
Drug companies alleged to have flooded West Virginia with opioid painkillers - sohkamyung
https://arstechnica.com/tech-policy/2018/01/drug-companies-submerged-wv-in-opioids-one-town-of-3000-got-21-million-pills/
======
emmab
> The letter also reveals that in Kermit, West Virginia, a town of just 406
> people, the company delivered 6.3 million hydrocodone and oxycodone pills
> between 2005 and 2011. For just the year of 2008, the numbers work out to
> Miami-Luken providing 5,624 opioid painkiller pills for every man, woman,
> and child in the town, the committee notes.

> “If these figures are accurate, HD Smith supplied this pharmacy with nearly
> five times the amount a rural pharmacy would be expected to receive,”

So it's normal to supply 1124 pills per capita&year to rural pharmacies?
Something seems strange about these two pieces of information...

~~~
jandrese
In rural areas almost nobody lives in the town limits, so the actual
population is considerably higher than the quoted figure. It is still a
staggering amount of narcotics.

I used to think that the old argument that drug companies killed marijuana
legalization efforts behind the scenes was tinfoil hat stuff, but now I'm not
so sure. This is basically a giant funnel of government money (many people in
these tiny communities have been on government assistance ever since the mines
shut down) directly into the revenue streams of these drug companies. Sure it
also tears the communities apart and destroys countless lives, but it's great
for the bottom line.

~~~
WillReplyfFood
They are always free to choose another drug and walk away from this company.
The market is free like that, the invisible hand distributing only where
demand exists.

~~~
stryk
Let me tell you this from direct personal experience: Opiate addicts are not
"free" to do much of anything -- very very least of all are they free to, on a
whim, switch and/or stop the drug. Yes that sounds over-exaggerated, but it is
not. There is a huge wave of opiate addiction that is sweeping back and forth
across the USA,, and nobody seems to be doing anything about. The White House
acknowledges the problem, but offers nothing more than platitudes for
political points [and doesn't even do that convincingly] and KellyAnn
McPlasticSurgeryLiarFace who couldn't find her own ass in the dark with both
hands.

And yea, the pharmaceutical companies are to blame -- of course it's not _all_
their fault, but a huge, HUGE % of it is. It started with over-prescribing of
pain pills. Particularly OxyContin. The pharmaceutical companies and their
reps, intentionally and knowingly, told the doctors "don't prescribe a higher
doseage, prescribe more pills of the lower dose" \-- along with giving them
financial incentives including straight cash kickbacks. They knew how
addictive these drugs were, and they didn't care, if any of them say different
they are flat out _lying_.

Then the government steps in, the DEA either pressures the doctors who are
over-prescribing until they give up and quit, or they shut them down directly.
Now there's a vacuum with a ton of cold hard cash floating around in it - the
addicts still have to have their opiates but the suppliers (which were their
doctors) are gone... what an opportune time for the heroin dealer to step in
and fill the void?!?! And that is _exactly_ what happened, and is happening
right now everywhere in the country.

And it's not like the DEA doesn't know this is what happens, they would have
to be bumbling idiots not to, but they have to show results in order to
justify their budgets and keep their jobs.

------
DanielBMarkham
There's something odd about this article. The opiod crisis _is_ a crisis, and
we should go about mitigating the consequences of having so many addicts (And
stop creating new ones as much as possible.)

I think it's because there are some hidden assumptions going on that the
author just needs to come out and fess up to.

One, that drug companies should look at shipments per town as being an
indicator of problems.

Two, that by shipping drugs, drug companies are causing the epidemic. They may
be profiting from it, they may support legislation to make it worse, but it
doesn't take millions of pills to get hooked. This is a _result_ of
additiction, not a cause of it. You shut-off/slow-down the pill flow, you just
create a bigger black market. Addiction is a natural result of using opiods to
treat pain. It is not caused by too many pills.

Three, that drug companies are the only people with agency here. Surely there
are doctors, pharmacists, nurse-practitioners, ministers, social workers, and
a slew of other people in these towns that are exposed to this problem every
day. Many of them assist in the problem, either directly or through studied
ignorance. This is a complex social problem with lots of players. Simplifying
it to "evil drug companies" dumbs the problem down to the point of being
intractable.

I'm not sure this article educated anybody as much as it made them upset. I'm
struggling to find something useful and positive to say about how it could be
improved. I sure don't want drug companies using some kind of statistical
process control to determine who can get pills or not. That's whack.

~~~
DanBC
> Two, that by shipping drugs, drug companies are causing the epidemic. They
> may be profiting from it, they may support legislation to make it worse, but
> it doesn't take millions of pills to get hooked. This is a result of
> additiction, not a cause of it. You shut-off/slow-down the pill flow, you
> just create a bigger black market. Addiction is a natural result of using
> opiods to treat pain. It is not caused by too many pills.

When you make the medication you know how additictive it is. You have all the
studies you published showing that it's mildly addictive. You have all the
studies you didn't publish showing it's somewhat more addictive.

You also know what safe dosing levels are, and what the target audience is,
and how many pills you predict to sell per capita in a region.

So when you see a small doctor's office ordering vast quantities you should be
clued in that maybe they're not a good doctor, maybe they're a pill-mill.

