An election-year analysis
By David Loomis
INDIANA — Last week, well into the second century of the nation’s endless war on drugs, The Washington Post and The New York Times independently reported on the opioid epidemic with an element absent from much anecdote-driven coverage of the ongoing crisis:
The Indiana Gazette’s local angle on the national story featured how many prescription oxycodone and hydrocodone pills (which together account for three-quarters of all U.S. opioid pills shipped between 2006 and 2012) that pharmaceutical companies delivered to drug stores in Indiana County. (The source was federal Drug Enforcement Administration records released July 23 in lawsuits filed against some of the nation’s biggest pharmaceutical companies.)
Blairsville Pharmacy dispensed the most opioids in Indiana County, according to the DEA data. The drug store filled prescriptions for 2,071,400 oxycodone and hydrocodone doses in a community with a 2012 population of 3,415 – the equivalent of 600 opioid pills for every resident during that seven-year period.
The local facility edged out the Wal-Mart pharmacy in Indiana, which dispensed 2,061,060 pills during the period, according to the DEA.
Wal-Mart’s corporate press office responded to a July 19 query in an automated email. “We strive to return media calls within one business day,” it read. No other response has been received.
John Pastorek, Blairsville Pharmacy co-owner, responded in a series of phone and text-message interviews July 19-27. He and his partners did not buy the place until 2015, three years after the period covered by the DEA data, he said.
The pharmacy’s former owner during the 2006-2012 period did not return a message left on a phone number listed in his name.
Pastorek said the opioid-pill counts reflect the Blairsville drug store’s business volume.
“We are probably one of the most popular pharmacies in Indiana County,” Pastorek said in a July 19 phone interview. “How many blood-pressure pills? Diabetes pills? We’re probably No. 1 on that, too.”
Pastorek added that the 2.1 million opioid doses Blairsville Pharmacy dispensed 2006-2012 represented 5.8 percent of the pharmacy’s total of 35.71 million doses of all medications it dispensed during the period.
OF COURSE, blood-pressure and diabetes medications are not associated with epidemic mortality rates that opioids have produced. But comparisons can be instructive.
For example, Blairsville Pharmacy’s 2.1 million opioids are one-fourth of the total dispensed by Indiana County’s top five opioid-dispensing drug stores combined during the 2006-2012 period. (See accompanying chart, above.)
Those 8.5 million-plus opioid doses dispensed by the county’s top-five pharmacies in 2006-2012 represent 30.6 pills per resident, according to the DEA data published in The Post. For comparison, in neighboring Armstrong County, it was 37.2 pills per person. In Cambria County, it was 61.5. In Mingo County, W. Va., it was 203.5.
It’s no coincidence that those pills were concentrated in these places. By 2012, all of the counties at the top of the list for receiving the most opioids were in Appalachia, where shipments rose most sharply over the seven-year stretch.
Result: The region suffered grievous mortality rates that correlated closely with the companies’ pill shipments.
Indiana County’s reported overdose deaths between 2008 and 2019 number 286, according to a University of Pittsburgh count. (The data also are broken down by borough and township.) Armstrong County’s overdose deaths are 238 between 2005 and 2019. Cambria County’s deaths are 299 between 2015-2019.
Nationwide, since Purdue Pharma began to market OxyContin in 1996, more than 400,000 Americans have died from prescription-opioid overdoses — more deaths than the U.S. military suffered in World War II.
About 2,000 lawsuits have been filed against Purdue and other corporate drug dealers in an effort to make them pay for the harm done to communities like those in Appalachia. Some communities, for example, are seeking compensation for their costs of caring for growing numbers of children orphaned or in foster care due to opioid-related deaths.
IN NORTHERN APPALACHIA, Indiana County voters will be electing local representatives this year and state and federal reps next year. Healing scars inflicted by the opioid epidemic should be on the public agenda for those candidates.
Josh Shapiro, Pennsylvania’s attorney general, showed the way by announcing in May that the commonwealth would become the 39th state to sue Purdue for its contribution to our opioid crisis. Shapiro soon added that he is preparing to sue more pharmaceutical companies.
The lawsuits assert that brand-name drug-makers committed fraud by minimizing risks of addiction, lobbying doctors to prescribe more pills at higher doses and failing to flag suspiciously large deliveries. (Lawsuits filed against distributors and drug stores – such as Blairsville Pharmacy and Wal-Mart — are less likely to succeed, according to Forbes magazine.)
Localities can join the plaintiffs, too. Of the thousands of lawsuits filed against the drug-makers, most have been filed by local governments – cities and counties.
Indiana County may be overdue for an accounting of the epidemic’s costs and the community’s claims in preparation for settlement of the lawsuits. One commonly cited model for this process is the landmark 1998 tobacco settlement that will pay $246 billion to settle claims against cigarette companies for their fraudulent advertising. (“Not a cough in a carload!”)
In 2018, the annual tobacco-settlement share paid to Pennsylvania was $806 million.
Indiana County’s accounting should not rely on hindsight alone. The opioid epidemic has roots that predate Prohibition, but those roots extend to the present and project into the future. Meanwhile, policies that punish drug users for their habits have been recognized as failures by bipartisan majorities in Congress – and by the White House.
THAT DOES NOT FORETELL a future of drug abuse on the wane. Consider recent local roller-coaster headlines:
- March 10, 2019, Indiana Gazette: “Official: OD deaths declining”
- April 21, 2019, Indiana Gazette: “Use of meth on the rise, officials say”
- July 8, 2019, Indiana Gazette: “OD deaths spiked in first half of 2019”
But the headlines do suggest that something deeper than drug use underlies the trends. For example:
- Jan. 11, 2019, Indiana Gazette: “Locally, suicides rise sharply in 2018”
Why are suicides on the rise? Two recent studies say despair is a reason. The headline: “In Pennsylvania, ‘deaths of despair’ are 50 percent higher than the national average.” These deaths are caused by drugs (particularly opioids), alcohol and suicide, and the trend is especially pronounced among millennials.
But the drugs are not the cause of the despair. That can be found in variety of social trends and public policies that are contributing to depression, anxiety and other mental health factors.
THOSE FINDINGS and the data from the opioid-epidemic lawsuits should be a call to action among would-be elected representatives to prioritize the local opioid epidemic, to account for its financial costs to the community and seek redress in court to repair the erosion of the county’s human capital.
Regional officials began to respond to the epidemic by gathering information from first responders, by coordinating prosecution among district attorneys, by expanding access to naloxone, and by emphasizing prevention among school children.
But the flood of new data from the thousands of civil lawsuits filed against the corporate drug pushers points in new directions. For starters, local officials can join the lawsuits, account for their costs and be prepared to lay claims on the anticipated court judgments.
That could provide the financial capital to restore the human capital lost to despair, in the way that the tobacco settlement supplied states with revenue to address public health costs of cigarette smoking. Federal officials can tighten evidently lax oversight and regulation of pharmaceutical corporations and their distributors.
These policy prescriptions are subjects for future columns. Meanwhile, they should serve as a stimulant for local officials to propose solutions of their own to voters.
David Loomis, Ph.D., emeritus professor of journalism at Indiana University of Pennsylvania, is editor of The HawkEye.
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