Louisville area pharmacies from 2006 through 2012 distributed more than 300 million opioid pills — enough for about 60 pills per year for every man, woman and child in Jefferson County.
The distribution of the drugs at the onset of the national opioid crisis contributed to a spike in overdose deaths, which locally have exceeded 1,000 in the last three years. The number of overdose deaths in Kentucky in the last three years has exceeded 4,300. Nationally, 130 people die from opioid-related drug overdoses every day.
The drug data come from a U.S. Drug Enforcement Administration database. The Washington Post analyzed 380 million transactions and shared the results “to help the public understand the impact of years of prescription pill shipments on their communities.”
The data cover only oxycodone and hydrocodone pills, which, according to the paper, “account for three-quarters of the total opioid shipments to pharmacies.”
The origins of the opioid crisis date to the late 1990s, when pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers, resulting in health care providers prescribing the drugs at greater rates, according to the U.S. Department for Health and Human Services. The increased prescriptions of opioid drugs led to widespread misuse of prescription and non-prescription opioids before it became clear that these medications could indeed by highly addictive.
In 2017, HHS declared a national public health emergency to combat the opioid crisis. Nearly 2,000 communities harmed by the epidemic have sued drug companies, according to the Washington Post. The city of Louisville filed a suit in 2017.
The DEA database includes 301 distributors in Jefferson County during the period, including some individual doctors who dispensed as few as 30 drugs in that seven-year span. However, more than half of the 300 million pills distributed locally during that period came from just two companies: Walgreens and Kroger.
Walgreens dispensed more than 110 million pills, while Kroger distributed nearly 58 million.
Kentucky Attorney General Andy Beshear in 2018 filed a civil lawsuit against Walgreens “for its role in fueling the opioid epidemic in the Commonwealth through unlawful business practices.” The company has sought to have the lawsuit dismissed, but its most recent effort was denied by a judge last week.
The Walgreens lawsuit and others Beshear and the city of Louisville have filed against drug manufacturers and distributors, including McKesson Corp., Cardinal Health and AmerisourceBergen, argue that the companies dispensed “excessive volumes” of opioids into Kentucky, that they must have known the quantities were so high that they could serve no legitimate medical purpose and that they ignored any warning signs in the interest of millions of dollars in profit.
“Walgreens,” Beshear wrote in the suit, “filled so many opioid prescriptions that the number of opioids dispensed … were unreasonable … and suspicious on their face.”
“Walgreens filled massive and/or suspicious orders of unusual size, orders deviating substantially from a normal pattern and orders of unusual frequency,” the lawsuit asserts. “These orders were for such large quantities of prescription narcotic pain medication that there could be no associated legitimate medical purpose for their use.”
Walgreens Pharmaceutical Wholesale division generated an operating profit of $376 million in fiscal 2015, and, the suit asserts, the company “failed to report to appropriate authorities such suspicious orders and failed to halt such excessive and suspicious shipments … (because it) did not want to disrupt or diminish its highly profitable business practices.”
Walgreens told Insider via email that it provided only legitimate prescriptions and has not distributed prescription controlled substances since 2014. Kroger could not be reached.
Walgreens’ total distribution in Jefferson County is inflated partially by its market dominance. The chain has the most local pharmacies in the DEA database, with 35, compared to 29 from Kroger, 18 from Rite Aid, 16 from CVS and 15 from Walmart.
However, Walgreens pharmacies also distributed more drugs per pharmacy than other chains: Walgreens on average distributed more than three million pills per pharmacy during the period, compared to fewer than two million per Kroger store, 1.9 million per Rite Aid, 1.7 million per CVS, and 1.1 million per Walmart.
Six of the top 10 pharmacies with the highest number of drugs distributed in Jefferson County were Walgreens. The company’s top selling Louisville pharmacy sold more than 8.7 million pills during the period, or nearly 12 pills for every Jefferson County resident.
A Walgreens spokesman, Phil Caruso, told Insider via email that its pharmacists “are highly trained professionals committed to dispensing legitimate prescriptions that meet the needs of our patients.
“Walgreens has not distributed prescription controlled substances since 2014 and before that time only distributed to our chain of pharmacies,” Caruso said. “Walgreens has been an industry leader in combating this crisis in the communities where our pharmacists live and work.”
The Jefferson County company that actually distributed the most opioids between 2006 and 2012 is PCA Corrections, which dispensed 9.6 million pills. However, PCA is an institutional pharmacy, meaning it provides pills only to patients in nursing homes, rehabilitation centers and other such locations. It does not sell directly to consumers.
Chief Operating Officer Joe Whitt told Insider that during those years, PCA provided medicines to 12,000 patients at facilities in three states, mostly elderly people getting medications after undergoing orthopedic surgeries such as knee or hip replacements. That works out to about 2.2 pills per patient per day.
PCAC works with physicians at those facilities, and “all medications are dispensed by a nurse,” Whitt said.
The company has seen significant growth since that period, has opened additional offices in other states and now provides services to 32,000 patients. In Louisville, the company employs 150.
Part 1 of a series.