[https://www.wvgazettemail.com/news/cops_and_courts/drug-
firm...](https://www.wvgazettemail.com/news/cops_and_courts/drug-firms-fueled-
pill-mills-in-rural-wv/article_14c8e1a5-19b1-579d-9ed5-770f09589a22.html)

~~~
DanielBMarkham
I follow the reasoning, it just strikes me as facile. Surely not every town
with a statistically-outlying amount of opiod drug purchases is full of
addicts. Some towns have hospitals that are not part of the town's population.
Or clinics. Or pain centers. You're mixing up a bunch of stats and claiming a
conspiracy.

Yes, _in general_ there's something amiss, no doubt. But in general people are
married with 2.3 kids. Generalities don't public policy make.

If we're all going to go banging on the drug companies, and I'm fine with
that, by the way, then let's talk about lobbying, kickbacks for doctors,
marketing, and so forth. They're doing actual direct things that may be making
the problem worse. Failure to follow up on anomalies like this isn't one of
them. What would you have them do? Create a report, investigate each problem?
Will you deny pain drugs to people who need them because other people in their
town are using a pill mill? There's no remedy here that makes any sense.

What it feels to me like is an easy fishing expedition where you can put
together some reports, make a few statements, bring in Big Pharma for a photo
op. Maybe get some donations for the next election. It doesn't feel like any
kind of process aimed at either discovering or dealing with causality. It's
crap.

Worse still, you play these stupid games, you end up having discussions like
we did with the cigarette companies. Most people who smoke do not get cancer.
That's a true stat -- they usually die from heart disease or other causes
before they live that long. Stats are fun. You can do all kinds of things with
them, just about anything. (Insert long discussion here about the problems
encountered when stats are used)

Sorry. I didn't mean to pick on you. Like I said, the article itself bugged
me. We have a serious problem and we need to take serious action to help
people. I think because it's such a serious problem, people tend to overreact
in public discussion. A bit of hyperbole is fine. Personal attacks are not.
Hopefully I didn't do that.

------
costcopizza
Crazy to think I could go buy a 16yr old a pack of smokes and likely get in
much more trouble than _anyone_ involved in this pill pushing operation.

~~~
jandrese
Or go and buy a dime bag of weed.

------
em500
The wording of this article seems strange to me. Presumably these painkillers
were ordered by local pharmacies on request of doctors/patients, rather than
dumped by drug companies in some random places in the towns.

~~~
Theodores
Pill mills - places where nobody has anything better to do than open a
pharmacy where the pills get handed out. Prescriptions are needed so doctors
have to be in on the scam too. Then word gets around amongst the addict
community and this place becomes the place to be to get these drugs.

The story is actually very old and the writer may be very new to it - I have
known of the epidemic for only a year and clearly it goes back a long time
before that. Therefore 'strange wording' might be just because the writer is
learning too. Since even Trump has paid lip service to the epidemic it is not
that new but maybe the scam is new to most people.

'Only a decentralised blockchain can solve the crisis and win the war on
drugs' would have been a new update to the story, alas no, here we have what
we already know.

------
slr555
This article suffers from a lack of precision in important terminology. "Drug
companies" are typically understood to be research based pharmaceutical
companies such as Merck or generics companies such as Teva (I realize there is
some overlap).

The entities mentioned in the article seem to be drug wholesalers who act as
middle men between manufacturers and pharmacies. This is not merely a semantic
difference.

There is certainly an opioid crisis in this country but poorly edited
journalism that does not adhere to the accepted nomenclature of the industry
only clouds the issues and obfuscates who the actual bad actors are.

~~~
JKCalhoun
> …poorly edited journalism that does not adhere to the accepted nomenclature
> of the industry only clouds the issues and obfuscates who the actual bad
> actors are.

The drug wholesalers and drug companies both stand to make truckloads of cash.
Seems likely that both parties know exactly what they're doing.

I'm not party to the industry and have no special insight — just a citizen
watching from the sidelines but suspicious when it is suggested that it's just
a couple of bad actors.

------
skookumchuck
The government has declared war on marijuana growers, meth cookers, cocaine
suppliers, etc., and has failed utterly at it. Why would going after opioid
suppliers fare differently?

~~~
probablybroken
Because opioids are regulated?

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oldcynic
So why aren't the doctors responsible for the over-prescription up in front of
the ethics boards, then being struck off?

~~~
pjc50
It may even be just one guy.

[https://www.wvgazettemail.com/news/health/drug-firms-
shipped...](https://www.wvgazettemail.com/news/health/drug-firms-shipped-m-
pain-pills-to-wv-town-with/article_ef04190c-1763-5a0c-a77a-7da0ff06455b.html)

"In 2015, more than 40 percent of the oxycodone prescriptions filled by
Westside Pharmacy in Oceana were coming from the Virginia doctor, according to
the committee’s letter. The following year, the Virginia Board of Medicine
suspended the doctor’s license, finding his practice posed a “substantial
danger to public health and safety.”"

Possibly the person named here:
[https://pilotonline.com/news/local/health/article_7b369428-0...](https://pilotonline.com/news/local/health/article_7b369428-0054-5131-aafe-55f95882b6bc.html)

------
melq
Where is the DEA in all of this?

~~~
jostmey
How about the FDA?

~~~
yborg
I'm fairly sure the opioids are highly effective when taken as directed. It
guarantees repeat business.

