Bartholomew County pharmacies were flooded with millions of prescription opioid pills from 2006 to 2012, including two pharmacies in Columbus — located a mere 450 feet from each other — whose inventories of oxycodone and hydrocodone were among the five largest in the state.
Records from the federal Drug Enforcement Administration show that just more than 36 million oxycodone and hydrocodone pills were shipped to pharmacies in Bartholomew County from 2006 to 2012 — or roughly 68 pills per person each year.
The Walgreens pharmacy at 2400 Beam Road was sent 8.5 million oxycodone and hydrocodone pills from 2006 to 2012, the third most of any pharmacy in the state. The CVS pharmacy at 2423 N. National Road received 8.2 million pills, fourth most in the state.
Over the span of 28 days in 2006, 119 shipping transactions totaling 669,500 oxycodone and hydrocodone pills were reported at the Walgreens pharmacy on Beam Road, according to the DEA figures. Nine shipping transactions totaling 58,700 pills were reported in a 24-hour period at the CVS pharmacy on National Road.
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More than 76 billion opioid pain pills were distributed to pharmacies across the country from 2006 to 2012, including 2.1 billion in Indiana.
The data comes from DEA’s Automation of Reports and Consolidated Orders System, or ARCOS, which is a data collection system that drug manufacturers and distributors use to report transactions of controlled substances, including around a dozen opioids, according to the DEA’s website.
The Washington Post made the data public after the newspaper and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, prevailed in a year-long legal battle with the DEA and the drug industry, which attempted to prevent the data from becoming public.
The data released by The Washington Post only includes oxycodone and hydrocodone shipments, which represent 75% of the total opioid shipments to retail pharmacies, according to The Washington Post.
An ‘enormous’ number
Dr. Kevin Terrell, medical director of Columbus Regional Health’s Treatment and Support Center and ASAP team member, said the figures are “enormous.”
“It’s actually a little bit embarrassing that we had so much prescribing within our community,” he said. “That just points to the fact that education still needs to happen. We still need to do more.”
Terrell, who leads Columbus Regional Health’s Treatment and Support Center as an addiction medicine physician and medical director, has been working to educate physicians around Bartholomew County on safe opioid prescribing practices locally.
“We have met with dozens of prescribers, both physicians, as well as dentists, within our community with the last year and half, and sometimes, it takes a little while to see a benefit from that outreach,” he said. “We’re hopeful that things will improve over time. But we’re going to continue that effort to be sure that we all understand how to safely manage pain in our community.”
“My feeling is that most of our providers have gotten the message, and really only time will tell if to what extent it makes a difference in prescribing within our community,” he added. “…We all understand that there is an opioid problem out there.”
Medical providers in Bartholomew County prescribed opioids at approximately 1.4 to 1.8 times the national average from 2006 to 2017, according to the federal Centers for Disease Control and Prevention.
In 2011, Bartholomew County providers prescribed 150.8 opioid prescriptions per 100 residents — more than one prescription per person and 13th highest of any county in the state. The national rate in 2011 was 80.9, and the rate in Indiana was 106.7.
The opioid prescription rate in Bartholomew County was greater than 100 prescriptions per 100 people each year from 2006 to 2015.
Since 2011, local opioid prescription rates have steadily fallen, but Bartholomew County providers were, as of 2017, still prescribing opioids at a rate of 81.4, compared to the national rate of 58.7.
“It really isn’t generally a problem with a three-day supply of Vicodin,” Terrell said. “It’s when people get a three-day supply, then they go back and see the doctor again and he or she giving them a two-week supply. Then they say, ‘Boy, this Vicodin is really helping me do the things I need to do.’ Then they get a month supply and then it spirals on from there. …That’s often how it happens. People will get a short couple days of pain pills and then it gets renewed until they’re getting monthly prescriptions. It’s really a disaster.”
New Epic platform
In 2017, Columbus Regional Health began using Epic, a unified medical record platform that, among other things, is designed to make it easier for physicians to monitor opioid prescribing.
