How Hard Was It to Detect the Opioid Epidemic as It Grew?
How did we get into the situation of opioid addiction like the one the U.S. struggles with now? To figure out how it happened, let’s take a look at how company executives may make decisions for the good of their company but that create serious problems among their consumers.
To get an idea of how these short-sighted decisions are made, imagine for a moment that you’re involved in the manufacture or delivery of an energy drink. You could be an executive, a sales manager or even a delivery driver. You’re proud of your company’s continuous expansion and every time sales go up, your paycheck gets fatter.
At company staff meetings, you hear executives talk about how fast sales of this energy drink are expanding. It seems like your company’s products are just flying off the shelves. You start thinking about how much money you’re going to be able to pocket to make your own personal dreams come true.
But then the situation begins to unravel just a little. If you’re a delivery driver, you notice that you’re delivering an insane amount of this energy drink to certain sales locations. You know the drink contains some pretty strong stimulants and you hope that some customers are not indulging in too many of these drinks. Some of these sales locations are right next to high schools or universities and that concerns you.
If you’re a sales manager, you exult in these increasing sales figures. But then one of your chemists comes to you to express their concerns about the product. Their tests reveal that the drink can be very hard on the heart if a person drinks too much of these stimulants. You laugh and tell him not to worry so much. When he leaves, you go back to looking at brochures of luxurious vacation homes.
If you’re an executive, you continue to apply heavy pressure on production facilities, sales crews, marketing, and delivery to ensure that every part of the machine is working perfectly to trounce the competition. You’re sure you should own this market completely. When you hear whispered concerns about the health of some customers who seem to be drinking huge amounts of this beverage every day, you brush them aside. “We can’t take responsibility for every individual out there,” you claim. “They make their own choices. We just make this drink available to them.”
The Situation Finally Blows Up—Along with Customers’ Hearts
Finally, reports start coming in that some people have become addicted to these drinks and that was their undoing. Essentially, they continued guzzling this beverage until their hearts exploded. Now, this product is in the headlines for all the wrong reasons.
In our imaginary example, how might each of these three individuals respond to this dangerous situation? The executive gets busy hiring lawyers and doing damage control. The sales manager works hard to try to prop up his empire and so maintain the company’s high level of sales. The delivery driver has had it. He quits his job and starts working for a company that isn’t harming anyone.
Long before this disruptive day arrived, each of these people knew that something was very wrong but they chose to focus on profits instead of actually dealing with the harm that was being done—at least, until the delivery driver quit. They had the sales reports and the distribution maps to know that some stores were receiving enormous shipments of these drinks—far more than their small number of customers might warrant.
Out of the public view, this has been the exact behavior of many companies and individuals involved in the manufacture, marketing and delivery of opioid painkillers. To protect their profits, thousands of individuals who had knowledge of the problems ignored them in favor of continuing high sales and profits.
As we now know, the result of this criminal level of neglect is nearly half a million dead from opioid overdoses, nearly 1.7 million addicted to these drugs and another half-million people addicted to heroin who could have started their habits with painkillers. [Table 5.1A]
Because there are nearly two thousand lawsuits against all these players, we now have the ability to look inside some of these companies at the utter neglect of the effects of their actions. It’s enough to infuriate the average person who IS able to consider the survival of others besides themselves. Apparently, these executives, sales reps and other pharmaceutical employees lacked that ability.
A Look Inside Some of These Companies
As reported by the Washington Post, here’s a couple of examples of corporate neglect taken from records of these lawsuits.
- In 2009, a Purdue Pharma executive received an order from a pharmaceutical distributor for more than 115,000 oxycodone pills. That order was nearly twice as large as any order over the previous three months. The order was immediately approved for delivery. An increase like this should have been a red flag for the executive.
- Mallinckrodt is a manufacturer of hydrocodone, buprenorphine, morphine, oxycodone, fentanyl, and methadone, among other drugs. In 2008, a customer service rep questioned an astonishingly large order from a new customer. The new customer, a Florida pharmacy, requested more than a quarter-million oxycodone tablets. The national account manager did not reject the order or query it. In 2011, the Drug (DEA) Enforcement Administration began to investigate Mallinckrodt when it was discovered that the company had shipped hundreds of MILLIONS of oxycodone pills to Florida.
