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Opioid Roadmap: 76 Billion Pills and Counting

You may not know or recognize his name, but Austrian Friedrich Serturner was a pharmacist's assistant who, through 14 years of research and testing, isolated the purest form of the alkaloid base compound morphine from opium poppies.1 He found the opium with the alkaloid removed was not effective on animals, but the alkaloid was 10 times more powerful than the processed opium.2

After spending years testing on himself, he died chronically depressed and addicted to morphine.3 By the mid-1820s morphine was used across Western Europe, provided by several sources, including a new chemical company started by Heinrich Merck.4 Although first thought to be a cure for opium addiction, by the 1870s it became clear morphine was also addictive.

A chemist in a London hospital searching for a nonaddictive drug option to treat pain discovered a more powerful drug called diacetylmorphine. Bayer Laboratories developed and tested the drug and found it was a powerful painkiller.5 They produced and marketed it as a "sedative for coughs" in 1898. They called it heroin.

Although physicians quickly welcomed the new drug, they soon recognized the potential for addiction and in 1913 Bayer stopped production, and instead focused their efforts on marketing their second discovery, aspirin.

Unwilling to be associated with heroin production and distribution, Bayer Laboratories had edited that period from their official company account.6 While the pharmaceutical industry may have initially operated in the best interests of the public and their patients, this quickly changed over the next 100 years.

Database reveals horrific extent of opioid distribution

Before the mid-1980s opioids were prescribed few and far between because of fear their patients would become dependent on these highly addictive drugs.7 In 2017, the National Institute on Drug Abuse8 records there were 1.7 million people who suffered from a substance abuse problem related to prescription opioid pain relievers and 652,000 from addiction to heroin.

During the same year there were 47,600 deaths from an opioid overdose and at least 130 who died every day in 2016 and 2017 from an opioid-related overdose.9 In total, the Centers for Disease Control and Prevention records nearly 218,000 people have died due to opioid-related prescription overdoses.10

The epidemic has devastated communities and families, while physicians, pharmaceutical manufacturers and distributors have enjoyed exceptional profits. This is the crux of a lawsuit brought by 2,000 communities in federal court against 2311 of the biggest drug companies they allege conspired to flood the country with drugs and their pockets with profits.12

The lawsuit covers 2006 to 2012, when the plaintiffs allege 76 billion opioid pain pills were distributed throughout the U.S. as the drug epidemic spiraled out of control.13 That's enough for every American in 201014 to take one pill every 1.5 days for one year. However, the shipment of the drugs was not evenly distributed throughout the U.S.

According to data from the DEA,15 one small town of 2,831 people received a shipment each month of 3,271 bottles,16 each containing 100 pills.17 The Washington Post reported on emails sent by Kristine Atwell, who managed Walgreens' distribution of controlled substances for their warehouse in Jupiter, Florida. She urged headquarters to require justification for large orders.18

"I ran a query to see how many bottles we have sent to store #3836 and we have shipped them 3271 bottles between 12/1/10 and 1/10/11. I don't know how they can even house this many bottle[s] to be honest. How do we go about checking the validity of these orders?"

Further emails in the plaintiff's lawsuit quoted Victor Borelli, an account manager for Mallinckrodt to Steve Cochrane, vice president of sales for KeySource Medical. In one exchange quoted in The Washington Post:

"Borelli told Cochrane in another email that 1,200 bottles of oxycodone 30 mg tablets had been shipped.

"Keep 'em comin'!" Cochrane responded. "Flyin' out of there. It's like people are addicted to these things or something. Oh, wait, people are …" Borelli responded: "Just like Doritos keep eating. We'll make more.""

DEA and drug companies fought to keep numbers secret

The DEA maintains a database of every controlled substance prescribed, sold and distributed throughout the U.S. — Automation of Reports and Consolidated Order System (ARCOS).19 In an age of digital reporting and computer aided analysis, it's difficult to imagine the DEA was unable to pinpoint those involved in fraud that was feeding an epidemic killing hundreds of thousands of Americans.

For the first time, data from ARCOS have been released to the public after The Washington Post and HD Media pushed for over one year to access the information. Until July 15, 2019, the litigation proceedings had been held in secrecy. On that date the federal judge lifted a protective order for part of ARCOS.20

Attorneys for the drug companies and the DEA challenged the public release of the information. The drug companies argued the data may give their competitors an unfair advantage in the marketplace.

While protecting market information for business is important to the Federal Trade Commission, it's also important to remember the drug companies wanted to protect their sales of opioid painkillers, the data which were being released.

The justice department argued the release may potentially compromise ongoing investigations. But the lawyers for the communities suing the drug companies we're happy to see the data released to the public. Paul Farrell Jr., co-lead counsel for the plaintiff said to The Washington Post:21

"The data provides statistical insights that help pinpoint the origins and spread of the opioid epidemic — an epidemic that thousands of communities across the country argue was both sparked and inflamed by opioid manufacturers, distributors, and pharmacies."

Each of the drug companies and pharmacies have made statements to the effect they hold no responsibility for the distribution of opioids across the U.S. — except one. Ohio-based pharmaceutical company Miami-Luken Inc. chairman Joseph Mastandrea stood before the House Energy and Commerce subcommittee along with four other executives from the nation's largest drug distribution companies.22

Each were sworn in and each denied they contributed to the opioid crisis. Only Miami-Luken accepted responsibility.23 Subsequently the company and four employees were indicted, charged with shipping millions of pills to rural Appalachia and 3.7 million pills from 2008 to 2011 to a town of 400 people.24

Pre-order Ronnie's New Book, Coming February 11

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