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Pill report lambastes supplier, lax DEA

December 22, 2018

CHARLESTON — In just 10 months, the sixth-largest company in America shipped more than 3 million prescription opioids — nearly 10,000 pills a day on average — to a single pharmacy in a Southern West Virginia town with only 400 residents, according to a congressional report released this week.

McKesson Corp. supplied “massive quantities” of the painkiller hydrocodone to the now-shuttered Sav-Rite Pharmacy in Kermit, even after an employee at the company’s Ohio drug warehouse flagged the suspect pill orders in 2007, the report found. That year, McKesson — ranked sixth in the Fortune 500 — reviewed its customers, including Sav-Rite, and reported to the Drug Enforcement Administration that the purchases were “reasonable,” according to the report.

McKesson’s shipments to Kermit — and to other small towns in West Virginia’s southern coalfields — were among more than a dozen “case studies” cited in a scathing report released by the House Energy and Commerce Committee after an 18-month investigation into pill dumping in West Virginia.

In addition to McKesson, the report sharply criticizes drug distributors Cardinal Health and AmerisourceBergen — along with regional suppliers Miami-Luken and H.D. Smith — for systemic “failures that contributed to the worsening of the opioid epidemic” by sending an “inordinate” number of prescription painkillers to the state.

McKesson, AmerisourceBergen and Cardinal Health alone combined to ship more than 900 million hydrocodone and oxycodone pills between 2005 and 2016. Thousands of West Virginians fatally overdosed after taking those prescription opioids during that time.

The report also blasts the DEA for turning a blind eye to the problem.

“Our bipartisan investigation revealed a number of alarming failures by the DEA and drug distributors to address the opioid epidemic,” said Rep. Greg Walden, R-Oregon, the committee’s chairman. “In instances identified by the report, (the) DEA and the drug distributors did not meet their obligations, and played a part in contributing to our nation’s opioid crisis.”

The report includes a transcribed interview with Dr. Joseph Mastandrea, board chairman of Miami-Luken, which also shipped millions of pain pills to Kermit. Mastandrea called the shipments by his company and its competitors to the small coal town an “abomination.”

“Clearly, this was drug diversion,” Mastandrea said. “No one was paying attention.”

Among other findings spotlighted in the report:

• Distributors’ shipments often increased dramatically from one month to the next — or even week to week. In just two weeks, Cardinal Health’s sales jumped 1,500 percent to a drugstore in Williamson.

• Distributors continued to supply pharmacies with prescription painkillers even though the companies were aware the drugstores were filling prescriptions for rogue doctors under investigation.

• In 2011, AmerisourceBergen, which shipped to Westside Pharmacy in Oceana, had a list of “pain doctors” who were writing the bulk of the store’s prescriptions. Five of the six had been convicted of federal charges or are under investigation. One doctor was located in Pembroke, Virginia, 100 miles away.

• The companies ignored federal laws that require them to report pharmacies that ordered a questionable number of prescription pain pills. Between 2006 and 2012, McKesson shipped 162.6 million hydrocodone and oxycodone pills to West Virginia but didn’t send any suspicious-order reports to the DEA. During the next four years, McKesson submitted 10,000 such reports.

• Distributors set limits on the number of opioids pharmacies could buy, but the companies routinely allowed the drugstores to exceed those caps. In Kermit, Sav-Rite ordered and received 36 times as many pills as McKesson’s in-house drug-monitoring program permitted.

• As overdose deaths increased, the DEA’s enforcement actions against distributors declined — from 58 in 2011 to five in 2015.

The DEA failed to use its drug-tracking database to flag massive shipments of painkillers to small towns like Kermit, Mount Gay and Williamson. Distributors shipped 13 million prescription opioids to Kermit between 2006 and 2012. By contrast, four Rite-Aid pharmacies combined only received about half that number of pills.

For years, the DEA assigned only two agents to investigate the illegal diversion of prescription drugs in the entire state. West Virginia had the highest drug overdose death rate in the nation those years — and still does. The agency now has eight drug diversion investigators here.

The report calls on federal lawmakers to enact more stringent regulations for reporting suspicious orders. The committee also urged the DEA to create a “realtime” drug-tracking system and review staffing levels in states hit hardest by the opioid crisis.

Four of the five distributors have denied that their shipments contributed to the opioid crisis. Only Miami-Luken, which has ceased shipping drugs to pharmacies, has admitted wrongdoing.

In a prepared statement Wednesday, Cardinal Health said it would “continue to implement rigorous anti-diversion controls,” while noting that it’s only an “intermediary” in the prescription drug supply chain. McKesson did not respond to requests for comment and AmerisourceBergen could not be reached.

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