Indiana State Department of Health
Indiana State Department of Health
Newly-released data shows Howard County was flooded with prescription pills from 2006 to 2012, a devastating phenomenon that has ravaged communities across the nation, but the magnitude of which is just now becoming clear.

And the problem is far from over.

A database maintained by the Drug Enforcement Agency was released this month showing how each pain pill sold in the United States during those years traveled from manufacturers and distributors to pharmacies across the country.

The Washington Post, which played a major role in getting the DEA database made public, then filtered the data, making it available at county and state levels “in order to help the public understand the impact of years of prescription pill shipments on their communities,” according to the paper.

Oxycodone and hydrocodone pills accounted for 75 percent of all opioid pill shipments to pharmacies across the U.S., found the Post, which says its version of the database “allows readers to learn how much hydrocodone and oxycodone went to individual states and counties, and which companies and distributors were responsible.”

'Pretty daunting'

The data shows that from 2006 to 2012 more than 40.7 million prescription pain pills — or enough for 69 pills per person per year — were supplied to Howard County. That is the 11th highest number of Indiana’s 92 counties.

More than 12 million of those pills were distributed by CVS, while more than 15.3 million were manufactured by Actavis Pharma, Inc., which Bloomberg says "develops, manufactures, and markets a broad line of generic pharmaceuticals."

Hook-SupeRx, LLC, which does business as CVS Pharmacy, received the highest number of pills in Howard County. In fact, a top five list of pill-receiving pharmacies in Howard County in comprised of three CVS pharmacies and two Walgreens.

Howard County’s most infamous pill mill was at the height of its influence for at least part of that time, a point acknowledged by Howard County Public Health Project Coordinator Jennie Cauthern.

“I would agree that was probably the result of those numbers since … the clinic was shut down in 2013,” she said in an email, referencing the Wagoner Medical Clinic.

Officials first raided the two Wagoner Medical Clinics, in Kokomo and Burlington, in March 2013, arresting several clinic doctors and employees roughly a month later in a case put together by Kokomo police and U.S. Drug Enforcement Agency officers.

In all, prosecutors filed 95 charges in April 2013 against the Wagoners and their associates, who police say would distribute narcotics prescriptions to patients even after failed drug screens.

Prosecutors say more than two dozen people died as a result of the illegal prescribing practices at the facilities, including pre-signed prescriptions utilized by physician assistants.

One doctor was accused of writing more than 10,000 prescriptions for controlled substances in 2012, showing the momentous impact the Wagoner clinics had on residents susceptible to drug abuse, many of whom would go on to overdose or develop debilitating drug addictions.

But Howard County’s problem with pills has not gone away, and it cannot be solely attributed to one pill mill.

Figures released by the state show that in 2018 Howard County averaged 301 opioid controlled substance prescriptions dispensed per 1,000 residents. The state average was 214.

Asked why Howard County’s numbers are so high, Cauthern said: “Unfortunately I really have no conclusive information that would answer this question.”

In previous comments to the Tribune, Cauthern noted that opioid prescription rates have dropped in Howard County in recent years, as outlined on the state’s Next Level Recovery website, which measures opioid prescriptions per 100 residents.

Those rates, however, remain well above the state average.

“Wagoner Clinic was shut down in 2013 and you’ll notice the number was around 170-174 [opioid prescriptions per 100 residents] from 2008 until 2013, then dropped to 146 in 2014,” she said.

“I believe while some of those patients stopped getting their prescriptions from the clinic and didn’t continue those scrips, some found doctors to continue to prescribe opioid scrips.”

In an interview following the data release, Kokomo Mayor Greg Goodnight pointed to troublesome prescribing practices as the main culprit in Howard County's prescription pill mess.

"I've said it a million times: It's because people are over-prescribed," he said.

"It's pretty daunting when you know there are people that took zero (pills), a lot of people that took zero," he added, specifically referencing the DEA database findings.

What put Howard County high on Indiana's list? Goodnight credited "a large percentage of people with decent to very good insurance plans."

"That's usually what drug manufacturers need, somebody that has the money to pay for it."

Overdoses

Howard County Coroner Steven Seele recently released figures showing the county experienced eight drug-overdose deaths in the second quarter of 2019. That means 19 people died of overdoses through this year's first half (one was a suicide).