“Epic allows us to set thresholds for prescribing,” Terrell said. “If the prescriber prescribes a certain dosage of an opioid pain pill, it will warn them and say, ‘Are you sure you want to prescribe that?’ and it will say something to the extent of, ‘We recommend lowering the dose of it, or lowering the duration of treatment.’ My goal and the system’s goal is having people prescribing the lowest effective dose of opioid medicine, but also trying to avoid opioid use when possible. We know that some people are going to need opioid pain medicines. If people have kidney stones or broken bones, they’re going to need opioid pain medicine, and some people who have cancer or in hospice or have other chronic painful condition, some of them are going to need some long-term pain management with opioids, but we still do have a lot of room to improve within our community on the opioid pain management front.”
Terrell said CRH has programmed Epic to meet the federal Centers for Disease Control and Prevention’s guidelines for prescribing opioids and “expects all of their providers to follow those CDC guidelines.”
“What we’re trying to do with Epic is we’re trying to make it easy to follow those (guidelines) by giving prompts and recommendations,” Terrell said. “…We’re prescribing fewer opioid pain pills than we used to, we just have improvement to make.”
Manufacturers that sold lower-priced generic opioids produced 90% of the pills, or 32.6 million, that were shipped to Bartholomew County from 2006 to 2012.
Actavis Pharma Inc. manufactured nearly 37% of the pills, or 13.2 million. SpecGx LLC, a subsidiary of Mallinckrodt, made 12.7 million of the pills, and Par Pharmaceutical manufactured 6.7 million of the pills.
Purdue Pharma L.P., the maker of OxyContin, manufactured 868,000 of the pills, or 2.4%, that were shipped to Bartholomew County.
The data sheds light on the staggering scale of the nation’s opioid epidemic, which the CDC has reported has in resulted in around 446,000 deaths attributed to opioids — more than all U.S. military deaths during World War II, according to numbers from the National World War II Museum.
In 2016, more than 42,000 deaths in the United States were caused by opioids — 40% of which involved a prescription opioid, according to the U.S. Department of Health and Human Services.
More than 3,000 people in Indiana died of opioid overdoses from 2010 to 2016, and an estimated 89,000 Indiana residents are suffering from opioid dependence and addiction, according to state figures.
In 2017, 21 Bartholomew County residents died from opioid overdoses, compared to a total of 13 from 2011 to 2016, according to data from the Indiana State Department of Health, which tracks causes of death by county of residence, not necessarily the county in which the person died.
A total of 4,000 Indiana residents — including 84 people who resided in Bartholomew, Brown, Jackson and Jennings counties — died from opioid overdoses between 2011 and 2017.
Additionally, Bartholomew County residents have visited hospital emergency departments a combined 468 times for non-fatal opioid overdoses from 2011 to 2017. Across the state, opioid overdoses resulted in 26,884 emergency department visits over the same period — or about one visit every 2 hours and 17 minutes every day for seven years.
“The research has shown that between about 2013 and 2015, pain pill overdose deaths went down,” Terrell said. “…But then in 2016 and 2017, they went back up. We’re back to a point where now people are dying more from pain pill overdoses than they ever had.”
Pharmacies in Jackson County received 17.8 million pills from 2006 to 2012, and Jennings County pharmacies received 12.1 million pills over the same time period.
“I have to think that most doctors who are practicing today would wish they could change some of the ways they practiced as far as not prescribing as many pain pills,” Terrell said. “My hope is that the pharmaceutical industry would have done it differently, that the government would have done it differently and that all providers would have done it differently. …Unfortunately, like most people, it was really, really out there and people were dying before I realized that there was a problem. It’s one of those things that the house was on fire, but we just didn’t realize it. And we were pouring gas on the house that was on fire, and we didn’t realize it was one fire. It’s been a horrible phenomenon to have been a part of this, but not knowing that I was a part of this and not knowing that it was problem — not knowing that I was doing patients a disservice many times when I would prescribe pain pills to them,” Terrell said “I would take back a lot of those prescriptions if I could.”
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Visit www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/ to see how many oxycodone and hydrocodone pills were shipped to pharmacies in the Bartholomew County area.
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Visit cdc.gov/drugoverdose/maps/rxrate-maps.html for more information about opioid prescription rates in the United States.
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Visit the website for the Alliance for Substance Abuse Progress at asapbc.org to learn more about addiction resources in Bartholomew County.
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