialties.” Kaiser reports reducing its opioid prescriptions 40% from 2011 to 2017.
Across its system, PeaceHealth has also made changes to its opioid prescribing and pain treatment procedures, according to spokesman Randy Querin. PeaceHealth lowered the default amount of opioids prescribed to patients after a procedure from 30 to 10. Between November 2018 and Jan. 31, this resulted in 134,000 fewer opioid pills dispensed across PeaceHealth’s 10 medical centers.
PeaceHealth and Kaiser both discuss alternative pain management methods with patients, educate patients about the risks of opioid use and use their electronic health record system to alert doctors and pharmacists of any duplicate prescriptions.
Opioid manufacturers are being sued in federal court in Cleveland by nearly 2,000 cities, towns and counties alleging that they conspired to flood the nation with opioids, despite evidence that the pills were being sold in apparent violation of federal law and diverted to the black market.
The companies, in turn, have blamed the epidemic on overprescribing by doctors and pharmacies and on customers who abused the drugs. The companies say they were working to supply the needs of patients with legitimate prescriptions desperate for pain relief.