Another report from the Los Angeles Times documents the case of a pharmacy in Huntington Park that ordered huge quantities of painkillers. More than a million pills were diverted from this one pharmacy to the black market. But neither the opioid manufacturer nor the distributor bothered to investigate this small pharmacy that was ordering outrageous quantities of pills.
In an even more shocking example, the Charleston Gazette reported that, over a ten-year period, drug companies shipped nearly 21 MILLION opioid pills to two pharmacies in a town of 2,900 residents. Drug wholesaler Miami-Luken also shipped 5.7 million hydrocodone and oxycodone pills to a pharmacy called Sav-Rite in Kermit, West Virginia. That’s enough to provide every resident of Kermit with 5,624 pills.
Who was involved in this excessive and negligent shipping? Who could have perhaps analyzed their records and detected the problems?
For a possible answer, we can consider the defendants listed in these thousands of lawsuits that have now been consolidated into one huge legal action in Ohio. Here’s a sample from the six-hundred defendants included in this action. We won’t know for many months if these companies are guilty of contributing to this problem, only that they were included in the lawsuits as possibly culpable. There are many manufacturers, wholesalers, distributors and pharmacies on this list.
- Albertsons Companies, Inc.
- Allergan USA, Inc.
- American Pain Foundation, Inc.
- American Pain Society, Inc.
- AmerisourceBergen Drug Corporation
- CVS Pharmacy Inc.
- Cardinal Health Pharmacy Services, LLC
- Cephalon, Inc.
- Costco Wholesale Corporation
- Eckerd Corporation
- Endo Pharmaceuticals, Inc.
- Giant Food Stores, LLC
- Indivior, Inc.
- Insys Therapeutics, Inc.
- Janssen Pharmaceuticals, Inc.
- K Mart Pharmacy
- Kroger Pharmacy
- Mallinckrodt LLC
- McKesson Specialty Distribution, LLC
- Miami-Luken, Inc.
- Novartis AG
- Ortho-McNeil-Janssen Pharmaceuticals, Inc.
- Publix Supermarkets, Inc.
- Purdue Pharma, Inc.
- Quest Pharmaceuticals, Inc.
- Rite Aid Corporation
- Safeway Inc.
- Sandoz International GMBH
- Smith Drug Company
- Smith’s Food & Drug Centers, Inc.
- Target Stores, Inc.
- Teva Pharmaceuticals USA, Inc.
- Walgreen Co.
- Walmart Inc.
- Winn-Dixie Stores, Inc.
- Zogenix, Inc.
The DEA Releases Drug Distribution Data
In 2019, the DEA released a vast database showing sales and distribution of addictive painkillers. With the use of this database, it is possible to instantly detect those areas with abnormally high levels of opioid orders and consumption.
The Washington Post took the time to map this data so it is easy to see where the excesses took place. Most significant areas on the map include Appalachia and surrounding states, Northern California and Southern Oregon, parts of Oklahoma, Northern Idaho and Western Washington, among others. In seven years ending in 2012, more than 76 BILLION pills of these potentially addictive drugs were distributed across America. You can view this map and the Washington Post coverage here.
What we learn from these lawsuits and the DEA database is that the data has long been available to detect areas where too many pills were being shipped. If the pharmaceutical manufacturers and distributors involved in creating this problem had curbed overprescribing by investigating massive orders, we might have a much smaller opioid problem than the one we currently have.
Sources:
- https://www.cdc.gov/drugoverdose/epidemic/index.html
- https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2018R2/NSDUHDetailedTabs2018.htm
- https://www.washingtonpost.com/investigations/newly-unsealed-exhibits-in-opioid-case-reveal-inner-workings-of-the-drug-industry/2019/07/23/acf3bf64-abe5-11e9-8e77-03b30bc29f64_story.html
- https://www.latimes.com/projects/la-me-oxycontin-part2/
- https://www.wvgazettemail.com/news/health/drug-firms-shipped-m-pain-pills-to-wv-town-with/article_ef04190c-1763-5a0c-a77a-7da0ff06455b.html
- https://www.govinfo.gov/app/details/USCOURTS-ohnd-1_17-md-02804/USCOURTS-ohnd-1_17-md-02804-0
- https://www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/
®