That is four more than Howard County had this time in 2018; it is six fewer than in 2017, the deadliest year ever for overdose deaths in the county.

Of the first-half cases, six involved heroin and six involved fentanyl, a synthetic opioid approved to treat severe pain, even advanced cancer pain, that has become better known for its deadly role in spiking drugs like heroin.

Studies have found that four in five new heroin users started with prescription drugs, although not necessarily from their own prescriptions.

"It's what started the process," noted Goodnight about prescription pills, describing "good people" who may have had medical procedures, got over-prescribed and started down the slippery slope that is prescription medication.

"Over-prescribing and easy access created a group of addicts."

He added: "I think we've talked about it enough that it's starting to trend back the other way, but it's not going to change as quickly as people – unfortunately for a lot of people, it's not going to change very quickly."

Seele has encouraged drug addicts to reach out to Turning Point Systems of Care, a local initiative meant to help residents struggling with substance abuse and mental health problems. Turning Point can be reached at 765-860-8365.

Lawsuits and a data dump


Kokomo and Howard County’s governments, like many across the nation, have filed lawsuits against opioid manufacturers and distributors, alleging they are to blame for the deadly, ongoing drug crisis on a national, state and local level.

Kokomo announced in October 2017 it was joining cities from across Indiana and the United States in a public nuisance lawsuit against the country's three largest wholesale drug distributors.

Those distributors - AmerisourceBergen, Cardinal Health and McKesson Corp. - are accused by the city in a press release of "dumping millions of dollars' worth of prescription opiates into its community" and as being "responsible for the opioid epidemic."

In January 2018, Howard County filed a lawsuit claiming that through misinformation on the addictive nature of opioid medications the public wasn’t adequately educated on the dangers associated with taking drugs.

A 165-page document outlined the county’s complaint and detailed the alleged negligent actions of the same three major drug distributors. About 20 other smaller companies are also named in the lawsuit as defendants.

Also under a microscope has been Purdue Pharma. Lawsuits have said the 1995 introduction of OxyContin, a time-released opioid, created a new playbook to push the use of opioids for more patients and in higher doses. Purdue has disputed its role in the epidemic, saying lower-priced generic drugs are actually to blame.

Many local governments have also sued other, often smaller, drugmakers, distribution companies and pharmacies.

“The important thing regarding this type of a lawsuit is to understand we will never litigate our way out of this situation that we’re in. That’s certainly not what we’re suggesting by any manner by participating in the lawsuit,” said Howard County Commissioner Paul Wyman when the lawsuit was being discussed.

He added, though, that there appears to be “egregious lapses in performance by these organizations. If that pans out to be true, it has certainly contributed to the epidemic that’s before us.”

Overall, roughly 2,000 state, local and tribal governments are suing the industry over the opioid crisis.

An Associated Press analysis of drug distribution data released as a result of lawsuits against the industry also found that the amount of opioids as measured by total potency continued to rise early this decade even as the number of pills distributed began to dip.

The reason: Doctors were prescribing — and the industry was supplying — stronger pills.

“It shows it wasn’t just the number of pills being shipped that increased. The actual amount of opioids being prescribed and consumed went up,” said Anna Lembke, a Stanford University professor who researches opioids and is serving as a paid expert witness for plaintiffs in the litigation.

“We know that the higher the dose of prescribed opioids, and the longer patients are on them, even for a legitimate pain condition, the more likely they are to get addicted.”

The AP found that the overall amount of opioid medication shipped to pharmacies, medical providers and hospitals increased 55% from 2006 through 2012. The number of pills rose significantly over that period, too — but that increase was lower, about 44%. [The amount of medication was calculated using a standard measure of potency known as a morphine milligram equivalent, or MME.]

The data comes from the DEA's collection of information from pharmaceutical companies about how controlled substances were distributed down to pharmacies, doctors and hospitals.

The first of the federal trials, involving claims from Ohio’s Cuyahoga and Summit counties, is scheduled to start in October.

Last week, a judge agreed to make public the data covering 2006 through 2012. During that period, opioid overdose-related deaths in the U.S. increased from about 18,000 a year to more than 23,000. Since then, the number has doubled, and opioids have overtaken automobile accidents as the top cause of accidental death in the country.

Heroin and even stronger illicit drugs such as fentanyl drove the increase for most of this decade.

The Associated Press contributed to this story.
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